Roemheld Syndrome: Causes, Symptoms & Treatment

Roemheld syndrome is a name for heart trouble caused by gas buildup in the gastrointestinal tract. Symptoms such as palpitations or shortness of breath occur.

What is Roemheld syndrome?

Roemheld syndrome was first described in the early 20th century by the internist Ludwig von Roemheld of Gundelsheim, Germany. Roemheld syndrome involves gastrointestinal symptoms. These are caused by gas accumulation in the intestines and stomach. In severe cases, Roemheld syndrome can be confused with angina pectoris or with a heart attack.

Causes

Roemheld syndrome results from gases in the gastrointestinal tract that push the diaphragm upward. This causes a reduction in the size of the chest cavity. The organs of the chest cavity have less room and are displaced or constricted. There are again several causes for the increased gas formation. Lavish meals, especially in combination with digestive weakness, can lead to gas formation. Functional disorders of the gastrointestinal tract can also be the cause of Roemheld syndrome. Functional gastrointestinal disorders are signs of illness or symptoms that occur without an identifiable organic cause. Likewise, however, an inflammation in the gastrointestinal tract can also cause increased gas formation. Another common cause of gas in the gastrointestinal tract is food intolerance. The most common are intolerances to lactose or fructose. The cause of these intolerances is usually an enzyme deficiency. Roemheld syndrome can also occur if the gallbladder function is disturbed. If the bile juices do not flow properly, ingested dietary fat cannot be digested in the intestine. The result is putrefaction and fermentation processes. A rather rare cause of Roemheld’s syndrome is the so-called hiatal hernia. This is also called a diaphragmatic hernia because part of the stomach enters the chest cavity through the diaphragm. Roemheld syndrome can also occur after taking acid blockers containing sodium bicarbonate.

Symptoms, complaints, and signs

Air accumulation in the stomach and intestines pushes the diaphragm upward. There it exerts direct or indirect pressure on the heart. The result is various heart complaints. There is palpitations, possibly even extrasystoles. In some cases, sinus bradycardia also occurs. Sinus bradycardia is a heart rate of less than 60 beats per minute. It originates from the sinus node, a pacemaker in the heart. The symptoms of Roemheld syndrome are similar to angina and even heart attack. Sufferers suffer from seizure-like chest pains. These can last seconds, minutes and rarely hours. Patients often describe this pain as a burning sensation. It is not uncommon for the symptoms to be confused with heartburn. The pain may radiate to the sides of the chest, shoulders, upper arms, upper abdomen, neck and lower jaw. In addition, hot flashes and dizziness occur in Roemheld syndrome. In severe cases, affected patients even faint.

Diagnosis and course of the disease

When diagnosing Roemheld syndrome, the first priority is to rule out organic heart disease as the cause of the symptoms. To do this, an ECG is first obtained. The ECG records the electrical activity of the heart muscle fibers. A long-term ECG is also usually performed. In this case, the heart current curve is recorded over a period of 24 hours. If the ECG still does not provide any information, further examinations of the heart are performed. Cardiac computed tomography allows high-resolution imaging of the coronary arteries. Any constrictions or thromboses can be detected in this way. However, echocardiography and left heart catheterization allow a better assessment of the vascular condition. Cardiac MRI may also be performed in affected patients.

Complications

Because of Roemheld syndrome, affected individuals suffer from discomfort in the stomach, intestines, and also the heart. In the worst case, Roemheld syndrome can also lead to the death of the affected person if no treatment is initiated. The affected person suffers from a strong pressure in the abdomen, so that the heart is also subjected to pressure. This can cause the heart rate to drop significantly, resulting in dizziness or even a fainting spell.In many cases, patients are dependent on a pacemaker in order to continue to survive. Patients experience severe chest pain and a burning sensation in the throat or around the heart. The arms or shoulders can also be affected by the pain as it spreads. The quality of life of the affected person is significantly reduced. As a rule, the treatment of Roemheld’s syndrome always depends on the root cause. This can take place with the help of antibiotics and fight inflammation. Complications do not occur in this case. Drinking teas can also significantly reduce abdominal bloating. With successful treatment, the patient’s life expectancy is not affected.

When should you go to the doctor?

Roemheld syndrome basically does not require another visit to the doctor once the diagnosis is confirmed. Nevertheless, there are reasons that may make it necessary to see a doctor. This applies to cases in which the gas accumulations leading to the heart sensations become unmanageable for the patient. Here the family doctor or internist, but also dieticians as competent contact persons can help. Often, exercise therapy is also useful, which can significantly reduce the gas accumulations in the intestines. Another reason for visiting the doctor in Roemheld syndrome is a change in the heart’s actions, which can be caused by the gas in the area of the intestine and stomach. If palpitations or heart palpitations develop to a degree that was previously unknown, the physician, possibly a cardiologist, should be consulted. He will clarify whether Roemheld syndrome is not masking a previously undetected heart disease. In many cases, the symptoms of Roemheld’s syndrome also disturb the sleep of those affected. Often, anxiety is added, as those affected consider the heart actions, which are basically harmless, to be threatening. Here, the general practitioner can help in conversation and, in cases where the anxiety seems uncontrollable, also refer the patient to a psychologist. Relaxation methods such as progressive muscle relaxation or yoga can also help to reduce anxiety and noticeably reduce insomnia.

Treatment and therapy

Therapy depends on the cause. In case of lactose intolerance, milk and dairy products such as yogurt, cheese or curd should be avoided. Depending on the severity of the intolerance, patients must follow a low-lactose diet or a lactose-free diet. The missing enzyme lactase can also be supplied in tablet form. This enables patients to tolerate some lactose-containing foods again. Treatment of fructose intolerance consists of a sorbitol-free diet and a low-fructose diet. If gastroenteritis underlies Roemheld syndrome, it may need to be treated with antibiotics, depending on the causative agent. Pronounced diaphragmatic hernias must be surgically removed. In addition to treatment of the underlying cause, anticarminatives may be used in Roemheld syndrome. Anticarminatives are remedies for flatulence. Carminative agents are especially herbal medicinal drugs with essential oils. Carminative plants include anise, fennel, caraway, peppermint, chamomile, and coriander. These oils have a spasmolytic effect on intestinal smooth muscle and an antimicrobial effect. They also increase blood flow to the intestinal mucosa. These effects lead to a reduced formation of fermentation gases.

Prevention

To prevent Roemheld syndrome, avoid foods and beverages that cause flatulence. Legumes, cabbage, onions, nuts, and some types of fruit are as likely to cause flatulence as starches, frozen foods, and artificial sweeteners. Carbon dioxide in drinks can also lead to gas accumulation in the gastrointestinal tract. Vegetables should only be eaten raw in exceptional cases. It is advisable to steam vegetables briefly before eating them. This allows the enzymes in the digestive tract to break down the vegetables better. There are fewer fermentation and rotting processes. Recent studies show that regular intake of probiotics can prevent gas formation in the intestinal gastrointestinal tract. In particular, the bacterial species Lactobacillus seems to play a role here. A cure with apple cider vinegar is also recommended. For it simply three times daily a teaspoon apple cider vinegar with half a glass of water on empty stomach drink. The cure should be carried out over three weeks. In order to prevent Roemheld syndrome, lavish meals should also be avoided.Better than a few large meals are five to six small portions eaten throughout the day.

Aftercare

Roemheld syndrome is a complaint that is particularly amenable to follow-up and absolutely requires the patient’s cooperation. This is because Roemheld syndrome is usually closely related to the patient’s behavior. In order to avoid the typical complaints in the long term, behavioral changes are often necessary, which should also be maintained during follow-up care. These include no longer eating sumptuous meals before bedtime. The same applies to fatty or flatulent foods, as these can also trigger Roemheld syndrome. Sleeping with a slightly elevated upper body can prevent or at least alleviate the symptoms. Drinking enough fluids is also important in the aftercare of Roemheld syndrome. Carbonic acid can fuel the symptoms. Therefore, especially still water and herbal teas are ideal in the aftercare of Roemheld syndrome. Alcohol should be avoided, as should nicotine. Roemheld syndrome is often associated with obesity. Therefore, it is advisable for these patients to consistently include weight reduction in their aftercare. Exercise is particularly suitable for this purpose and can be integrated into an individual aftercare concept in consultation with sports instructors or fitness trainers. Dieticians or nutritionists help with the right diet, which consists of plenty of fruits and vegetables and contains little fat.

Here’s what you can do yourself

Roemheld’s snydrome is particularly amenable to self-help in everyday life; in fact, it makes the active cooperation of patients in coping with this manifestation indispensable. This is because cardiac sensations resulting from a full stomach require that the fullness of stomach contents be consciously kept at a comfortable level. This means not eating so much until a distinct feeling of fullness occurs, but stopping even before that. Crushing the food through consistent chewing and drinking sufficient amounts also play an important role in this context. Flatulent foods such as legumes are also better reduced. The same applies to fatty and indigestible foods that are heavy on the stomach. Food should be taken consciously, especially at dinner. Heavy food before going to bed may in fact aggravate Roemheld’s syndrome under certain circumstances, as the contents of the stomach are pushed upwards in the supine position. Exercise is also an important factor when it comes to managing Roemheld syndrome in everyday life. This is because the digestive tract reacts positively to movement and can be activated as a result. A walk after a meal is often very helpful here. In acute Roemheld syndrome, light exercise is also better than resting in the supine position. Gentle massage in the abdominal area may also speed up digestion somewhat and soon alleviate symptoms.