Most small hiatal hernias do not directly cause abnormal heart rhythms. However, reflux and post-meal symptoms may occur alongside palpitations, and very large hiatal hernias can rarely affect nearby cardiac structures.
A hiatal hernia is not considered a common direct cause of heart palpitations. Most small sliding hiatal hernias cause no symptoms or mainly cause gastroesophageal reflux. Palpitations may occur at the same time because of meals, reflux, anxiety, stimulants or an independent heart rhythm problem. In rare cases, a very large hiatal or paraesophageal hernia can extend far enough into the chest to compress nearby cardiac structures, and arrhythmias have been reported. Recurrent palpitations should therefore be evaluated rather than automatically attributed to the hernia.
What Is a Hiatal Hernia?
Your chest and abdominal cavities are separated by a large muscle called the diaphragm.
The esophagus passes through a natural opening in the diaphragm called the esophageal hiatus before connecting with the stomach.
A hiatal hernia occurs when part of the stomach moves upward through this opening into the chest.
Hiatal hernias are common, particularly with increasing age. Many are discovered incidentally during imaging, endoscopy or another investigation because the person has no symptoms.
What Are the Different Types of Hiatal Hernia?
Type I: Sliding hiatal hernia
This is by far the most common type. The gastroesophageal junction, where the esophagus meets the stomach, moves upward through the diaphragmatic opening.
Many sliding hernias cause no symptoms. When symptoms occur, they are commonly related to gastroesophageal reflux.
Types II–IV: Paraesophageal hernias
In paraesophageal hernias, part of the stomach — and in more advanced types sometimes other abdominal structures — moves into the chest alongside the esophagus.
These hernias can become large and may cause mechanical symptoms or complications in selected patients.
Paraesophageal hernias deserve more careful assessment because complications such as obstruction, twisting of the stomach (gastric volvulus) or impaired blood supply can occasionally occur.
However, it is not correct to say that every paraesophageal hernia is an immediate surgical emergency. Management depends on symptoms, anatomy, patient health and the estimated risks and benefits of treatment.
What Symptoms Can a Hiatal Hernia Cause?
Most small hiatal hernias cause no symptoms.
When symptoms do occur, they may include:
- heartburn;
- acid reflux or regurgitation;
- belching;
- upper-abdominal discomfort;
- chest discomfort;
- feeling full soon after eating;
- difficulty swallowing;
- nausea; and
- shortness of breath in some people with large hernias.
Racing, fluttering, pounding or skipped-heartbeat sensations are not considered a routine defining symptom of a small hiatal hernia. If palpitations repeatedly occur, the heart rhythm itself may need separate evaluation.
Can a Hiatal Hernia Cause Heart Palpitations?
Possibly in selected circumstances, but the relationship needs to be described carefully.
Current evidence does not show that an ordinary small hiatal hernia commonly causes heart arrhythmias.
Several different situations may explain why a person with a hiatal hernia notices palpitations.
Palpitations after meals
Hiatal-hernia and reflux symptoms often become noticeable after eating. Palpitations can also occur after meals for unrelated reasons, including normal cardiovascular responses, stimulants, alcohol, anxiety, premature beats or another arrhythmia.
Increased symptom awareness
Fullness, reflux or discomfort in the upper abdomen and lower chest may make a person pay closer attention to nearby heartbeat sensations. This can make an otherwise unnoticed heartbeat feel prominent.
GERD occurring with the hernia
Hiatal hernia can increase the likelihood or severity of gastroesophageal reflux. GERD and atrial fibrillation have been associated in observational research, but a direct cause-and-effect relationship has not been established.
Rare cardiac compression
Very large hernias can occasionally occupy enough space in the chest to compress or distort nearby structures, including the left atrium. Arrhythmias and hemodynamic problems have been described in rare cases.
Shared triggers
Alcohol, caffeine, large meals, stress or certain medicines may worsen digestive symptoms while independently making palpitations more noticeable.
An unrelated arrhythmia
PACs, PVCs, supraventricular tachycardia or atrial fibrillation can occur in someone who also happens to have a hiatal hernia. Two common conditions occurring together do not necessarily mean one caused the other.
If your symptoms occur mainly after eating, see our dedicated guide to heart palpitations after eating .
Important Correction: The Vagus Nerve Explanation Is Too Simplistic
Older explanations sometimes claim that a hiatal hernia irritates or compresses the vagus nerve and therefore directly causes abnormal heartbeats.
The esophagus, stomach and heart are all influenced by the autonomic nervous system, and researchers have proposed several neural and inflammatory mechanisms linking gastrointestinal disease with atrial arrhythmias.
However, there is not enough evidence to tell most patients that their hiatal hernia is physically irritating the vagus nerve and causing their palpitations. The actual heart rhythm should be documented when symptoms are recurrent or concerning.
Can a Large Hiatal Hernia Affect the Heart?
This is the situation in which a direct mechanical relationship becomes more medically plausible.
The stomach and esophagus lie close behind the heart. A very large hiatal or paraesophageal hernia can sometimes occupy substantial space within the chest.
Published case reports have documented:
- compression of the left atrium;
- reduced cardiac filling in severe cases;
- shortness of breath or exercise intolerance;
- atrial fibrillation or atrial flutter;
- other supraventricular arrhythmias;
- rare ventricular arrhythmias; and
- rare hemodynamic compromise.
These Are Unusual Presentations
Cardiac compression from a hiatal hernia is described mainly in case reports and small series involving particularly large hernias.
These reports demonstrate that a hiatal hernia can occasionally contribute to cardiac symptoms. They do not show that everyday sliding hiatal hernias commonly compress the heart or cause atrial fibrillation.
A large retrospective study also reported an association between hiatal hernia and atrial fibrillation, but association alone cannot establish that the hernia caused the arrhythmia in an individual patient.
More recent reviews examining whether treating GERD or repairing hiatal hernias improves arrhythmias remain limited mainly to case reports, case series and small studies.
What About GERD, Hiatal Hernia and Palpitations?
Hiatal hernia can make gastroesophageal reflux more likely by affecting the normal relationship between the lower esophageal sphincter and diaphragm.
GERD can produce:
- heartburn;
- regurgitation;
- burning behind the breastbone;
- chest discomfort;
- chronic cough; and
- difficulty swallowing in some patients.
Observational research has identified an association between GERD and atrial fibrillation, and several mechanisms have been proposed.
However, causality has not been established well enough to tell a patient that reflux directly caused their AF, PVCs or other arrhythmia.
Treating clinically important reflux is appropriate for gastrointestinal health, but it should not be promised as a cure for heart palpitations.
Read our complete guide to GERD and heart palpitations .
How Are Hiatal Hernia and Palpitations Evaluated?
If both conditions are present, clinicians may need to investigate the gastrointestinal and cardiac symptoms separately and then determine whether there is evidence that they are connected.
For the palpitations
Your clinician may ask:
- what the heartbeat feels like;
- whether it seems regular or irregular;
- how suddenly it starts and stops;
- how long episodes last;
- whether meals reliably trigger them;
- whether body position changes the symptoms;
- whether bloating or reflux occurs simultaneously;
- whether there is dizziness or fainting;
- whether chest pain or breathlessness occurs; and
- whether there is known cardiovascular disease.
12-lead ECG
An electrocardiogram can identify the heart rhythm when it is recorded and may show conduction abnormalities or another cardiac finding.
A normal resting ECG does not completely exclude an intermittent arrhythmia.
Holter, patch or event monitor
If the episodes occur intermittently, ambulatory ECG monitoring may be useful to establish a symptom-rhythm correlation.
This is particularly helpful when a patient reports that every large meal or reflux episode seems to trigger a palpitation. The recording can show whether the rhythm actually changes at that time.
How is a hiatal hernia evaluated?
Depending on the symptoms and clinical question, testing may include:
- upper gastrointestinal contrast imaging;
- upper endoscopy;
- esophageal manometry;
- reflux testing in selected patients; and
- CT imaging when anatomy or a large intrathoracic hernia needs further definition.
What if cardiac compression is suspected?
If a very large intrathoracic hernia is suspected of affecting the heart, cardiac imaging such as echocardiography together with cross-sectional imaging may help determine whether a cardiac chamber is actually being compressed.
How Is a Hiatal Hernia Treated?
Treatment depends much more on the type of hernia, symptoms and complications than on the mere presence of a hiatal hernia on a scan.
Small or asymptomatic hiatal hernia
Many small sliding hiatal hernias require no specific treatment when they cause no symptoms.
When reflux symptoms are present
Management may include lifestyle changes and medicines directed at GERD.
Depending on the individual, useful measures may include:
- eating smaller meals;
- avoiding lying down soon after eating;
- identifying foods or drinks that repeatedly worsen reflux;
- weight management when appropriate;
- avoiding smoking;
- limiting excessive alcohol;
- elevating the head of the bed for troublesome nighttime reflux; and
- using appropriate acid-suppressing therapy when recommended.
These measures treat the digestive problem. They should not be described as guaranteed treatment for an arrhythmia.
When might surgery be considered?
Surgery may be considered for selected patients with significant symptoms, complications, large paraesophageal hernias, objectively confirmed troublesome reflux or other clinically important effects.
A hiatal-hernia repair generally involves returning the stomach to the abdomen and repairing the enlarged opening in the diaphragm.
Fundoplication may be performed as part of the operation to improve the antireflux barrier in appropriate patients.
Surgery Is Not Automatically Required for Every Paraesophageal Hernia
Current surgical guidance does not support a simple rule that every asymptomatic type II, III or IV hiatal hernia must immediately be repaired.
Decisions should take into account symptoms, hernia anatomy, objective reflux findings, possible non-gastrointestinal effects, surgical risk, age, overall health and patient preferences.
Will surgery stop the palpitations?
Not necessarily.
Case reports describe patients with very large hiatal hernias and documented arrhythmias whose rhythm symptoms improved after hernia treatment.
However, the evidence is too limited to promise that repairing a hiatal hernia will cure palpitations or atrial fibrillation.
If an arrhythmia is documented, it should be evaluated and managed according to the specific cardiac diagnosis rather than relying on hernia treatment alone.
Dr. Albana’s Note
When a patient with a known hiatal hernia tells me that palpitations occur after meals, I take the timing seriously, but I do not automatically assume that the hernia is irritating the vagus nerve or pressing on the heart. I first ask whether the heartbeat actually becomes fast or irregular, whether reflux or marked fullness occurs at the same time, and whether there are symptoms such as dizziness, chest pain or shortness of breath. If the episodes continue, documenting the rhythm during symptoms is usually much more informative than trying to diagnose the cause from the digestive symptoms alone.
When Should You See a Doctor?
Arrange medical assessment if:
- palpitations keep returning;
- episodes are becoming more frequent or prolonged;
- your heartbeat becomes persistently fast or markedly irregular;
- palpitations repeatedly occur after meals;
- you have recurrent chest or upper-abdominal discomfort;
- you have difficulty swallowing;
- you feel full after very small meals;
- you develop persistent vomiting;
- you have unexplained weight loss;
- you develop increasing shortness of breath; or
- you have a known large or paraesophageal hiatal hernia with worsening symptoms.
If your main symptom is abdominal distention rather than a diagnosed hernia, see our guide to bloating and heart palpitations .
Urgent Warning Signs
Do not assume serious chest symptoms are caused by a hiatal hernia.
Seek urgent or emergency medical care if palpitations occur with:
- significant chest pain, pressure or tightness;
- fainting or loss of consciousness;
- collapse;
- severe shortness of breath;
- severe dizziness or near-fainting;
- a sustained very rapid or markedly irregular heartbeat;
- severe or rapidly worsening weakness; or
- other rapidly worsening cardiovascular symptoms.
A known hiatal or paraesophageal hernia also deserves urgent assessment if you develop severe persistent chest or upper-abdominal pain, repeated vomiting, inability to keep food down, or other symptoms suggesting obstruction or another acute complication.
For more information about the cardiac combination, see chest pain and heart palpitations , but emergency symptoms require medical care first.
Most Asked Questions
Can a hiatal hernia cause heart palpitations?
Most small hiatal hernias are not established direct causes of heart palpitations. However, palpitations may occur around meals or reflux symptoms, and very large hiatal hernias have rarely been reported to compress cardiac structures and contribute to arrhythmias.
Can a hiatal hernia cause atrial fibrillation?
Research has identified an association between hiatal hernia and atrial fibrillation, and rare cases involving large hernias and cardiac compression have been reported. However, causality is not established for most patients. Atrial fibrillation should be evaluated and treated as a cardiac diagnosis rather than automatically attributed to the hernia.
Does a hiatal hernia irritate the vagus nerve?
Autonomic mechanisms involving vagal and sympathetic pathways have been proposed in research on gastrointestinal disease and arrhythmias, but it is too simplistic to say that ordinary hiatal hernias physically irritate the vagus nerve and thereby cause palpitations.
Can a large hiatal hernia press on the heart?
Yes, rarely. Very large hiatal or paraesophageal hernias can extend into the chest and have been documented compressing cardiac structures, particularly the left atrium. These are unusual presentations rather than what happens with most small sliding hernias.
Why do my palpitations happen after eating?
Meals can trigger digestive fullness, reflux and bloating while also exposing you to possible cardiac triggers such as caffeine or alcohol. Normal post-meal physiological changes, premature beats or another arrhythmia may also explain the timing. A rhythm monitor can be useful when the relationship is reproducible.
Will treating acid reflux stop my heart palpitations?
Not necessarily. Treating confirmed GERD is appropriate for reflux symptoms and esophageal health, but current evidence does not support promising that reflux treatment will eliminate palpitations or an arrhythmia.
Will hiatal hernia surgery cure atrial fibrillation?
This cannot be promised. Individual case reports describe improvement of certain arrhythmias after repair of large hiatal hernias, but the available evidence is too limited to consider hiatal-hernia surgery a standard treatment for atrial fibrillation.
Does every paraesophageal hernia need surgery?
No universal rule applies. Symptoms, anatomy, complications, reflux, age, surgical risk and patient preferences all influence the decision. Current surgical guidance acknowledges insufficient evidence for a blanket recommendation to repair every asymptomatic paraesophageal hernia.
Can a normal ECG rule out the cause of my palpitations?
Not always. A standard ECG records only a short period. If symptoms are intermittent, a Holter, patch or event monitor may be needed to record the rhythm during an actual episode.
Related Heart Palpitation Guides
Medical References
- Daly S, Kumar SS, Collings AT, et al. SAGES Guidelines for the Surgical Treatment of Hiatal Hernias. Surgical Endoscopy. 2024;38(9):4765-4775.
- Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology. 2022;117(1):27-56.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Gastroesophageal Reflux and GERD. National Institutes of Health.
- Cleveland Clinic. Hiatal Hernia: Symptoms, Types and Treatment. Medically reviewed June 2023.
- Mayo Clinic. Hiatal Hernia: Symptoms, Causes, Diagnosis and Treatment. Updated 2025.
- Roy RR, Sagar S, Bunch TJ, et al. Hiatal Hernia Is Associated With an Increased Prevalence of Atrial Fibrillation in Young Patients. Journal of Atrial Fibrillation. 2013.
- Apard M, Pognonec C, Yordanov Y, Thiebaud PC. Left Atrial Compression by a Large Hiatal Hernia: A Rare Cause of Cardiac Dysfunction. American Journal of Emergency Medicine. 2021;49:265-267.
- Ganam S, et al. Exploring the Link — Hiatal Hernia Repair and GERD Treatments for Managing Arrhythmias: A Systematic Review. American Surgeon. 2026.
- American Heart Association. Symptoms, Diagnosis and Monitoring of Arrhythmia. Last reviewed October 2024.
About the Medical Team
Dr. Albana Greca, MBBS, MMedSc
Family Physician / General Practitioner
Dr. Albana Greca has more than 20 years of experience in primary care, general medicine, chronic disease management, prevention, patient education and digital health.
Dr. Benard Shehu, MBBS, MS
Cardiologist
Dr. Benard Shehu has more than 19 years of cardiovascular experience, including clinical experience relevant to arrhythmias and cardiovascular disease.