Hiatal Hernia and Heart Palpitations: Can They Be Connected?
Some patients with a hiatal hernia notice heart palpitations, chest pressure or shortness of breath, particularly after meals. This can understandably make them wonder whether the stomach problem is affecting the heart.
In most people, a hiatal hernia does not directly cause an abnormal heart rhythm. However, very large hiatal hernias can occasionally affect nearby structures in the chest, and rare cardiac rhythm disturbances associated with large hernias have been reported.
Can a Hiatal Hernia Cause Heart Palpitations?
A hiatal hernia is not a common direct cause of heart palpitations.
Many hiatal hernias are small and cause no symptoms at all. Larger hernias may cause reflux, chest or upper-abdominal discomfort, difficulty swallowing, early fullness or shortness of breath.
In unusual cases, a very large hiatal hernia may compress structures behind the heart, including the left atrium, and published medical reports have described associated atrial or ventricular rhythm disturbances.
Reflux, pain, anxiety or discomfort after eating can also make you more aware of your heartbeat without necessarily causing an arrhythmia.
For that reason, recurrent palpitations should be evaluated on their own merits instead of automatically being blamed on the hiatal hernia.
What Is a Hiatal Hernia?
A hiatal hernia occurs when part of the stomach moves upward through the opening in the diaphragm through which the esophagus passes.
The diaphragm separates the chest from the abdomen. The normal opening for the esophagus is called the esophageal hiatus.
When part of the stomach moves through this opening into the chest, a hiatal hernia is present.
Sliding Hiatal Hernia
This is the most common type. The junction between the esophagus and stomach, together with part of the stomach, moves upward through the diaphragm.
Sliding hiatal hernias are frequently associated with gastroesophageal reflux disease (GERD), although having a hiatal hernia does not automatically mean that you will have significant reflux.
Paraesophageal Hiatal Hernia
With paraesophageal hernias, part of the stomach — and in some large hernias, other abdominal structures — can move into the chest.
Larger paraesophageal hernias deserve careful assessment because they can sometimes cause obstruction, compression, bleeding or gastric volvulus.
What Symptoms Can a Hiatal Hernia Cause?
Many small hiatal hernias cause no symptoms. When symptoms occur, they often relate to reflux or to the size of the hernia.
Heartburn & Reflux
Acid reflux, regurgitation and burning behind the breastbone are common symptoms associated with symptomatic hiatal hernia.
Chest or Upper-Abdominal Pain
Some patients experience discomfort, pressure or pain in the chest or upper abdomen.
Difficulty Swallowing
Food may feel as though it is sticking or passing slowly through the lower chest.
Early Fullness
Larger hernias may make some people feel full sooner than expected during a meal.
Shortness of Breath
Large hiatal hernias may sometimes be associated with breathlessness or reduced exercise tolerance.
Gastrointestinal Bleeding
Vomiting blood or passing black stools can indicate gastrointestinal bleeding and requires medical attention.
Why Might Hiatal Hernia and Palpitations Occur Together?
There is no single proven mechanism that explains every case of palpitations in someone with a hiatal hernia.
Increased Heartbeat Awareness
Chest discomfort, reflux, bloating or abdominal pressure can make some people more conscious of sensations occurring in the chest.
Pain and Stress Response
Pain, anxiety or distress can activate the body’s stress response, increasing heart rate or making the heartbeat feel stronger.
Reflux and Meal-Related Symptoms
Some patients notice palpitations after eating at the same time that reflux, fullness or upper-abdominal discomfort becomes worse.
Large-Hernia Cardiac Compression
In selected patients with very large hiatal hernias, part of the stomach in the chest may physically compress nearby cardiac structures.
Can a Large Hiatal Hernia Compress the Heart?
Yes. Very large hiatal hernias can extend far enough into the chest to compress structures near the heart.
Research involving patients with large hiatal hernias has documented compression of the left atrium and other posterior cardiac structures.
Such compression may contribute to shortness of breath, reduced exercise capacity or cardiovascular symptoms in selected patients.
There are also published case reports of uncommon arrhythmias, including premature ventricular contractions and ventricular tachycardia, occurring in association with very large hiatal hernias and improving after surgical repair.
These cases demonstrate that a connection can exist, but they are not evidence that ordinary small hiatal hernias routinely cause arrhythmias.
What Role Does Acid Reflux Play?
Hiatal hernia can contribute to gastroesophageal reflux by affecting the normal relationship between the diaphragm, lower esophageal sphincter and stomach.
GERD commonly causes heartburn, regurgitation and chest discomfort.
Some patients report palpitations around the same time as reflux symptoms or after meals. However, the presence of GERD does not prove that reflux is causing an arrhythmia.
If you have recurrent palpitations, particularly if the heartbeat feels very fast or irregular, the heart rhythm may need to be evaluated separately.
How Should Hiatal Hernia Palpitations Be Evaluated?
The digestive symptoms and heart symptoms should be considered together — but they may still require separate testing.
Describe the Pattern
Tell your doctor whether palpitations occur after meals, while lying down, during reflux symptoms, during exercise or independently of digestive symptoms.
ECG / EKG
An electrocardiogram can identify many arrhythmias if the abnormal rhythm is present during the recording.
Heart-Rhythm Monitoring
If palpitations come and go, a Holter or another ambulatory ECG monitor may help determine what the heart is doing during symptoms.
Hiatal Hernia Evaluation
Depending on the situation, evaluation may involve upper endoscopy, imaging, barium studies, esophageal testing or other investigations.
Do Not Let One Diagnosis Explain Every Symptom
When a patient already knows that they have a hiatal hernia, it is very easy to attribute every chest sensation to the stomach or reflux.
The timing of palpitations after eating or during reflux is useful information, but it does not prove the cause.
If the palpitations are new, recurrent, prolonged, very fast or irregular — or if they occur with dizziness, fainting, breathlessness or chest pain — the heart itself deserves appropriate evaluation.
How Is a Hiatal Hernia Treated?
Treatment depends on the type and size of the hernia, the symptoms it causes and whether complications are present.
What About Fundoplication?
Fundoplication is an anti-reflux procedure that may be performed during certain hiatal hernia repairs. Part of the upper stomach is positioned around the lower esophagus to reinforce the anti-reflux barrier.
Current surgical guidance suggests that patients undergoing repair of type II, III or IV hiatal hernias may benefit from fundoplication, but the recommendation is conditional and based on relatively low-certainty evidence.
The choice of surgery and type of fundoplication should therefore be individualized rather than described as one universal “gold standard” operation for every patient.
When Should You Seek Urgent Medical Care?
Seek urgent assessment for sudden or severe symptoms such as:
- Severe or persistent chest or upper-abdominal pain
- Repeated vomiting or inability to keep food or fluids down
- Vomiting blood
- Black, tarry stools
- Severe or rapidly worsening shortness of breath
- Difficulty swallowing that is sudden or severe
In a large paraesophageal hernia, sudden severe symptoms can occasionally indicate obstruction or twisting of the stomach and require urgent surgical evaluation.
If palpitations occur with chest pain, fainting, severe dizziness or severe shortness of breath, seek urgent medical care rather than assuming the symptoms are caused by the hiatal hernia.
Hiatal Hernia and Palpitations: FAQs
Can a hiatal hernia make your heart race?
A small hiatal hernia does not usually directly cause a racing heart. Pain, reflux, anxiety or meal-related discomfort may make the heartbeat more noticeable. Rarely, very large hernias have been associated with cardiac compression and rhythm disturbances.
Can a hiatal hernia cause skipped heartbeats or PVCs?
Rare case reports have described frequent premature ventricular contractions (PVCs) associated with very large hiatal hernias, including cases that improved after hernia repair. This appears to be uncommon and does not mean that most PVCs are caused by a hiatal hernia.
Can a hiatal hernia cause atrial fibrillation?
Atrial arrhythmias have been reported in association with large hiatal hernias, particularly when there is significant compression of structures near the left atrium. However, the evidence does not establish hiatal hernia as a common cause of atrial fibrillation.
Can a hiatal hernia press on the heart?
A very large hiatal hernia can extend into the chest and compress nearby structures, including the left atrium and other posterior cardiac structures. This is mainly a concern with large hernias, not the typical small sliding hiatal hernia.
Will hiatal hernia surgery stop palpitations?
Not necessarily. If a large hernia is directly contributing to cardiac compression, symptoms or an associated arrhythmia may improve after repair in selected cases.
If the palpitations have another cause, repairing the hernia may not eliminate them.
Should I see a cardiologist for palpitations if I have a hiatal hernia?
A primary-care physician can often begin the evaluation. Cardiology assessment may be appropriate if palpitations are recurrent, prolonged, very fast or irregular, if an abnormal ECG is found, or if they occur with concerning symptoms.
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Evidence Used for This Article
- Mayo Clinic. Hiatal Hernia: Symptoms and Causes .
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Guidelines for the Surgical Treatment of Hiatal Hernias .
- Katz PO, et al. American College of Gastroenterology. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease .
- Naoum C, et al. Left Atrial Compression and the Mechanism of Exercise Impairment in Patients With a Large Hiatal Hernia . Journal of the American College of Cardiology. 2011.
- Gnanenthiran SR, et al. Posterior Cardiac Compression From a Large Hiatal Hernia: A Novel Cause of Ventricular Tachycardia . HeartRhythm Case Reports. 2018.
- Bhandari A, et al. A Large Hiatal Hernia Causing Frequent Premature Ventricular Contractions With Bigeminy . Journal of Cardiology Cases. 2023.