Heart scan curiosities 2



This is an example of a so-called "hiatal hernia", meaning the stomach has migrated through the diaphragmatic hiatus into the chest--the stomach is literally in the chest. This example is an unusually large one. Hiatal hernias can cause chest pain, indigestion, and a variety of other gastrointestinal complaints. Heart scans are reasonably useful to screen for this disorder, though very small ones could escape detection by this method.

Sometimes, you can actually hear the gurgling of stomach contents (the common "growling" stomach) by listening to the chest. Large ones like this actually crowd your heart (the gray structure above the circled hernia), irritating it and even causing abnormal rhythm disorders. The dense dark material within the hernia represents lunch.

I would not advocate CT heart scans as a principal method to make a diagnosis, but sometimes it just pops up during a heart scan and we pass it on to the person scanned.

Comments (2) -

  • Anonymous

    8/2/2007 5:42:00 PM |

    Awesome, just awesome.Brilliant blog that has helped me ALOT so I am eternally grateful. Phil

  • Anonymous

    10/4/2007 2:01:00 AM |

    I just had a heart scan. 44 year old female with family history of heart disease.  Both parents in 40's with heart attacks/by-pass surgery...My cardiologist ask if I had ever been diagnosed with a hiatal hernia and the scan looked somewhat like the one you show.  It looked like I had one Big Heart!  He told me to follow-up with my PCP.  I did, he is new for me and not sure I see eye-to-eye with him, but he insist a hernia can not show up on a heart scan, I told him, I saw it, I saw the scan, I saw the white circle...I have had GERD for 5-6 years now, nausea almost every morning on top of the reflux in the morning and my family always complain how long it takes me to eat! Guess what, I'm having an upper GI in the morning.  Thanks for this information...I thought maybe I was loosing my mind!

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I need to do more procedures!

I need to do more procedures!

I sat next to a cardiology colleague of mine last evening at a dinner. He was lamenting the fact that, because of changes in hospital affiliations of his several-member cardiology group, he'd seen a drop in the volume of heart catheterizations he was performing.

"I'm used to doing 5 cases a day! Now I'm down to 3 or 4 a day." He went on to tell me how he's working to increase his volume. "I'm branching out into doing carotid stents and anything I can find in the legs." He also described how he was cultivating referring physicians to send him more procedural patients.

Now, this colleague, I believe, is a hard-working, conscientious physician. But his attitude reflects the perverse logic of many physicians: I need to do more procedures, not because it benefits patients, but because that's what I want to do--to be busy, make more money, acquire more experience, build my ego, etc.

Doing more procedures has nothing to do with an altruistic goal of doing more good for society. It is purely for selfish reasons. Beware of this shockingly common, pervasive attitude. There's a proper time and place for heart procedures, or any procedure, for that matter. But feeding your doctor's ambitions is not a good reason.
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