Abstract
Hiatal hernia is one of common conditions in the elderly. Most patients with hiatal hernia are asymptomatic. However, some reports have described cardiac complications such as heart failure or arrhythmias due to cardiac compression. We report a diagnostically challenging case of heart failure accompanied by preexisting giant hiatal hernia, atrio-ventricular block (AVB)-related bradycardia and aortic valve stenosis (AS). Initial transthoracic echocardiogram (TTE) at the time of 2:1 AVB revealed moderate AS with no cardiac compression by a giant hiatal hernia. Repeated TTE after the correction of heart rate with pacemaker showed decreased peak velocity and mean pressure gradient. The true severity of AS was considered mild under the hemodynamically stable condition. Eventually, AVB-related bradycardia was identified to be responsible for heart failure rather than AS or giant hiatal hernia. The number of diagnostic occasions of heart failure is being increasing especially in the elderly. This case highlights the importance of careful evaluation to determine the major cause of heart failure accompanied by multiple comorbidities.