Can a hiatal hernia cause this?

[Wiliam]

  Doctor,
  I'm posting on behalf of my mother.  She is in her 70's and had
  been diagnosed with a hiatal hernia about 15 years ago.  She has
  been having unusual 'spells' every few months for the last 8
  years or so.  She will get a tightness or pressure in her chest.
  Her blood pressure and pulse will rise rapidly, she will usually
  suffer a general loss of muscle control and balance.  At this
  point she has extreme chest pain.  Many times she will go into
  spasmatic retching and convulsing, but nothing comes up.  Other
  times she will go into shock.
  When her electrocardiogram has been taken during these episodes,
  they show a healthy heartbeat; albeit with severely heightened
  rate and blood pressure.
  The doctor usually treats her with a sedative; this will cause
  the pressure in her chest to subside and generally bring her out
  of her 'fit'.
  While her doctor acknowledges that she has a hiatal hernia, he
  believes that her symptoms are psycho-somatic, or a manifistation
  of panic.  I do not believe this to be the case.  My mother is
  very level headed and does not have a history of hypochondria,
  emotional instability, or mental illness of any kind.  She does
  not drink alcohol or abuse drugs.  She does have diverticulosis
  and watches her diet because of this; she does not eat spicy
  foods.
  Also, many times when she eats, the food or water will not go
  down or will come back up immediately; not exactly vomiting,
  more like regurgiation.
  Her doctor and various emergency workers has said that a hiatal
  hernia doesn't cause these symptoms, but I've read that a large
  and/or paraezophegeal hiatal hernia can cause some symptoms that
  are consistent with hers.
  My questions are threefold:
  1) Is it possible that these symptoms are resulting from her
  hernia?
  2) If they are hernia related; how serious a threat to her
  health is it if she continues to get these 'episodes'? (can a
  paraezophegeal hernia cause a heart attack or some other
  permanently damaging condition)?
  3) If these symptoms are hernia related, how can I convince her
  Doctor to take us seriously and look into treatment?  Is there
  a medical paper or reference that I can site?
  Thanks in advance for your help, and thanks for reading through
  such a long posting.
  -William
______________
Dear william,
Simple hiatal herrnias are very common.  Your physicians are correct that the sliding esophageal hernia would not cause the described problems.  It is possible , however, that your mother has a paraesophageal hernia with intermittent obstruction. The severe pains that you report could result under these circumstances. Paraesophageal hernias can be very serious and will require surgical repair.  An upper GI x-ray will demonstrate whether your mother has a paraesophageal hernia.
A second explanation for the chest pain is esophageal spasm.  An esophageal motility study will evaluate that possibility.
This information is provided for educational purposes only.  always consult your physician for specific medical issues.
If you want, we would be happy to see your mother in the Division of Gastroenterology at Henry Ford Hospital and perform the necessary investigations after we have had the chance to meet yher and to review the history in greater detail. Depending on our assessment, we would then refer you to the appropriate surgeon.  You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of esophageal disorders by calling the Henry Ford Physician Referral Line at [phone].