Roemheld Syndrome

By | June 8, 2022

Roemheld syndrome is a term for heart problems caused by gas accumulation in the gastrointestinal tract. Symptoms include palpitations and shortness of breath.

What is Roemheld Syndrome?

Roemheld syndrome was first described by the internist Ludwig von Roemheld from Gundelsheim in the early 20th century. For broken jaw definition, please visit

Gastrointestinal problems occur in Roemheld syndrome. These are caused by gas build-up in the intestines and stomach. In severe cases, Roemheld syndrome can be mistaken for angina pectoris or a heart attack .


Roemheld syndrome is caused by gases in the gastrointestinal tract pushing the diaphragm up. This leads to a reduction in the size of the chest cavity. The organs in the chest cavity have less space and are displaced or constricted. There are several reasons for the increased gas formation. Heavy meals, especially in combination with indigestion, can lead to gas formation.

Functional disorders of the gastrointestinal tract can also be the cause of Roemheld syndrome. Functional gastrointestinal complaints are signs or symptoms that occur without a recognizable organic cause. Inflammation in the gastrointestinal area can also lead to increased gas formation. Food intolerance is also a common reason for gas in the gastrointestinal tract. The most common are intolerances to lactose or fructose. The cause of these intolerances is usually an enzyme deficiency.

Roemheld syndrome can also occur if the gallbladder is not functioning properly. When bile is not flowing properly, ingested dietary fat cannot be digested in the intestines. The result is putrefaction and fermentation processes. A rather rare reason for Roemheld syndrome is the so-called hiatal hernia. This is also known as a diaphragmatic hernia because part of the stomach enters the chest cavity through the diaphragm. Roemheld syndrome can also occur after taking acid blockers with sodium bicarbonate.

Symptoms, Ailments & Signs

The accumulation of air in the stomach and intestines pushes the diaphragm upwards. There it exerts direct or indirect pressure on the heart. The consequences are various heart problems. There is palpitations, possibly even extrasystoles. Sinus bradycardia also occurs in some cases. Sinus bradycardia is a heart rate less than 60 beats per minute.

It originates from the sinus node, a pacemaker in the heart. The symptoms of Roemheld syndrome are similar to angina pectoris and even a heart attack. Those affected suffer from paroxysmal chest pains. These can last seconds, minutes and rarely even hours. Patients often describe this pain as a burning sensation. It is not uncommon for the symptoms to be confused with heartburn.

The pain can radiate to the sides of the chest, shoulders, upper arms, upper abdomen, neck, and lower jaw. In addition, hot flashes and dizziness occur in Roemheld syndrome. In severe cases, the affected patients even faint.

Diagnosis & course of disease

When diagnosing Roemheld syndrome, the primary goal is to rule out organic heart disease as the cause of the symptoms. First, an EKG is made. The ECG records the electrical activity of the heart muscle fibers. A long-term ECG is also usually carried out. The cardiac current curve is recorded over a period of 24 hours.

If the ECG does not provide any information, further examinations of the heart are carried out. Cardiac computed tomography can be used to display the coronary arteries in high resolution. Any constrictions or thrombosis can be detected in this way. However, echocardiography and left heart catheter examination allow a better assessment of the condition of the vessels. A cardiac MRI may also be performed on the affected patients.


Due to Roemheld syndrome, those affected suffer from problems in the stomach, intestines and heart. In the worst case, Roemheld syndrome can also lead to the death of the affected person if no treatment is initiated. Those affected suffer from strong pressure in the abdomen, so that the heart is also under pressure.

This can cause the heart rate to drop significantly, which can lead to dizziness or fainting. In many cases, those affected are dependent on a pacemaker in order to be able to continue to survive. There is severe chest pain and patients experience a burning sensation in the throat or in the heart area.

The arms or shoulders can also be affected by the pain as it spreads. The quality of life of those affected is significantly reduced. The treatment of Roemheld syndrome is usually always aimed at the root cause. This can take place with the help of antibiotics and fight inflammation. There are no complications. Drinking tea can also significantly reduce abdominal bloating. If the treatment is successful, the life expectancy of the patient is not affected.

When should you go to the doctor?

Once the diagnosis has been confirmed, Roemheld syndrome basically no longer requires a further visit to the doctor. Nevertheless, there are reasons that may make it necessary to go to the doctor. This applies to cases in which the accumulation of gas, which leads to the heart sensations, cannot be controlled by the patient. Here the family doctor or internist, but also dieticians as competent contact persons can help. Exercise therapy, which can significantly reduce the accumulation of gas in the intestine, is also often useful.

Another reason to see a doctor if you have Roemheld syndrome is a change in heartbeat that can be caused by the gas in the intestines and stomach. If tachycardia or palpitations occur to an extent that was previously unknown, a doctor, possibly a cardiologist, should be consulted. He will clarify whether Roemheld syndrome is not masking a previously undiscovered heart disease.

In many cases, Roemheld syndrome and its symptoms also disturb the sleep of those affected. Fears are often added because those affected consider the heartbeats, which are basically harmless, to be threatening. Here the family doctor can help in a conversation and, in cases in which the fear does not seem to be manageable, can also refer you to a psychologist. Relaxation methods such as progressive muscle relaxation or yoga can also help to reduce anxiety and noticeably reduce insomnia.

Treatment & Therapy

The therapy depends on the cause. If you are lactose intolerant, you should avoid milk and milk products such as yoghurt, cheese or quark. Depending on the severity of the intolerance, patients must follow a low-lactose or lactose-free diet. The missing enzyme lactase can also be taken as a tablet. This allows the patients to tolerate some lactose-containing foods again.

The treatment of fructose intolerance consists of a sorbitol-free and low-fructose diet. If the Roemheld syndrome is based on gastroenteritis , it may have to be treated with antibiotics, depending on the pathogen. Pronounced diaphragmatic hernias must be surgically removed. In addition to treating the root cause, anticarminative drugs can be used in Roemheld syndrome.

Anticarminatives are medicines for flatulence. Herbal medicines with essential oils in particular have a carminative effect. Carminative plants include anise, fennel, cumin, peppermint, chamomile, and coriander. These oils have a relaxing effect on the smooth intestinal muscles and have an antimicrobial effect. The blood flow in the intestinal mucosa is also increased. These effects lead to a reduced formation of fermentation gases.


To prevent Roemheld syndrome, flatulent foods and drinks should be avoided. Legumes, cabbage, onions, nuts and some types of fruit are just as bloating as starches, frozen foods and artificial sweeteners. Carbon dioxide in drinks can also lead to gas accumulation in the gastrointestinal tract. Vegetables should only be eaten raw in exceptional cases.

It is advisable to steam the vegetables briefly before consumption. This allows the enzymes in the digestive tract to break down the vegetables better. There are fewer fermentation and putrefaction processes. Recent studies show that regular intake of probiotics can prevent gas formation in the gastrointestinal tract. In particular, the bacterial species Lactobacillus seems to play a role here.

A cure with apple cider vinegar is also recommended. Simply drink a teaspoon of apple cider vinegar with half a glass of water on an empty stomach three times a day. The cure should be carried out over three weeks. In order to prevent Roemheld syndrome, heavy meals should also be avoided. Five to six small portions eaten throughout the day are better than a few large meals.


Roemheld syndrome is a symptom that is particularly accessible for follow-up care and absolutely requires the cooperation of the patient. This is due to the fact that Roemheld syndrome is usually closely related to the behavior of the patient. In order to avoid the typical symptoms in the long term, changes in behavior are often necessary, which should also be maintained during aftercare.

This includes stopping eating heavy meals before bed. The same applies to fatty or flatulent foods, as these can also trigger Roemheld syndrome. Sleeping with a slightly elevated upper body can prevent or at least alleviate the symptoms. Adequate drinking is also important in the aftercare of Roemheld syndrome. Carbonic acid can exacerbate the symptoms. That is why still water and herbal teas are ideal for aftercare for Roemheld syndrome. Alcohol should be avoided, as should nicotine.

Roemheld syndrome is often associated with being overweight. It is therefore advisable for these patients to consistently include weight reduction in the follow-up care. Exercise, which can be integrated into an individual aftercare concept in coordination with sports teachers or fitness trainers, is particularly suitable for this. Dietitians or nutritionists can help you choose the right diet, which is high in fruit and vegetables and low in fat.

You can do that yourself

The Roemheld syndrome is particularly accessible for self-help in everyday life, it even makes the active cooperation of patients indispensable in coping with this phenomenon. Because heart sensations that come about through a full stomach require that the fullness of the stomach content is consciously kept at a comfortable level. This means not eating until you feel really full, but stopping before that.

Breaking up the food by chewing it consistently and drinking enough water also play an important role in this context. Flatulent foods such as legumes are also better to reduce. The same goes for fat and indigestible foods that weigh heavily on the stomach. The food should be eaten consciously, especially at dinner. Eating a heavy meal before going to bed can make Roemheld syndrome worse because the stomach contents are pushed up when you lie on your back.

Exercise is also an important factor when it comes to coping with Roemheld syndrome in everyday life. Because the digestive tract reacts positively to movement and can be activated as a result. A walk after a meal is often very helpful here. In acute Roemheld syndrome, light exercise is also better than resting in the supine position. A gentle massage in the abdominal area can also speed up digestion and soon alleviate the symptoms.

Roemheld Syndrome