Chest pain and dyspnoea are among the most common complaints seen in the emergency room and each symptom calls for a broad differential diagnosis. Large hiatal hernias are infrequent, but they can lead to atypical symptoms mimicking different cardiovascular, pulmonary and neoplastic diseases. We present two cases of older patients with an apparent left atrial mass on transthoracic echocardiography, which was subsequently identified as hiatal hernia by other imaging modalities. A multidisciplinary team with multimodality imaging is necessary for diagnostic work-up of chest pain and dyspnoea of non-cardiac origin and especially for a suspected mass compressing the heart, causing chest discomfort.

Background: Sleep-disordered breathing (SDB), particularly Cheyne–Stokes respiration (CSR), is highly prevalent among patients hospitalized with acute decompensated heart failure (ADHF) and is associated with worse clinical outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiorenal benefits in heart failure, but their effects on nocturnal respiratory parameters remain underexplored. Objectives: This study aims to evaluate the impact of SGLT2i therapy on key respiratory and cardiac indices including CSR burden, oxygenation, and right heart function in patients with ADHF and reduced left ventricular ejection fraction. Methods: In this single-center prospective cohort study, 60 patients with ADHF, LVEF < 40%, and a baseline apnea–hypopnea index (AHI) > 5 were assessed before and three months after the initiation of SGLT2i therapy. Sleep respiratory parameters were measured using home polygraphy (ApneaLink^TM), while cardiac and renal indices were evaluated by echocardiography, NT-proBNP, and the estimated glomerular filtration rate (eGFR). Structural and functional echocardiographic changes were analyzed both at baseline and following the 3-month treatment period. Patient-reported outcomes were assessed using the Epworth Sleepiness Scale (ESS) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Results: After 3 months of SGLT2i therapy, significant improvements were observed in daytime sleepiness (ESS: −2.68 points; p < 0.001), CSR index (−5.63 events/h; p < 0.001), AHI (−3.07 events/h; p < 0.001), ODI (−6.11 events/h; p < 0.001), and mean nocturnal SpO₂ (+1.95%; p < 0.001). KCCQ scores increased by 9.16 points (p < 0.001), indicating improved quality of life. Cardiac assessments revealed reductions in NT-proBNP (−329.6 pg/mL; p < 0.001) and E/e′ ratio (−1.08; p < 0.001), with no significant change in LVEF or chamber dimensions. Right ventricular function improved, as evidenced by the increased TAPSE/sPAP ratio (+0.018; p < 0.001). Renal function remained stable, with a non-significant upward trend in eGFR. Conclusions: This exploratory study suggests that SGLT2 inhibitors may be associated with the attenuation of Cheyne–Stokes respiration and an improvement in right heart function in patients with ADHF, warranting further investigation in controlled trials. These findings highlight the potential of SGLT2is to address overlapping cardio-respiratory dysfunction in this high-risk population.

Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results: From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel–Cox) p = 0.044). Conclusions: This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.

Background: Atrial fibrillation (AF) develops along the cardiometabolic continuum, where visceral adiposity and early atrial dysfunction may precede overt disease. We aimed to identify independent predictors of new- onset and recurrent AF in middle-aged individuals with cardiometabolic risk. Methods: This observational cohort included 240 outpatients (40–60 years; 71 controls, 77 new-onset AF, 92 recurrent AF). Conventional anthropometric parameters (body mass index, body roundness index) and biochemical markers (fasting glucose, uric acid, creatinine clearance, inflammatory markers and high-sensitivity troponin I- hsTnI) were assessed. A comprehensive echocardiographic assessment including left atrial reservoir strain (LASr), electromechanical delay (EMD), and epicardial adipose tissue (EAT) were analyzed. Binary logistic regression and ROC analyses were performed. Results: New-onset AF was independently associated with fasting glucose (OR 3.604; 95% CI 1.338–9.704; p=0.011), EAT thickness (OR 1.479; p=0.006), electromechanical delay (OR 1.043; p=0.001), uric acid (OR 1.006; p=0.026), and lower LASr (OR 0.944; p=0.045). Among the evaluated parameters, EAT demonstrated the highest discriminatory ability for new-onset AF (AUC 0.664; p<0.001). Recurrent AF was independently associated with age (OR 1.122; p<0.001), BMI (OR 1.209; p=0.028), hsTnI (OR 3.546; p<0.001), and lower LASr (OR 0.845; p<0.001). LASr showed good discriminatory performance for recurrent AF (AUC 0.781; p<0.001). Conclusion: These findings demonstrate that visceral adiposity and metabolic alterations are independently associated with atrial dysfunction and atrial fibrillation in middle-aged individuals with cardiometabolic risk.