Acute Heart Failure Physiology Reversed by Endoscopic Removal of Retained Toothbrushes: a case report of gastro-cardiac (Roemheld) syndrome

Abstract Background Roemheld (gastro-cardiac) syndrome describes cardiac symptoms precipitated by gastrointestinal pathology, typically gastric distension or hiatal hernia. Foreign body ingestion is common, but retention of long objects such as toothbrushes is rare and usually requires endoscopic removal. We present an unusual case of acute heart failure with restrictive filling pattern and markedly elevated NT-proBNP, in which cardiac symptoms resolved after extraction of two retained toothbrushes from the stomach. Case Summary A 44-year-old woman was admitted for progressive dyspnea, 6-kg weight gain, and NT-proBNP of 853 pg/mL. Echocardiography revealed restrictive diastolic dysfunction. After IV furosemide, diuresis reached 4 L in the first 24 hours. Cardiac magnetic resonance showed preserved ejection fraction and no structural abnormalities; however, two foreign bodies were incidentally visualized within the stomach. Gastroscopy was performed and two toothbrushes were removed. Total diuresis reached 12 L and NT-proBNP decreased to 58 pg/mL by day 3. Psychiatry evaluation excluded psychosis or self-harm intent; the patient denied ingestion. She reported wearing complete dentures due to early-onset periodontitis at age 33. Symptoms resolved completely after extraction. Conclusion This case supports that gastric retention of foreign bodies may trigger or exacerbate heart failure via gastric distension, vagal stimulation, and impaired venous return—a form of Roemheld gastro-cardiac syndrome.