Pesky Hiccups; May be Risky!

Background: Hiccups are benign and self-limited condition, but attention should be paid to the underlying conditions when persist. There are various causes of persistent hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. Case Summary: We report a case of intractable hiccups in a 67 y/o male as the initial symptom of coronary heart disease. He presented with a few-week history of hiccups and no other complaints. Echocardiography demonstrated wall motion abnormalities in the left ventricle with severe impairment of systolic function. He was He was admnistered chlorpromazine and anti-ischemic treatment, and a thallium viability study was advised before cardiac catheterization to confirm viable or nonviable myocardium. He refused further evaluation and was discharged with appropriate care. The gentleman was readmitted for heart failure two weeks after discharge due to poor medication adherence. The delay in treatment had affected his chances of survival, and his hiccuping symptoms had recurred and persisted. Finally, he died after two months from the time of diagnosis. Discussion: This case makes highlights the importance of having a high index of suspicion, especially in elderly diabetic patients where benign self-limiting conditions like hiccups can only present symptoms of severe cardiac disease. Cardiac disease should be considered even when the symptoms are only gastrointestinal; simple investigations in the form of changes in electrocardiogram with cardiac enzyme elevation may disclose the cardiac findings, as they did in our case!