{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T18:53:23Z","timestamp":1781895203444,"version":"3.54.5"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 44-year-old woman was admitted for progressive dyspnoea, 6-kg weight gain, and NT-proBNP of 853\u2005pg\/mL. Echocardiography revealed restrictive diastolic dysfunction. After IV furosemide, diuresis reached 4 L in the first 24\u2005h. 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\u2005pg\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case supports that gastric retention of foreign bodies may trigger or exacerbate heart failure via gastric distension, vagal stimulation, and impaired venous return\u2014a form of Roemheld gastro-cardiac syndrome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag445","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T08:20:01Z","timestamp":1780993201000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute heart failure physiology reversed by endoscopic removal of retained toothbrushes in gastro-cardiac (Roemheld) syndrome: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-9691","authenticated-orcid":false,"given":"Ivana","family":"Jurin","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Dubrava , Avenija Gojka \u0160u\u0161ka 6, Zagreb 10000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomislava Bodro\u017ei\u0107 D\u017eaki\u0107","family":"Poljak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, University Hospital Dubrava , Avenija Gojka \u0160u\u0161ka 6, Zagreb 10000 ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bulum","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Dubrava , Avenija Gojka \u0160u\u0161ka 6, Zagreb 10000 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foreign bodies in the upper gastrointestinal tract in adults: European society of gastrointestinal endoscopy (ESGE) clinical guideline","volume":"48","author":"Birk","year":"2016","journal-title":"Endoscopy"},{"key":"2026061914121156000_ytag445-B7","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1016\/S0140-6736(00)04238-0","article-title":"A swallowed toothbrush","volume":"357","author":"Faust","year":"2001","journal-title":"Lancet"},{"key":"2026061914121156000_ytag445-B8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1159\/000326962","article-title":"Successful endoscopic removal of a swallowed toothbrush: case report","volume":"5","author":"Tonki\u0107","year":"2011","journal-title":"Case Rep Gastroenterol"},{"key":"2026061914121156000_ytag445-B9","first-page":"63","article-title":"Endoscopic retrieval of toothbrushes in a schizophrenic patient","volume":"109","author":"Beristain-Hern\u00e1ndez","year":"2017","journal-title":"Rev Esp Enferm 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