Symptomatic left atrial compression is a rare clinical condition presenting with heart failure, syncope or shock. A Med-line search with the term "left atrial compression" showed only 271 hits. Only 17 cases, of which 11 with hiatus hernia, of left atrial compression due to structures of the gastrointestinal tract were found. We describe a 86-year-old man suffering from repeating syncope due to left atrial compression by a hiatus hernia. This prompted us to review the few cases of atrial compression caused by gastro-intestinal structures.