The doctor suspected that she had “coronary heart disease and angina”, but no abnormalities were found in the coronary angiogram. Later, after gastroscopy, it was found that the patient’s chest pain and tightness were actually caused by an esophageal hiatal hernia. Esophageal hiatal hernia is very common in Westerners, and its incidence is relatively low in Han Chinese. However, the number of cases has increased significantly in recent years with the awareness of the disease. The esophagus is mainly located in the thoracic cavity and the stomach is mainly located in the abdominal cavity, and the interconnection between the two is located in the esophageal hiatus in the middle of the diaphragm. When the pressure in the abdominal cavity rises for various reasons, it may cause part of the stomach to rise through the esophageal foramen in the diaphragm and enter the thoracic cavity, causing gastroesophageal reflux, which mainly manifests as chest pain and chest tightness. Clinically, these patients are mainly found to have sliding esophageal hiatal hernia, which accounts for about 90% of esophageal hiatal hernia. The vast majority of patients are asymptomatic, but a few patients may present with chest pain and chest tightness, often located behind the lower end of the sternum, sometimes resembling angina pectoris, and mostly occurring at night, so it is easily confused with coronary heart disease chest pain. When heart disease is ruled out and the patient still has chest pain and tightness, an esophageal X-ray barium meal imaging or gastroscopy should be performed as early as possible to confirm the diagnosis of esophageal hiatal hernia. Even if you have a hiatal hernia, don’t worry too much. Asymptomatic hiatal hernia usually does not need treatment, while symptomatic patients can be treated with acid-suppressing and gastric-promoting drugs, and those with serious conditions that are not effective with conservative treatment should receive laparoscopic minimally invasive hernia repair and fundoplication surgery in time. It should be reminded that once a patient is diagnosed with esophageal hiatal hernia, he/she should receive active treatment under the guidance of a doctor and should not delay for a long time to avoid causing esophageal erosion and even cancer in serious cases.