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Left atrial compression by the esophagus, the stomach, or both is an uncommon but important cause of hemodynamic compromise. Achalasia is a disease of the esophagus with dilatation of the distal part and constriction of the lower oesophageal sphincter. Dilated esophagus is a rare cause of left atrial compression. Timely and precise diagnosis is of paramount importance in cases of left atrial compression and echocardiography enables clinicians to make a differential diagnosis successfully in most cases. Correction of primary pathology will usually lead to the return of normal hemodynamic function. We describe a case of extrinsic left atrial compression caused by the dilated esophagus due to achalasia that caused paroxysms of atrial tachycardia and hemodynamic compromise.