Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus

Kang, Kwi Young; Cho, Wook Hyun; Kim, Myung Chan; Chang, Hee Jong; Chung, Jae Il; Won, Dong Jun

doi:10.3904/kjim.2005.20.1.68

Cited by 30 publications

(37 citation statements)

References 7 publications

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“…Mechanoreceptors in the esophagus, which are activated by stretching, may play an important role. 4 They sense distension and send signals along the esophageal plexus via the vagus nerve to the brainstem. The efferent impulses from the brainstem reach the sinoatrial (SA) node via the right vagus nerve and the AV node via the left vagus nerve.…”

mentioning

confidence: 99%

Swallow Syncope: A Case Report and Review of the Literature

Mitra¹,

Ludka²,

Rezkalla³

et al. 2011

Clinical Medicine & Research

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confidence: 99%

Swallow Syncope: A Case Report and Review of the Literature

Mitra¹,

Ludka²,

Rezkalla³

et al. 2011

Clinical Medicine & Research

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“…The postulated mechanism involves aberrant conduction of the afferent and efferent impulses of the vagus nerve [1,2]. Swallow syncope is a dysautonomic syndrome associated with hypersensitive vagal activation induced by esophageal stimulation, producing the so-called upper gastrointestinal cardiac vagovagal reflexes, which by sympathetic inhibition can induce a variety of bradyarrhythmias: sinus bradycardia, sinus arrest, sinoatrial block, AV block, or atrial and ventricular asystole [3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Blackout during meals: A case report of swallow syncope due to sinus arrest

Okahara

Nagamoto

Umemoto

et al. 2014

Journal of Cardiology Cases

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IntroductionSwallow syncope is a rare cause of syncope that belongs to the neurally mediated reflex syncopal syndromes. It occurs because of a vagal reflex during deglutition causing inhibition of the cardiac conduction system. Most cases with swallow syncope show an underlying abnormality of the esophagus or heart; however, some cases demonstrate no organic abnormality. Here, we report on a case of blackout caused by sinus arrest only during meals. Case reportA 79-year-old male with diabetes mellitus and dyslipidemia had been suffering from blackout only during meals from the age of 75 years; however, no detailed examination had been performed. During these episodes, he usually stopped eating and the feeling of blackout spontaneously disappeared. He had a history of percutaneous coronary intervention (PCI), with the stent placed at the left anterior descending artery for unstable angina at the age of 72 years. PCI for the residual lesion at right coronary artery (RCA) and left circumflex artery was not performed because the patient refused to provide consent. The patient underwent laminectomy for cervical spondylosis at the orthopedic department in our hospital at the age of 79 years. Postoperative Holter electrophysiology (ECG) revealed sinus arrest with no ventricular escape beats for 4.3 s during hospital diet (Fig. 1). There were no associated symptoms of chest pain, dyspnea, diaphoresis, or palpitations. The patient had no history of medication for the suppression of heart rate (HR) such as beta-blockers, calcium blockers, and digitalis. A 12-lead ECG showed a first-degree atrioventricular (AV) block with a PQ interval of 240 ms, indicating aberrant AV conduction. Carotid sinus massage and Valsalva maneuvers did not reproduce symptoms or bradycardia. Neurological abnormality by spondylosis was observed; however, magnetic resonance imaging did not Journal of Cardiology Cases 10 (2014) 91-93 A B S T R A C TA 79-year-old male, with a history of percutaneous coronary intervention (PCI), was referred to our cardiovascular department for a detailed examination of blackout caused by sinus arrest only during meals. Ultrasound echocardiography showed normal cardiac contraction with no asynergy, irrespective of the remaining stenotic coronary lesion. An electrophysiological study revealed deteriorated atrioventricular nodal conduction at a Wenckebach point of 70 beats per minute. However, sinus node function was normal as demonstrated by a sinus node recovery time of 1369 ms. Coronary angiography showed triple-vessel disease including the remaining stenotic coronary lesion, and a PCI was performed on the right coronary artery. Nevertheless, sinus arrest during meals was unchanged. Swallow syncope was partially improved by dietary modification; however, pacemaker implantation (PMI) was performed eventually, and the patient became asymptomatic after PMI.

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“…In past reports, the average age of swallowing syncope patients was 57 years (range, 15‐85 years), and 67% of patients were male . In some patients, severe sinus bradycardia and sinus arrest were documented, while in other reports, transient atrioventricular block was described …”

Section: Discussionmentioning

confidence: 99%

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

Kohno

Adkisson

Detloff

et al. 2018

Cardiovasc electrophysiol

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Background: Syncope triggered by swallowing is a well-known but uncommon condition that has been the focus of case reports but is otherwise largely unstudied. To better understand swallow syncope we examined heart rate (HR) and blood pressure (BP) changes during swallowing in clinically suspected swallow syncope patients and asymptomatic control subjects. Methods: The study population comprised four individuals with a history suggesting swallow syncope (three men, 53 ± 14.9 years) and 15 (nine men, 46 ± 17.1 years, P = NS vs patients) asymptomatic volunteer control subjects. Studies in all individuals comprised noninvasive beat-to-beat HR and BP measurement during swallowing 150 mL of cold liquid while standing. Additional tests in swallow syncope patients included: active standing, Valsalva maneuver, carotid sinus massage (CSM), and headup tilt (HUT).Results: Swallowing resulted in a greater decrease of both HR (−22 ± 22.1 vs −3 ± 11.7 beats/minute [bpm]; P = 0.045) and BP (−22 ± 17.4 vs − 2 ± 11.8; P = 0.036) in swallow syncope patients than in controls. Further, in swallow syncope patients the time to lowest HR and BP differed (9 ± 5.5 vs 19 ± 7.2 seconds; P = 0.02), suggesting that both cardioinhibitory (CI) and vasodepressor (VD) mechanisms are present but operate independently. Other autonomic studies were normal in swallow syncope patients except for CSM pause more than 3 seconds in two patients.Conclusion: Swallow syncope is associated with transient and temporally independent CI and VD features, consistent with reflex syncope. Potentially, a swallowing test during autonomic evaluation may be useful to unmask relative magnitudes of CI and VD responses, thereby facilitating treatment strategy decisions. K E Y W O R D S autonomics, head-up tilt, swallowing, syncope J Cardiovasc Electrophysiol. 2019;30:221-229. wileyonlinelibrary.com/journal/jce How to cite this article: Kohno R, Adkisson WO, Detloff BLS, Sakaguchi S, Benditt DG. Swallow (deglutition) syncope: An evaluation of swallowing-induced heart rate and hemodynamic changes in affected patients and control subjects.

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Cases of Swallow Syncope Induced by the Activation of Mechanorecepters in the Lower Esophagus

Cited by 30 publications

References 7 publications

Swallow Syncope: A Case Report and Review of the Literature

Swallow Syncope: A Case Report and Review of the Literature

Blackout during meals: A case report of swallow syncope due to sinus arrest

Swallow (deglutition) syncope: An evaluation of swallowing‐induced heart rate and hemodynamic changes in affected patients and control subjects

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