Swallow Syncope: A Case Report and Review of the Literature

Mitra, Subhashis; Ludka, Tiffany; Rezkalla, Shereif H.; Sharma, Param P.; Luo, Jiangming

doi:10.3121/cmr.2010.969

Cited by 41 publications

(77 citation statements)

References 20 publications

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“…1 Several disorders of the esophagus are associated with deglutition syncope, caused by a number of bradyarrhythmias. 2 The intrathoracic stomach caused intense vagal stimulation in our patient when he ate, leading to sinus node slowing, followed by arrest, resulting in transient syncopal episodes. …”

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confidence: 67%

The Way to a Man’s Heart Is Through His Stomach

2013

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A 64-year-old man with hypertension was eating fast food while driving home when he suddenly experienced nausea and tunnel vision. He lost consciousness and awoke to find his truck in a cornfield. He called his family who brought him to the ED.Computed tomography scan of the chest and abdomen demonstrated an intrathoracic stomach due to a large hiatal hernia ( Fig. 1). Surgical repair was scheduled, and he was started on a liquid diet. Immediately after ingesting ∼20 cc of broth, he developed bradycardia, followed by sinus arrest with junctional escape beats (Fig. 2), at which time he lost consciousness. His rhythm spontaneously reverted back to sinus, and he regained consciousness. He was kept NPO until repair of his hernia with resolution of his symptoms.Deglutition syncope is a neurally mediated reflex syndrome. The common innervation of the esophagus, stomach, and heart by the vagus nerve is important in the pathogenesis, whereby deglutition causes inhibition of the cardiac conduction system. 1 Several disorders of the esophagus are associated with deglutition syncope, caused by a number of bradyarrhythmias. 2 The intrathoracic stomach caused intense vagal stimulation in our patient when he ate, leading to sinus node slowing, followed by arrest, resulting in transient syncopal episodes.

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confidence: 67%

The Way to a Man’s Heart Is Through His Stomach

2013

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“…Nonetheless, episodes of swallow-induced bradycardia are characteristic for "swallow syncope," a rare syndrome that belongs to the reflex syncope syndromes. 5 The pathophysiology of swallow syncope is incompletely understood but likely involves a vagal reflex that is initiated by activation of the glossopharyngeal nerve during swallowing. [5][6][7] Efferent impulses lead to the sinoatrial node (right vagus nerve) or the AV node (left vagus nerve) and may lead to various types of paroxysmal bradycardias and reduction of cardiac output.…”

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confidence: 99%

“…5 The pathophysiology of swallow syncope is incompletely understood but likely involves a vagal reflex that is initiated by activation of the glossopharyngeal nerve during swallowing. [5][6][7] Efferent impulses lead to the sinoatrial node (right vagus nerve) or the AV node (left vagus nerve) and may lead to various types of paroxysmal bradycardias and reduction of cardiac output. The importance of vagal pathways in this reflex is stressed by studies in which pretreatment with atropine or other anticholinergic drugs is effective in preventing swallow-induced bradycardia.…”

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confidence: 99%

“…A recent review of all 80 published cases of swallow syncope showed that the majority of cases (62%) had underlying cardiac or gastrointestinal disease, although a substantial minority of patients did not have any underlying pathology. 5 Treatment of the syndrome may involve implantation of a permanent pacemaker. In patients in whom quality of life is severely affected by recurrent syncopal events, this treatment is usually effective.…”

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confidence: 99%

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Clinical Reasoning: Heart to swallow

et al. 2016

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A 55-year-old woman was admitted to our intensive care department after intoxication with lithium. Her medical history was relevant for bipolar disorder for which she received medical treatment with lithium, haloperidol, and citalopram. In the week before admission, she had developed a clinical picture of gastroenteritis with diarrhea and vomiting, which resulted in dehydration and a marked deterioration in kidney function. During the last days before admission, she had become progressively lethargic and had developed dysarthria as well as postural tremors of the extremities. The tremors were coarse and irregular, most clearly present in the hands with a frequency of approximately 8 Hz. At admission, she opened her eyes spontaneously, localized pain, and showed normal verbal responses (E4M5V5). Physical examination showed severe dysarthria, ataxia, and no focal neurologic deficits. Reflexes were normal. Laboratory investigation revealed a de novo elevated creatinine level (220 mmol/L, normal 49-90) corresponding to an estimated glomerular filtration rate of 22 mL/min/1.73 m 2 (normal .60) and a lithium level that was 5.8 mmol/L (target value 0.6-0.8 mmol/L). ECG at admission was normal except for a prolonged QTc interval of 533 milliseconds (normal ,450).Questions for consideration:

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“…Achalasia is a motor dysfunction of the oesophagus characterized by increased pressure in the lower sphincter and incomplete relaxation after swallowing (1). Classical symptoms include dysphagia, regurgitation, chest pain and weight loss.…”

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confidence: 99%