Swallow Syncope, a Case Report and Review of the Literature

Omi, Wataru; Murata, Yoshiharu; Yaegashi, Takanori; Inomata, Jun-ichiro; Fujioka, Masahiko; Muramoto, Shingo

doi:10.1159/000089543

Cited by 58 publications

(73 citation statements)

References 87 publications

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“…This syndrome is more common in males, and most patients have been adults, but some cases were also noted in young children. 2 Swallow syncope has been known to occur in patients with organic or functional disorders of the esophagus. These disorders include esophageal spasm, esophageal stricture, achalasia, esophageal diverticula, esophageal cancer, and hiatal hernia.…”

Section: Discussionmentioning

confidence: 99%

“…These disorders include esophageal spasm, esophageal stricture, achalasia, esophageal diverticula, esophageal cancer, and hiatal hernia. 2 Swallow syncope may also occur in the absence of esophageal diseases and has been observed in the setting of cardiac diseases like acute myocardial infarction, rheumatic carditis, and with digoxin use.…”

Section: Discussionmentioning

confidence: 99%

“…Sympathomimetic agents like adrenaline and isoprenaline have been used to increase the ventricular rate directly; however, the results have been inconsistent and limited by side effects. 2 Beta-blockers may be effective in carefully selected patients. 8 In the appropriate clinical setting, correction of any underlying esophageal pathology should be attempted.…”

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confidence: 99%

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Swallow Syncope: A Case Report and Review of the Literature

Mitra¹,

Ludka²,

Rezkalla³

et al. 2011

Clinical Medicine & Research

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…Swallow syncope is more common in males; it frequently occurs in adults but rarely in young children. 1 Swallow syncope has been known to occur in patients with organic or functional disorders of the esophagus, but is more likely to occur independent of underlying esophageal diseases. The vagal reflex has been postulated to play the main role in the pathophysiological mechanism underlying swallow syncope.…”

mentioning

confidence: 99%

Swallow syncope

Saitoh

Satoh

Makino

et al. 2014

Acute Medicine & Surgery

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Swallow syncopeDear Editor, A 70-year-old man was admitted to our emergency department owing to syncope. One month earlier, he began to complain of faintness, and sometimes experienced it when swallowing a large stuff. On the day of admission, he lost consciousness when swallowing a relatively large piece of fried potato. He denied any alcohol use, illicit drug use, or family history of sudden cardiac death. Candesartan cilexetil had been prescribed for the past 2 years for hypertension.On admission, the patient's resting blood pressure was 125/68 mmHg and his heart rate was 58 b.p.m. Physical examination showed no neck bruit, and neurological findings were normal. Laboratory data indicated normal complete blood count, liver enzyme level, renal function, and electrolyte level. No abnormalities were noted in the electrocardiogram (Fig. 1A), carotid ultrasound and echocardiography, or chest and brain computed tomography at admission. On the third day after admission, he experienced faintness, with a 10-s pause seen on the remote telemetry monitor (Fig. 1B), when he was sitting on a bed and swallowing a mouthful of tea, but recovered rapidly and completely. Cardiac catheter examinations were carried out, but no evidence of coronary artery disease was observed on coronary angiography. In the electrophysiological study, the maximal sinus node recovery time and atrioventricular node conduction time were within normal limits. A gastric endoscopic image showed varioliform erosion in the esophagus. The patient refused the test to induce the syncope by eating or drinking a large stuff due to his fear of the syncope; however, integrating these findings, the patient's condition was diagnosed as swallow syncope. Subsequently, a dual-chamber pacemaker was implanted, and the syncope did not recur. The electrocardiogram record based on pacemaker check showed some pacing without any complaints during meals.Swallow syncope is a rare type of neurally mediated syncope. Swallow syncope is more common in males; it frequently occurs in adults but rarely in young children. 1 Swallow syncope has been known to occur in patients with organic or functional disorders of the esophagus, but is more likely to occur independent of underlying esophageal diseases. The vagal reflex has been postulated to play the main role in the pathophysiological mechanism underlying swallow syncope. 2 In affected individuals, the stretching of the mechanoreceptor in the esophagus during swallowing stimulates the afferent fibers from the esophageal vagal nerve plexus to the brainstem, leading to stimulation of efferent fibers and, ultimately, to cardiovascular inhibition. The consistency and temperature of food products are believed to play a vital role in the pathogenic mechanism of swallow syncope; 3 however, other researchers have insisted no relation with temperature of products. 4 Patients with swallow syncope are thought to subconsciously refrain from ways of swallowing that induce syncope; therefore, we might be unaware of many patients with swallow sync...

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Swallow Syncope, a Case Report and Review of the Literature

Cited by 58 publications

References 87 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 syncope

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