Swallow Syncope in a Patient With Esophageal Stenosis Caused by an Ascending Aorta Aneurysm: Differential Diagnosis From Postprandial Hypotension

Abstract

Swallow syncope is usually caused by organic or functional disorders of the esophagus due to abnormal vasovagal reflex. In elderly patients this situation could be confused with postprandial hypotension. We present a case of an elderly patient who presented with swallow syncope that was caused by a waist in the midportion of esophagus induced by an ascending aorta aneurysm.

Swallow Syncope: A Case Report and Review of the Literature

“…2 Some reported cases were associated with ascending aortic aneurysm, 3 thoracic surgery, advanced lung cancer, and transient hypoxia. 2 However, in a significant number of cases, no underlying disease could be found.…”

Swallow Syncope Associated With Intermittent Sinus Pause and High-Degree Atrioventricular Block: A Case Report

“…The pathophysiology of swallow syncope is not completely understood, and several different mechanisms causing it may have not yet been discovered [3]. Swallow syncope is a dysautonomic syndrome associated with vagal afferent activation caused by esophageal stimulation, meaning that it is a dysfunction of the vagal nerve that regulates the heart, causing arrhythmia when swallowing [4]. In some cases, it may cause complete loss of consciousness through the reduction of blood flow to the brain caused by arrhythmia [4].…”

“…Swallow syncope is a dysautonomic syndrome associated with vagal afferent activation caused by esophageal stimulation, meaning that it is a dysfunction of the vagal nerve that regulates the heart, causing arrhythmia when swallowing [4]. In some cases, it may cause complete loss of consciousness through the reduction of blood flow to the brain caused by arrhythmia [4]. Mechanoreceptors in the esophagus, which are activated by stretching or movement, possibly play an important role [5].…”

“…Disorders of the esophagus that have been described with swallow syncope include esophageal spasm, esophageal stricture, achalasia, esophageal diverticula, esophageal cancer, and hiatal hernia. In some cases, cardiac diseases, such as ascending aortic aneurysm, thoracic surgery, advanced lung cancer, and transient hypoxia, have also been described as associated pathologies with swallow syncope [1,4]. However, in a significant number of cases, there are no underlying causative pathologies described [8].…”