SWALLOW SYNCOPE ASSOCIATED WITH INTERMITTENT SINUS PAUSE AND HIGH DEGREE AV BLOCK KMalone BSN; MP Modi MD, VS Koripalli MD, A Amorn, MD, FHRS Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA
INTRODUCTION: Swallow syncope or deglutition syncope is a relatively rare, neurogenically mediated syncope associated with life- threatening bradyarrhythmia and hypotension triggered by oral intake. Swallow syncope when diagnosed, is treatable but is challenging to identify without proper history and prior knowledge of this disorder.
CASE: 68-year-old female with a complex history presented with complaints of worsening long-term intermittent lightheadedness and dizziness, which was associated with swallowing. During her hospital stay, the patient was noted to have a high- degree AV block on telemetry during dinner time. A repeat electrocardiogram demonstrated a prolonged P-R interval, and a temporal relationship between swallowing cold water and electrocardiogram changes was demonstrated. A diagnosis of swallow syncope was confirmed. Electrophysiology was consulted on the patient, and she had a pacemaker placed. Symptoms of swallow associated dizziness, lightheadedness and arrhythmias completely resolved after pacemaker implantation. DISCUSSION: Current literature postulates the mechanism of swallow syncope is related to dysfunction of the vagal nerve that regulates the heart which causes the arrhythmia while swallowing. Stretching of the esophagus through swallowing sends afferent signals along the esophageal plexus via the left vagus nerve to the brainstem. The efferent impulses may then reach the SA node via the right vagus nerve and the AV node via the left vagus nerve. These efferent signals may lead to a number of different bradyarrhythmias and temporary reductions in cardiac output, leading to syncope. While swallow syncope is highly treatable once identified, the challenge is in identifying the disorder. History is especially important in demonstrating a temporal relationship with this diagnosis after underlying mechanical esophageal and ischemic cardiac disease is ruled out.
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