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Deglutition Syncope: A Case Report and Review of the Literature.

Kahn A, Koepke LM, Umar SB - ACG Case Rep J (2015)

Bottom Line: Telemetry monitoring demonstrated high-grade atrioventricular block and pause associated with swallowing.His symptoms and swallow-associated arrhythmia resolved after dual chamber pacemaker implantation.DS is highly treatable once identified and multidisciplinary coordination is helpful in optimizing outcomes and avoiding superfluous testing.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Mayo Clinic, Phoenix, AZ.

ABSTRACT
Deglutition syncope (DS) is a rare, neurally-mediated syncopal syndrome arising from an aberrant vagotonic reflex during swallow-associated esophageal dilation. Its association with gastroesophageal disorders often prompts gastroenterology consultation. An 89-year-old man with recent dysphagia and otalgia was admitted after a syncopal episode occurred while eating. Esophageal imaging and endoscopy demonstrated no causative abnormalities. Maxillofacial imaging revealed chronic sinusitis and mastoiditis. Telemetry monitoring demonstrated high-grade atrioventricular block and pause associated with swallowing. His symptoms and swallow-associated arrhythmia resolved after dual chamber pacemaker implantation. DS is highly treatable once identified and multidisciplinary coordination is helpful in optimizing outcomes and avoiding superfluous testing.

No MeSH data available.


Related in: MedlinePlus

Examination of the (A) esophagus and (B) duodenum demonstrated normal landmarks and endoscopic appearance. (C) Antral erythema in a patchy distribution was noted. (D) Retroflexion and examination of the fundus and cardia was also normal.
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Figure 2: Examination of the (A) esophagus and (B) duodenum demonstrated normal landmarks and endoscopic appearance. (C) Antral erythema in a patchy distribution was noted. (D) Retroflexion and examination of the fundus and cardia was also normal.

Mentions: The following morning, he was swallowing medications and experienced recurrent symptoms accompanied by a period of atrioventricular block resulting in a 3-second pause (Figure 1). A dual chamber permanent pacemaker was placed after electrophysiology evaluation. Upper endoscopy revealed a normal esophagus without stricture, stenosis, or inflammation. There was mild chronic gastritis without Helicobacter pylori (Figure 2). The patient's dysphagia resolved and has not recurred at 3-month follow-up. His otalgia initially persisted, but was corrected by subsequent sinus surgery. Surveillance pacemaker interrogation has not revealed any recurrent pauses or arrhythmias requiring pacemaker correction.


Deglutition Syncope: A Case Report and Review of the Literature.

Kahn A, Koepke LM, Umar SB - ACG Case Rep J (2015)

Examination of the (A) esophagus and (B) duodenum demonstrated normal landmarks and endoscopic appearance. (C) Antral erythema in a patchy distribution was noted. (D) Retroflexion and examination of the fundus and cardia was also normal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612749&req=5

Figure 2: Examination of the (A) esophagus and (B) duodenum demonstrated normal landmarks and endoscopic appearance. (C) Antral erythema in a patchy distribution was noted. (D) Retroflexion and examination of the fundus and cardia was also normal.
Mentions: The following morning, he was swallowing medications and experienced recurrent symptoms accompanied by a period of atrioventricular block resulting in a 3-second pause (Figure 1). A dual chamber permanent pacemaker was placed after electrophysiology evaluation. Upper endoscopy revealed a normal esophagus without stricture, stenosis, or inflammation. There was mild chronic gastritis without Helicobacter pylori (Figure 2). The patient's dysphagia resolved and has not recurred at 3-month follow-up. His otalgia initially persisted, but was corrected by subsequent sinus surgery. Surveillance pacemaker interrogation has not revealed any recurrent pauses or arrhythmias requiring pacemaker correction.

Bottom Line: Telemetry monitoring demonstrated high-grade atrioventricular block and pause associated with swallowing.His symptoms and swallow-associated arrhythmia resolved after dual chamber pacemaker implantation.DS is highly treatable once identified and multidisciplinary coordination is helpful in optimizing outcomes and avoiding superfluous testing.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Mayo Clinic, Phoenix, AZ.

ABSTRACT
Deglutition syncope (DS) is a rare, neurally-mediated syncopal syndrome arising from an aberrant vagotonic reflex during swallow-associated esophageal dilation. Its association with gastroesophageal disorders often prompts gastroenterology consultation. An 89-year-old man with recent dysphagia and otalgia was admitted after a syncopal episode occurred while eating. Esophageal imaging and endoscopy demonstrated no causative abnormalities. Maxillofacial imaging revealed chronic sinusitis and mastoiditis. Telemetry monitoring demonstrated high-grade atrioventricular block and pause associated with swallowing. His symptoms and swallow-associated arrhythmia resolved after dual chamber pacemaker implantation. DS is highly treatable once identified and multidisciplinary coordination is helpful in optimizing outcomes and avoiding superfluous testing.

No MeSH data available.


Related in: MedlinePlus