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Unusual swallow syncope caused by huge hiatal hernia
Toru Maekawa1, Masakuni Suematsu, Temiko Shimada
1Department of Gastroenterology, Kanebo Memorial Hospital, Kobe.
Internal Medicine (Tokyo, Japan)
|April 4, 2002
Summary
Swallowing can rarely cause syncope. A hiatal hernia led to a 76-year-old woman
Area of Science:
- Gastroenterology
- Cardiology
- Neurology
Background:
- Syncope, or fainting, is a rare symptom associated with swallowing.
- A 76-year-old female presented with postprandial (after eating) loss of consciousness.
Observation:
- Initial cardiogenic assessments were unremarkable.
- Upper gastrointestinal barium study revealed a large hiatal hernia.
- Echocardiography and MRI showed left atrial collapse caused by the herniated stomach.
Findings:
- A water-pouring test reproduced the patient's lightheadedness, confirming the link to swallowing.
- Surgical intervention with Nissen's fundoplication was performed.
- The patient experienced no further syncopal episodes post-surgery.
Implications:
- Large hiatal hernias can cause swallowing-induced syncope through mechanical cardiac effects.
- Diagnostic water-pouring tests can identify swallowing triggers for syncope.
- Surgical correction of hiatal hernias is an effective treatment for this rare condition.