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Swallowing syncope: complex mechanisms of the reflex
Takeshi Shirayama1, Mitsuyoshi Hadase, Takashi Sakamoto
1Second Department of Medicine, Kyoto Prefectural University of Medicine.
Internal Medicine (Tokyo, Japan)
|April 4, 2002
Summary
Swallowing can trigger syncope (fainting) due to sinus node dysfunction, potentially involving non-vagal pathways. This study highlights a complex mechanism behind swallowing-induced cardiac events.
Area of Science:
- Cardiology
- Electrophysiology
- Gastroenterology
Background:
- Syncope, or fainting, can be triggered by various physiological events.
- Swallowing is a known, albeit less common, trigger for syncopal episodes.
Observation:
- A 69-year-old woman experienced syncope, dizziness, and loss of consciousness specifically when consuming solid food.
- Ambulatory electrocardiogram (ECG) monitoring revealed sino-atrial block during swallowing, with a prolonged sinus pause of 6 seconds.
Findings:
- Electrophysiologic studies confirmed pre-existing sinus node dysfunction, exacerbated by esophageal balloon inflation.
- Atropine mitigated the esophageal pressure-induced slowing of the basal sinus rate but did not affect the maximum sinus node recovery time.
- These results suggest a non-vagal component contributing to the syncope mechanism.
Implications:
- This case deepens the understanding of swallowing-induced syncope, implicating both vagal and non-vagal pathways.
- It underscores the importance of considering esophageal stimulation in the evaluation of unexplained syncope.
- Further research into the non-vagal mechanisms of the swallowing reflex and cardiac function is warranted.