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Related Experiment Videos

Deglutition syncope with coexistent carotid sinus hypersensitivity.

Y Shapira1, B Strasberg, T Ben-Gal

  • 1Department of Internal Medicine "B", Massada Center for Heart Diseases, Beilinson Medical Center, Petah Tiqva, Israel.

Chest
|June 1, 1991
PubMed
Summary

A 63-year-old man experienced atrioventricular (A-V) block triggered by swallowing and carotid sinus pressure. Central vagal hyperresponsiveness, potentially unmasked by myocardial infarction, likely caused these events.

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Area of Science:

  • Cardiology
  • Neuroscience
  • Electrophysiology

Background:

  • Symptomatic atrioventricular (A-V) block can arise from various causes, including autonomic dysfunction.
  • Carotid sinus hypersensitivity and deglutition-induced reflexes are known triggers for bradyarrhythmias.

Observation:

  • A 63-year-old male presented with symptomatic atrioventricular (A-V) block.
  • The patient exhibited a mixed-type carotid sinus hypersensitivity and experienced A-V block upon swallowing.
  • Electrophysiologic studies ruled out intrinsic A-V nodal dysfunction.

Findings:

  • Carotid sinus massage induced a vasodepressor response, suggesting central vagal hyperresponsiveness.
  • This hyperresponsiveness likely explains the cardioinhibitory responses observed during both swallowing and carotid sinus stimulation.

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  • Posterior myocardial infarction may have unmasked or contributed to these autonomic reflexes.

    • Implications:

    • Central vagal hyperresponsiveness can manifest as symptomatic atrioventricular block triggered by common physiological events.
    • Understanding these autonomic mechanisms is crucial for diagnosing and managing unexplained bradyarrhythmias.
    • Myocardial infarction can unmask underlying autonomic dysregulation, necessitating comprehensive cardiovascular evaluation.