Asystole Triggered by Swallowing: Insights From a Case of Infective Endocarditis in a 35-Year-Old HIV Patient

BACKGROUND Asystole during swallowing is a rarely observed phenomenon attributable to several underlying factors. The present report documents a case of asystole during swallowing, caused by cardiac arrhythmias associated with infective endocarditis, resulting in diagnostic difficulties. CASE REPORT A man in his 30s infected with human immunodeficiency virus (HIV) was admitted to the hospital in serious condition due to pneumonia, decompensated type 1 diabetes, and systemic infection. His symptoms included chest discomfort, shortness of breath, elevated inflammatory markers, anemia, thrombocytopenia, and irregular, macular thickening in all lung fields on imaging tests, which suggested pneumocystosis. A subsequent angio-CT scan of the chest yielded a diagnosis of pulmonary embolism. Despite the implementation of both intensive and extensive treatment measures, his condition markedly deteriorated, further manifesting as asystole during swallowing. Echocardiography (ECG) revealed tricuspid valve vegetation, leading to a diagnosis of infective endocarditis. The patient received antibiotic treatment and further specialist care at a cardiac surgery center, including removal of tricuspid valve vegetation, which resulted in elimination of disruptions during swallowing. CONCLUSIONS Given the patient's atypical cardiac rhythm disturbances during swallowing, in conjunction with pneumonia, decompensated diabetes, and HIV, arriving at a diagnosis of endocarditis was a considerable challenge. This case study emphasizes the necessity of a comprehensive diagnostic assessment for patients with HIV, including ECG, even when the initial presentation is suggestive of pneumonia.