Correspondence

Syncope after Eating

N Engl J Med 1993; 328:1572May 27, 1993

Article

To the Editor:

A 62-year-old physician from Moscow was admitted to the emergency department of the University Hospital in Vienna because of fainting after eating at a medical-convention banquet. In the ambulance on the way to the hospital, atrial fibrillation with a rapid rate was noted, and a physician administered 5 mg of verapamil intravenously. The physical examination and electrocardiogram in the emergency room showed a hemodynamically stable patient with sinus tachycardia. The chest film showed almost complete opacification of the right hemithorax, with normal findings in the left lung (Figure 1Figure 1Chest X-Ray Film, Showing Almost Complete Opacification of the Right Hemithorax.). The mottled appearance of the opacification was atypical of pneumonia or atelectasis. An image obtained with a barium swallow showed a huge dilatation of the esophagus, which filled most of the right hemithorax, compatible with longstanding achalasia (Figure 2Figure 2Extensive Dilatation of the Esophagus Due to Achalasia on an Image Obtained after a Barium Swallow.).

Through an interpreter, the patient said that he had been suffering from dysphagia caused by achalasia for 36 years and that he was unable to eat solid food in a normal manner. In recent years, he had had several fainting spells after swallowing food or liquids.

Achalasia is defined by incomplete or absent relaxation of the gastroesophageal sphincter and aperistalsis in the esophageal body. Dilatation of the esophagus due to food stasis may occur. Syncope caused by atrioventricular heart block after swallowing1-3 or by pneumatic dilatation of the esophagus3 has been reported. Paroxysmal tachycardiac atrial fibrillation associated with swallowing has been observed only rarely4,5. In addition to an electrocardiogram, a diagnostic workup of the esophagus is indicated for syncope after swallowing. The combination of atypical opacification of the hemithorax and dysphagia should also trigger a search for an esophageal process.

Wolfgang Schima, M.D.
Fritz Sterz, M.D.
Peter Pokieser, M.D.
University of Vienna, A-1090 Vienna, Austria

5 References

1. 1

   Kopald HH, Roth HP, Fleshler B, Pritchard WH. Vagovagal syncope: report of a case associated with diffuse esophageal spasm. N Engl J Med 1964;271:1238-1241
   Full Text | Web of Science | Medline

2. 2

   Weiss S, Ferris EB Jr. Adams-Stokes syndrome with transient complete heart block of vagovagal reflex origin: mechanism and treatment. Arch Intern Med 1934;54:931-951
   Web of Science

3. 3

   Iglauer S, Schwartz BA, Heart-block periodically induced by the swallowing of food in a patient with cardiospasm (vagovagal syncope)Ann Otol Rhinol Laryngol 1936;45:875-880
   

4. 4

   Berges W, Wienbeck M. Herzrhythmusstorungen bei der Dehnungsbehandlung der Achalasie des Osophagus. Z Gastroenterol 1978;16:376-380
   Web of Science | Medline

5. 5

   Bajaj SC, Ragaza EP, Silva H, Goyal RK. Deglutition tachycardia. Gastroenterology 1972;62:632-635
   Web of Science | Medline

Citing Articles (4)

Citing Articles

1. 1

   FRANCESCO CASELLA, ALESSANDRO DIANA, MARA BULGHERONI, MONICA SOLBIATI, ELISA CERIANI, FRANCESCO PENTIMALLI, ANTONIO SAGONE, NICOLA MONTANO. (2009) When Water Hurts. Pacing and Clinical Electrophysiology 32:11, e25-e27
   CrossRef

2. 2

   Enrico Favaretto, Nella Schenal, Nicola Russo, Gianfranco Buja, Sabino Iliceto, Claudio Bilato. (2008) An uncommon case of right-sided throat pain and swallow syncope. Journal of Cardiovascular Medicine 9:11, 1152-1155
   CrossRef

3. 3

   Wataru Omi, Yoshiharu Murata, Takanori Yaegashi, Jun-ichiro Inomata, Masahiko Fujioka, Shingo Muramoto. (2006) Swallow Syncope, a Case Report and Review of the Literature. Cardiology 105:2, 75-79
   CrossRef

4. 4

   Samer Gawrieh, Ty Carroll, Walter J. Hogan, Konrad H. Soergel, Reza Shaker. (2005) Swallow Syncope in Association with Schatzki Ring and Hypertensive Esophageal Peristalsis: Report of Three Cases and Review of the Literature. Dysphagia 20:4, 273-277
   CrossRef