Author + information
- Received December 26, 2013
- Accepted January 28, 2014
- Published online May 27, 2014.
A hospitalized 25-year-old man experiences pre-syncope upon swallowing oral medications with water. This correlated with more than 5 s of asystole on telemetry (Online Video 1) and on an electrocardiogram (A). The patient reported a long history of similar severe presyncopal episodes triggered by drinking beverages. Continuous noninvasive blood pressure (BP) and electrocardiographic (ECG) monitoring demonstrated reproducible asystole and hypotension in response to swallowing ice water (B), cold carbonated cola (C), and warm coffee (D).
The patient’s findings are consistent with deglutition syncope. This is a poorly understood condition associated with bradycardia and/or asystole and hypotension elicited by swallowing (1). It has classically been described with ingestion of cold liquids (2), but our case demonstrated that the trigger could be temperature-independent. Because an increase in vagal tone is believed to mediate this response (1), anticholinergic medications may be tried before considering permanent pacemaker placement.
- Received December 26, 2013.
- Accepted January 28, 2014.
- American College of Cardiology Foundation