Atrioventricular Block Induced by Swallowing in a Patient With Diffuse Esophageal Spasm

Bortolotti, Mauro

doi:10.1001/jama.1982.03330180057033

Cited by 36 publications

(8 citation statements)

References 6 publications

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“…Two of the patients with a vasovagal episode had abdominal discomfort, nausea or vomiting before hypotension and bradycardia. Susceptible patients may have indirect vagal stimulation in response to these symptoms after regadenoson injection [28, 29]. This effect could have been exacerbated by the nonfasted status of our patients.…”

Section: Discussionmentioning

confidence: 99%

Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

Brinkert

Reyes

Walker

et al. 2013

Eur J Nucl Med Mol Imaging

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PurposeRegadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012.MethodsClinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was defined as any symptom that persisted for more than 30 min or that required investigation or treatment.ResultsOf 1,764 consecutive patients, 1,581 (90 %) received regadenoson combined with submaximal exercise unless contraindicated. Symptoms were common (63 %) but transient and well-tolerated. The severity of symptoms was recorded in most patients as mild (84 %). Dyspnoea (36 %) and chest discomfort (12 %) were the commonest side effects. Adverse events were reported in eight patients (0.5 %), thought to be vasovagal in seven of these. All patients recovered fully without sequelae. There were no deaths, myocardial infarction or hospital admissions. Regadenoson stress was performed in 206 patients (12 %) with asthma or chronic obstructive pulmonary disease (COPD) without bronchospasm or any other major side effect.ConclusionWe studied the symptom profile of regadenoson in the largest European cohort to date. Regadenoson combined with submaximal exercise was well tolerated, notably also in patients with asthma or COPD. The majority of regadenoson-related adverse events were vasovagal episodes without sequelae.

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Section: Discussionmentioning

confidence: 99%

Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

Brinkert

Reyes

Walker

et al. 2013

Eur J Nucl Med Mol Imaging

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“…Since Spens described a possible case of swallow syncope in 1793,4) approximately 60 similar cases have been reported 2). Swallow syncope is associated with various conditions, including esophageal disorders, such as esophageal stricture, esophageal diverticulum, esophageal spasm, esophageal cancer, achalasia, and hiatal hernia,5-7) as well as cardiac diseases, including myocardial infarction, heart failure, and atrial fibrillation 8)9). In contrast, Palmer10) reported cases of swallow syncope without involvement of esophageal or cardiac diseases.…”

Section: Discussionmentioning

confidence: 99%

A Case of Swallow Syncope Associated With Cold Beverage Ingestion

Kim

et al. 2012

Korean Circ J

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Swallow syncope (also known as deglutition syncope) is a relatively rare type of syncope that is treatable if diagnosed correctly. We report a case of a 39-year-old man with recurrent swallow syncope. The patient did not have structural heart disease. He developed a complete atrioventricular block upon drinking a cold beverage (Chilsung cider) while undergoing a repeated head-up tilt test. The patient was advised to avoid cold beverages and has been symptom free for 5 months.

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“…Aborad to the balloon there were 3 manometric ports 5 cm apart, the most orad of which was just below the end of the balloon. Manometric catheters were perfused by means of a pncumohydraulic low-compliance pump and connected to pressure transducers and a polygraph, fol lowing a method described in detail elsewhere [8]. The ECG was recorded by means of two precordial leads connected to an ECG amplifier of the same polygraph.…”

Section: Methodsmentioning

confidence: 99%

“…The esophagus may be involved in the genesis of some reflex cardiac arrhythmias, either spontaneous, such as those responsible for the 'swallow syncope' [1,2], or sec ondary to esophageal manipulations [3,4], In swallow syncope, the stimulation of tensoreceptors of the esopha geal wall by the ingested bolus elicits an inhibitory reflex, which induces in the heart a bradyarrhythmia with conse quent syncope [5][6][7][8], This phenomenon may be repro duced by inflating a balloon into the esophagus [6][7][8]. As the most frequent esophageal disorder found in these patients is diffuse spasm [8][9][10][11][12], it seemed appropriate to investigate the presence of this esophagocardiac reflex in patients so affected.…”

Section: Introductionmentioning

confidence: 99%

“…As the most frequent esophageal disorder found in these patients is diffuse spasm [8][9][10][11][12], it seemed appropriate to investigate the presence of this esophagocardiac reflex in patients so affected. All the more because some of the patients with diffuse spasm may have an angina-like chest pain [13][14][15], the esophageal origin of which can be estab lished by means of intraesophageal balloon distension [16].…”

Section: Introductionmentioning

confidence: 99%

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Abnormal Esophagocardiac Inhibitory Reflex in Patients with Diffuse Esophageal Spasm

Bortolotti¹,

Sarti²,

Brunelli³

et al. 1995

Digestion

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The aim of this study was to establish if patients with an esophageal dysmotility similar to that found in the majority of patients with ‘swallow syncope’ may also have a pathologic esophagocardiac reflex similar to that observed in these patients. The effects on heart rate induced by dry and solid swallows and by intraesophageal balloon distension were studied in 8 normal subjects and in 10 patients with diffuse esophageal spasm by simultaneous recording of ECG and intraesophageal pressures. Dry swallows induced a brief increase in heart rate, while deglutition of a solid bolus initially induced an increase followed by a decrease in heart rate, significantly more marked in patients with diffuse spasm. The intraesophageal balloon inflation induced a decrease in heart rate which was significantly more intense in patients with diffuse spasm. In conclusion, the esophageal wall distension either due to solid bolus ingestion or to balloon inflation elicits an inhibitory esophagocardiac reflex which is more intense in patients with diffuse spasm and might induce cardiac arrhythmias in predisposed subjects.

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Atrioventricular Block Induced by Swallowing in a Patient With Diffuse Esophageal Spasm

Cited by 36 publications

References 6 publications

Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

A Case of Swallow Syncope Associated With Cold Beverage Ingestion

Abnormal Esophagocardiac Inhibitory Reflex in Patients with Diffuse Esophageal Spasm

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