Dysphagia in the aging cardiovascular patient

Abstract

Dysphagia is not a normal process of aging. Dysphagia aortica refers to external compression of the distal esophagus from an enlarged, ectatic or aneurysmal thoracic aorta leading to mechanical obstruction of the food bolus. It is a rare cause of dysphagia seen in the older population and predisposing risk factors include female gender, short stature, and kyphosis. We selected the case of an octogenarian with a significant cardiovascular history presenting with dysphagia where the diagnosis of dysphagia aortica was delayed but ultimately identified. Although rare, we urge and remind a high index of suspicion for clinicians treating this patient population.

Case report: an aortic aneurysm as cause of pseudoachalasia

“…When confronted with more severe symptoms, surgical correction of the aneurysm or dissection should be considered. In patients who are not deemed fit for surgery, enteral nutrition through nasogastric tube or PEG placement might be an option [11]. It is clear from this case that it is important to differentiate pseudoachalasia from achalasia in elderly patients where primary investigations are suggestive for primary achalasia.…”

A patient with dysphagia

“…The left atrial enlargement causes dysphagia by external compression of the esophagus. [ 1 2 4 7 ] Dysphagia can also be caused by the extrinsic compression of the esophagus that can result from vascular anomalies, such as an aneurysmal thoracic aorta. Besides, direct compression on esophagus causing dysphagia and other suggested mechanisms for cardiovascular dysphagia include deranged peristalsis due to local ischemia of the esophageal mucosa and nerve plexus caused by the elevated external pressure; prolonged exposure of the distal esophagus to high external pressure may cause proximal esophageal muscle fatigue and dysphagia.…”

“…Besides, direct compression on esophagus causing dysphagia and other suggested mechanisms for cardiovascular dysphagia include deranged peristalsis due to local ischemia of the esophageal mucosa and nerve plexus caused by the elevated external pressure; prolonged exposure of the distal esophagus to high external pressure may cause proximal esophageal muscle fatigue and dysphagia. [ 1 2 5 6 7 ] Our patient was suffering from dysphagia and had mitral stenosis. Dysphagia was also progressively worsening and due to it our patient suffered from malnutrition and weight loss.…”

Aortic compression of the esophagus: A case report and literature review

“…Other authors also established this phenomenon among patients, mostly elderly women with a history of hypertensive or arteriosclerotic heart failure, in many cases with kyphosis. [3][4][5][6] Almost all patients had gone to the doctor because of dysphagia, while complaints of heartburn or abdominal or retrosternal pain were less common. In general, the greater the number of symptoms, especially dysphagia, the more explicit the findings on CT images and barium swallow were.…”

“…Other authors also established this phenomenon among patients, mostly elderly women with a history of hypertensive or arteriosclerotic heart failure, in many cases with kyphosis. 3 – 6 …”