Trigemino-Cardiac Reflex and High-Degree Atrioventricular Block in Recurrent Epistaxis

Abstract

We present a case of a 55-year-old male who presented to emergency department with recurrent epistaxis. After placement of a 16-French Foley catheter in his right nare to tamponade the bleeding, the patient subsequently developed two episodes of syncope. Review of the telemetry rhythm strips showed that he had developed PR interval prolongation followed by complete atrioventricular block. Our case was likely secondary to stimulation of the trigemino-cardiac reflex, a neuro-cardiogenic reflex, that can occur after stimulation of the trigeminal nerve, whether centrally or peripherally. Patients can develop severe bradycardia, hypotension, asystole, and even death. The relatively common occurrence of epistaxis and its treatment with direct nasal tamponade require an increased awareness and possibly a requirement for telemetry monitoring to prevent complications from stimulation of this reflex.