Baylor University Medical Center Proceedings July 2017 - 293

Deglutition syncope
Nachiket Patel, MD, Saif Ibrahim, MBChB, Jainil Shah, MBBS, Menfil A. Orellana-Barrios, MD, Timothy E. Paterick, MD, JD,
and A. Jamil Tajik, MD

Deglutition syncope, also known as swallow syncope, is a neurally mediated reflex syndrome. The common intervention of the heart, esophagus,
and stomach by the vagus nerve is central to its pathogenesis, whereby
swallowing causes inhibition of the cardiac conduction system. It is most
commonly associated with disorders of the esophagus, both organic and
functional. Herein we describe the case of a 48-year-old man presenting
with transient syncopal episodes that occurred while eating caused by
an intrathoracic stomach due to a hiatal hernia.

lucidating the cause of true syncope requires a careful
analysis of a patient's symptoms and clinical ﬁndings.
Herein we present a case of deglutition syncope, a rare
syndrome that is vagally mediated, in which swallowing
results in a transient loss of consciousness.
CASE PRESENTATION
A 48-year-old man presented to the emergency department
after a true syncopal episode. His only medical history was gastroesophageal reﬂux, for which he took daily omeprazole. While
sitting and having breakfast with his wife, the patient developed
sudden nausea and tunnel vision and almost instantly lost consciousness. He regained awareness after approximately 10 seconds
and was cognitively intact. He denied any prodromal symptoms
of chest pain or palpitations. There were no seizure-like movements, tongue biting, or loss of bowel or bladder control. He
never had similar symptoms in the past. His wife called emergency
medical services, which brought him to the emergency department. For 2 days prior to the syncopal episode, he had complaints
of intermittent epigastric abdominal discomfort intermittently
described as "gas-bloating." He denied fever, chills, vomiting,
constipation, diarrhea, melena, or bright blood per rectum.
On arrival to the emergency department, the patient was
alert and oriented. His temperature was 37.0°C; blood pressure, 130/85 mm Hg; heart rate, 70 beats per minute without
evidence of vasodepressor or cardio-inhibitor changes on positional testing; respirations, 16 breaths per minute; and oxygen
saturation, 99% on room air. The ﬁrst and second heart sounds
were normal, and no murmur, gallop, click, or rub was heard.
The lungs were clear to auscultation. His abdomen was soft,
nondistended, with mild epigastric tenderness to palpation, and
Proc (Bayl Univ Med Cent) 2017;30(3):293-294

Figure 1. Chest x-ray demonstrating an air-fluid level, raising suspicion of an
intrathoracic stomach.

bowel sounds were present in the chest. There was no guarding
or rebound tenderness. The electrocardiogram revealed normal
sinus rhythm with normal PR, QRS, and QT intervals.
The patient was monitored with continuous telemetry. His
chest radiograph showed an air-ﬂuid level in the thoracic cavity
suspicious for an intrathoracic stomach (Figure 1). His blood
count, metabolic panel, cardiac enzymes, amylase, and lipase
were normal. Computed tomography of the chest and abdomen disclosed an intrathoracic stomach due to a large hiatal
hernia (Figure 2).

From the Division of Interventional Cardiology, Banner University Medical
Center, Phoenix, Arizona (Patel); Division of Cardiovascular Medicine, University
of Florida College of Medicine, Jacksonville, Florida (Ibrahim, Shah, OrellanaBarrios); Methodist Cardiovascular Consultants, Methodist Health System, Dallas,
Texas (Paterick); and Cardiac Specialty Centers, Aurora Health Care, Milwaukee,
Wisconsin (Tajik).
Corresponding author: Nachiket Patel, MD, Division of Interventional Cardiology,
Banner University Medical Center, 755 E. McDowell Road, 4th Floor, Phoenix,
AZ 85006 (e-mail: nachiketjpatel@gmail.com; Twitter handle: nachiketjpatel).
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