What causes swallow syncope?

Posted on Mon, 8 Dec 2014 in Hypertension and Heart Disease

Question: First thing in the morning I always drink 2 glasses of water. I have been doing this for years and I have no problem. Last November 10 woke up 6am to get ready to work and of course I drank my first glass of water. I felt tummy pain lean to the basin and that is all I remember. All I know was my husband was frantically waking me up, I was confuse did not know what happen but I remember that I drank water. My husband rang the ambulance and I ended up in the Emergency Department in the hospital for 4 hours because I hit my head on the bath tub and pretty shaken. All my vital signs and blood test and ECG were normal. They say I had syncope attack and was discharged. 4 days after at 2 am I woke up went to the toilet and drunk a glass of water but made sure I was sitting down on the bed just in case. And my God everything just turn around and I started to vomit everything I eat mostly undigested food. My husband call the ambulance again but I did not go to the hospital because I was feeling better when they came. I went to the doctor today and same thing, I had syncope attack. I still feel lightheaded and a bit giddy when I drink water.

Answered by Dr. Prakash H Muddegowda 2 hours later

Brief Answer:
It is swallow syncope

Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.

1. It appears to be swallow syncope
2. The mechanism involves impulses from Gastro intestinal tract affecting the heart that can produce a variety of bradyarrythmias with atrioventricular block.
3. It occurs within 3-5 seconds of swallowing. Frequently triggered by liquids, particularly cold carbonated beverages. Bolus of food or any solid are also known to cause swallow syncope.
4. Change in drinking/eating habits is often helpful. Pacemakers (Rate responsive, dual chamber) may be needed. However a confirmation with telemetry monitoring or electrophysiological tests during induction of swallow syncope may demonstrate low heart rate.
5. Esophagus pathology also needs to be ruled as in few cases, a stricture or hernia is known to have caused it.
6. I am not sure about the investigations done. Barium swallow of esophagus and telemetry or monitoring of ECG during swallow induced episodes could demonstrate bradyarrythmias or decreased heart rate.
7. Anti-cholingergic medications to block vagal conduction or Beta blockers in few cases have known to be helpful.

Meet your doctor to get the investigations done. After a confirmation, based on pathology identified, appropriate treatment can be possible.

Get well soon.
Hope it helps.
Any further queries, happy to help again.

Dr. Prakash HM

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Answered by

Dr. Prakash H Muddegowda

Geriatrics Specialist

Practicing since :2004

Answered : 2138 Questions

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Question is related to
Diseases and Conditions	Syncope, Hernia, Atrioventricular block
Lab Tests	Blood test
Medical Topics	Esophagus, Heart rate, Vital signs

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