Document Detail

Continuous haemodynamic monitoring in an unusual case of swallow induced syncope.
MedLine Citation:
PMID:  10406995     Owner:  NLM     Status:  MEDLINE    
A 69 year old man is described with a 12 year history of intermittent syncope associated with ingesting solid food, mainly after having fasted. He was taking enalapril, propranolol, bendrofluazide (bendroflumethiazide), omeprazole, finasteride, and aspirin. Detailed investigations, including gastrointestinal evaluation, measurement of various gut hormones, and autonomic testing, indicated no abnormality. A liquid meal, performed before fasting, failed to elicit an episode. However, a solid meal after an overnight fast provoked near-syncope. Continuous non-invasive haemodynamic monitoring (with a Portapres II) indicated a short lived rise in blood pressure and heart rate, followed by severe hypotension, a fall in stroke volume and cardiac output, and then bradycardia. This favoured an initial increase in sympathetic activity, followed by vasodepression due to sympathetic withdrawal or activation of humoral vasodilatatory mechanisms, with bradycardia secondary to impaired cardiac filling. Withdrawal of enalapril abolished the episodes. The unusual nature of this case, in which haemodynamic recordings continuously were made during and after swallow syncope, induced soon after food ingestion, is discussed.
K Deguchi; C J Mathias
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  67     ISSN:  0022-3050     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-02     Completed Date:  1999-09-02     Revised Date:  2008-11-20    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  220-2     Citation Subset:  IM    
Autonomic Unit, University Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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MeSH Terms
Blood Pressure / physiology
Cardiac Output / physiology
Deglutition / physiology*
Eating / physiology
Enalapril / adverse effects
Fasting / physiology
Heart Rate / physiology
Hemodynamics / physiology*
Monitoring, Physiologic*
Stroke Volume / physiology
Syncope / chemically induced,  etiology*,  physiopathology*
Vascular Resistance / physiology
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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