Post Total Thyroidectomy Deglutition Syncope.

Deglutition syncope is a form of situational syncope where patients develop presyncope or syncope during swallowing. This condition has been observed to occur most commonly in patients with prior gastroesophageal conditions. Our patient developed deglutition syncope that started to occur a few weeks after undergoing a total thyroidectomy. The patient was found to have paroxysmal atrioventricular (AV) block, with up to 5.1 seconds of asystole during swallowing, manifested with episodes of dizziness and lightheadedness. A barium swallow test revealed normal peristalsis and no evidence of dysmotility. The patient underwent placement of a dual chamber pacemaker, and the syncopal episodes resolved. Interrogation of the pacemaker showed no recorded abnormal events.

[Autonomic nervous system and reflex syncope]. / Autonomes Nervensystem und Reflexsynkope.

This review discusses important aspects of pathophysiology, diagnosis and therapy of reflex syncope. The autonomic nervous system plays a crucial role in the origin of this frequently observed form of syncope. In most cases, reflex syncopes occur under specific circumstances. Thus, a detailed history is essential. Besides a physical exam und a normal 12-lead ECG, dedicated tests like tilt-table-testing, carotid massage and the implantation of a loop recorder often assist in making the correct diagnosis. The basis of therapy for all patients is reassurance about the benign course of the disease as well as education about adequate measures. Pharmacotherapy is reserved to a minority of patients. In older patients with repeat or severe syncopes and documented asystoles, pacemaker therapy is a valuable option.

Abordaje del síncope situacional en Atención Primaria. De la sospecha al diagnóstico / Approach to situational syncope in Primary Care. From the suspicion to the diagnosis

Se presenta el caso de un adolescente de 12 años con episodios repetidos de sensación de pérdida de conciencia inminente con recuperación posterior completa, mientras se prepara para ir al colegio. La anamnesis, exploración y pruebas complementarias serán clave para realizar el diagnóstico de exclusión y la posterior pauta de normas de conducta para su evitación (AU)

We report the case of a 12-year-old male patient with repeated episodes of sudden and transient loss of consciousness sensation with immediate recovery, while preparing himself for school. Anamnesis, exploration and complementary tests will be key elements for a diagnosis of exclusion and the subsequent set of guidelines for its avoidance (AU)

The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing.

OBJECTIVE: Situational syncope is a subtype of neurally mediated syncope and associated with specific circumstances. This paper is to assess the clinical characteristics and underlying causes of situational syncope. METHODS: This is a retrospective study of patients who underwent head-up tilt testing (HUTT). Medical records including age at HUTT, gender, number of syncopal episodes, family history of syncope, triggers before the syncopal episode, position during the syncopal episode and the responses to HUTT were reviewed. RESULTS: Among 3140 patients, 354 patients (mean age 28.3 ± 16.6 years old, with 184 males and 170 females) were diagnosed with situational syncope. The causes of situational syncope included micturition (50.85%), defecation (15.82%), bathing (10.45%), swallowing (6.50%), cough (4.80%), post-dinner (3.95%), singing (3.11%), teeth brushing (2.26%), and hair grooming (2.26%). Patients with syncope triggered by micturition, cough, post-dinner were more likely to be men, while those caused by bathing, swallowing, singing, teeth brushing and hair grooming were more likely to be women. 34.75% of patients with situational syncope were between the ages of 10-19 years old, and 20.34% were between the ages of 40-49 years old. 74.01% of situational syncopal events occurred in an upright position. 47.74% of patients had positive responses to HUTT. CONCLUSIONS: These findings show that micturition was the most common cause of situational syncope in both children and adults. There were significant gender and age differences among situational syncope triggered by different causes. Most of situational syncope occurred in the upright position and nearly half of the patients had positive responses to HUTT.

Dangerous noodle: A case of swallowing syncope and a review of 122 cases from the literature.

Swallowing syncope is a rare medical condition. Even though it has been known as a neurally mediated syncope, the definitive mechanism of this condition remains unclear. We show in this study an additional case of swallowing syncope and review the 122 reported cases from the literature. A 47-year-old Japanese man had been suffering from recurrent syncopal attacks, when he fainted immediately after swallowing. Holter electrocardiogram monitoring demonstrated a sinus pause (maximum R-R interval of 3.8 seconds) after he swallowed a noodle quickly. A permanent pacemaker was implanted because the frequency of syncope increased.

Citrus fruits induced swallow syncope with atrioventricular block or sinus arrest.

Swallow syncope is a relatively rare syndrome and caused by various foods and drinks. A 76-year-old man was admitted with frequent syncope while eating. Holter electrocardiogram revealed frequent occurrence of atrioventricular block during meals. Both atrioventricular block and sinus arrest were induced by only eating citrus fruits, citrus jelly, and acidic foods but not by other drinks and foods. These arrhythmias were suppressed after administration of atropine. No further episodes of syncope recurred after the implantation of a DDD pacemaker. This case indicated that acidic stimulation of citrus induced a vasovagal reflex via esophageal nociceptors leading to syncope.

Etiology and prognosis of children and adolescents with situational syncope / 中华实用儿科临床杂志

Objective To retrospectively analyze the etiology and prognosis of the children and adolescents with situational syncope in a single center.Methods There were 4 274 cases of children and adolescents [aged from 2 to 18 years old,the average age being (10.82 ± 3.13)years old],male 2 208 cases,female 2 066 cases with ortho-static intolerance syndromes,such as unexplained syncope or symptoms of presyncope,etc,who were treated at Children's Syncope Outpatient Department or Inpatient Department in the Second Xiangya Hospital,Central South University from January 2000 to November 2017.All subjects underwent detailed history investigation,careful physical examinations, routine 12-lead electrocardiogram,Holter electrocardiogram(ECG),chest X-ray,echocardiography,electroencephalo-gram(EEG)and head computerized tomography(CT)or magnetic resonance imaging(MRI),blood biochemical exami-nation (including fasting glucose,myocardial enzymes)and organic diseases in the heart,brain,blood vessels were ex-cluded,but the cause of syncope was still not clear.The head-up tilt table test (HUTT)was performed after the pa-tients or/and the families wrote the informed consent agreement.Results A total of 177 (4.14%)patients with situa-tional syncope were diagnosed among 4 274 cases.Etiology included the abdominal musecle exercise (35.59%,63/177 cases),urination (24.29%,43/177 cases),bathing (9.60%,17/177 cases),defecation (7.34%,13/177 cases), singing (5. 08%,9/177 cases),rides (4.52%,8/177 cases),blood-injection-injury phobia (3.95%,7/177 ca-ses),swallowing (3.39%,6/177 cases),and hair-grooming (2. 82%,5/177 cases),syncope during acupuncture treatment (2. 26%,4/177 cases),and cough (1.13%,2/177 cases). The common positions were upright position (84.18%,149/177 cases),squatting to standing position (8.47%,15/177 cases),sitting position (5.08%,9/177 cases),and squatting position (2.26%,4/177 cases).HUTT positive rate was 69.49%(123/177 cases),common type of hemodynamic were the vasodepressive type of vasovagal syncope (45.20%,80/177 cases),mixed type of vaso-vagal syncope (19.77%,35/177 cases),postural orthostatic tachycardia syndrome (3.39%,6/177 cases)and the cardiac suppressive type of vasovagal syncope (1.13%,2/177 cases).In 35 cases of situational syncope,the number of children and adolescents with syncope was significantly reduced by health education and upstanding training.By the first follow-up review,the cases were reduced from (2.69 ± 1.81)times to (0.59 ± 0.96)times after healthy edu-cation of 2-16 weeks [(4.97 ± 3.16)weeks].By the second follow-up review,3 out of 8 cases did not faint,3 cases fainted 1 time,1 case fainted 2 times,and 1 case fainted 4 times.The outcomes of the first reexamination of HUTT in 16 cases were negative,and other 3 cases were negative by twice visit.Conclusions The etiology of children and adoles-cents are flag-raising(abdominal muscle exercise),urination,bathing,defecation,singing,riding,blood-injection-injury phobia,swallowing,hair -grooming,syncope during acupuncture treatment and coughing. Healthy education is good for situational syncope.

Pathophysiology of reflex syncope: A review.

In this correspondence, the pathophysiology of reflex syncope (vasovagal syncope, carotid sinus syndrome, and situational syncope) is reviewed, including clarification of the nomenclature.

Diagnostic role of head-up tilt test in patients with cough syncope.

AIMS: The aim of this study was to describe the head-up tilt (HUT) test and carotid sinus massage (CSM) responses, and the occurrence of syncope with coughing during HUT in a large cohort of patients. METHODS AND RESULTS: A total of 5133 HUT were retrospectively analysed to identify patients with cough syncope. Head-up tilt followed by CSM were performed. Patients were made to cough on two separate occasions in an attempt to reproduce typical clinical symptoms on HUT. Patients with cough syncope were compared with 29 age-matched control patients with syncope unrelated to coughing. A total of 29 patients (26 male, age 49 ± 14 years) with cough syncope were identified. Coughing during HUT reproduced typical prodromal symptoms of syncope in 16 (55%) patients and complete loss of consciousness in 2 (7%) patients, with a mean systolic blood pressure reduction of 45 ± 26 mmHg, and a mean increase in heart rate of 13 ± 8 b.p.m. No syncope or symptoms after coughing were observed in the control group. The HUT result was positive in 13 (48%) patients with the majority of positive HUT responses being vasodepressor (70% of positive HUT). Carotid sinus massage was performed in 18 patients being positive with a vasodepressor response causing mild pre-syncopal symptoms in only 1 patient. CONCLUSION: Syncope during coughing is a result of hypotension, rather than bradycardia. Coughing during HUT is a useful test in patients suspected to have cough syncope but in whom the history is not conclusive.