SWALLOW SYNCOPE

Swallow Syncope



Swallow Syncope

Introduction

The temporary loss of consciousness upon swallowing. Syncope is the temporary loss of consciousness or, in plain English, fainting. The situations that trigger this reaction are diverse and include having blood drawn, straining while urinating (micturition syncope) or defecating, coughing or swallowing. The reaction also can be due to the emotional stress of fear or pain.

Under these conditions, people often become pale and feel nauseated, sweaty, and weak just before they lose consciousness.

Situational syncope is caused by a reflex of the involuntary nervous system called the vasovagal reaction. The vasovagal reaction leads the heart to slow down (bradycardia) and, at the same time, it leads the nerves to the blood vessels in the legs to permit those vessels to dilate (widen). The result is that the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head. The brain is then deprived of oxygen, and the fainting episode occurs. (Nakagawa 2009)

The vasovagal reaction is also called a vasovagal attack. And situational syncope is also called vasovagal syncope, vasodepressor syncope, and Gower syndrome after Sir William Richard Gower (1845-1915), a famous English neurologist whose name is also associated with a sign, a solution, another syndrome, and a tract in the central nervous system.

Historical note and nomenclature

Swallow syncope is a loss of consciousness during or immediately following a swallow. Recognition of the disorder dates from the late 1700s, but most cases have been reported since 1900. Swallow syncope is usually caused by upper gastrointestinal-cardiac vagovagal reflexes initiated by swallowing and rapid gastric distention. (Guberman 2009)

Clinical manifestations

Swallow syncope may occur within 3 to 5 seconds of swallowing. Many bouts result only in presyncope, however, with associated visual grey-out, tunnel vision, etc. Swallow syncope may occur several times a day and may occur while either upright or supine. There may be associated brief jerking or rhythmic movements (ie, convulsive syncope), but there is no associated incontinence, tongue biting, or postictal state. Recovery usually occurs within seconds without vasomotor or other sequelae. Patients are amnestic for the period of lost consciousness. (Drake 2007)

Swallow syncope is frequently triggered by liquids, particularly cold, carbonated beverages, but selective precipitation of swallow syncope by solids has also been reported in individual patients. Factors that influence fainting are taking in too little food and fluids, low blood pressure, hypoglycemia, growth spurts, physical exercise in excess of the energy reserve of the body, and lack of sleep. Even standing up too quickly or being in too hot a room can cause fainting. Recommended treatment is to allow the person to lie on the ground with his or her legs a little elevated. As the dizziness and the momentary blindness passes, the person may experience visual disturbances in the form of small bright dots (phosphene). These will also pass within a few minutes. If fainting happens frequently, or if there is no obvious explanation, it is important to see a doctor about ...