Julia Enos, DO
Fellow
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Matthew Kutcher, MD, MS
Assistant Professor
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Daniella Dipaolo, n/a
Student
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Title: Case of Severe Bradycardia Associated with Swallowing Liquids
Case Report Body:
Introduction: Beta blockers are intended to slow heart rate. There are studies that have demonstrated that rare, life threatening bradycardia can result. Swallowing syncope has been described in a few case reports that associated severe bradycardia with swallowing, resulting in syncope. We discuss a case of bradycardia associated with swallowing that appeared to be related to the initiation of a beta blocker.
Description: A 46 year old man was admitted to the ICU after a motor vehicle accident. His injuries included a splenic laceration, mesenteric injury at the splenic flexure of the colon, as well as a descending aortic dissection. He was taken to the operating room for a splenectomy and left hemicolectomy. He had no spinal or other chest injuries and EKG on admission was unremarkable. For the aortic dissection he was started on impulse control with a beta blocker. He recovered in the ICU and once extubated, was started on a liquid diet. This is when he was noted to have large swings in his heart rate. After taking multiple sips of liquids, his heart rate would drop into the 20-30 beats per minute range, starting when he swallowed. It would quickly rise back up to normal once he stopped. He was asymptomatic during the episodes. His blood pressure remained unchanged, presumably due to the brevity of the bradycardia. We stopped his beta blocker and monitored him in the ICU. Over the next day we had him swallow different consistencies. Solid foods did not seem to have the same effect. The most profound change in heart rate was with iced and room temperature water and apple juice. Since discontinuing his beta blocker, the bradycardia events have ceased.
Discussion: Bradycardia associated with swallowing is a documented rare cause of syncope. This patient was asymptomatic and may have remained undiagnosed if he was not in the ICU when the events were seen. This problem resolved with medication modification but other cases report needing permanent pacemakers to prevent syncopal episodes.