Situational Syncope Triggered by Swallowing

Syncope is characterized by a transient loss of consciousness. Swallow syncope, a rare cause of syncope, is caused by vagus nerve activation resulting in vasodilation and bradycardia, thus causing transient hypotension and cerebral hypoperfusion. It is diagnosed through clinical history, cardiac, and esophageal evaluation. We present a case of swallow syncope in a patient with significant cardiac history. Initial cardiac and esophageal testing was normal. Long-term telemetry revealed bradycardia with swallowing, and the patient underwent pacemaker placement. Swallow syncope is associated with a variety of esophageal and cardiac conditions. Management involves addressing the underlying cause; pacemaker placement is sometimes necessary. KEYWORDS: syncope; swallow syncope; reflex syncope; pacemaker.