swallow syncope

Swallow Syncope - I know it well

by Gemita - 2023-02-23 04:32:16

Hello 5ID, I was found to have had both intermittent swallow and intermittent arrhythmia induced syncope and a pacemaker has indeed helped since it is able to support pausing and sudden falls in heart rate.  By doing so, it has also helped stabilise my blood pressure at these times, although a pacemaker cannot prevent sudden blood pressure falls which can also be a cause for syncope.  

My pacemaker doesn’t completely eliminate the “pre-syncope” sensation I have during these ongoing intermittent episodes and I usually have to sit or lie down when they occur, but they are certainly more controlled now and less frequent and I haven’t actually collapsed with any episodes since implantation and that is what is important.  You don’t want to lose consciousness when driving or when you are out in public places.  A fall may cause serious injury and a car crash, well . . .

So yes my indication for a pacemaker was also because of syncope and pausing due to arrhythmias and oesophageal motility problems.  Because of the proximity of our oesophagus to our heart, it is perhaps easy to understand how one problem could well affect the other.  My final diagnosis was tachycardia/bradycardia syndrome, Syncope.

Have a read of the following links 5ID.  One from a member of the Pacemaker Club on this subject and lots of helpful responses and also a web link on swallow syncope giving lots of good information.  Swallow syncope isn’t necessarily progressive if we can find some culprit food causes or mechanisms that trigger the problem, like swallowing too quickly a large amount of solid food or liquids especially on an empty stomach, swallowing very cold food or drinks, carbonated liquids.

For example, after not eating for several hours, my swallow reflex may not work well and I have to take sips of tepid water initially to test how well the liquid will go down.  When I experience any oesophageal motility problems it feels as though my swallow reflex is temporarily paralysed.  It is quite frightening, but if you stay calm and keep trying to clear this by gentle swallowing attempts, you will eventually feel the wave like muscle contractions start moving again.  Once these start you know you are safe to start eating and drinking normally.  There are meds that can be prescribed to help and I saw a neuro-gastroenterologist for extensive testing before my pacemaker.  However, she felt I had two separate problems:  a gastric motility one AND a cardiac rhythm one and both needed treating.  Personally I think you have the two separate issues too, but you need to be guided by your doctors who will know your condition best, but if you have pausing, syncopal episodes and evidence of heart block 5ID, it seems to me the pacemaker is needed?

You will need to copy and paste the following links into your main general browser to open:-

https://www.pacemakerclub.com/message/41678

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891415/

Swallow Syncope - I know it well

by 5id - 2023-02-24 12:56:42

Thank you for your response Gemita!

Exactly the specific information I was looking for. Let me say that I expect everyone in this support group that already has a PM was “in my shoes” at some point. I accept the likelihood that I will need one but when; is my question that I expect to be answered by my EP mid-March at my follow-up appointment. Once he reviews the full monitoring report and if I am not asked to get in to see him sooner then that might be a good sign that my Synope is not determined to be critical…yet.

I do take this seriously and am aware that most everyone that might read my post already has a PM. But I’ll bet that many Pacemaker Club members do not yet have a PM and are trying to find that same answers and reassurance that I am seeking.

I’ll post an update after my EP follow-up.

I found this post to be interesting:

https://www.pacemakerclub.com/message/31463/refusing-the-pacemaker

Thank you for the link

by Gemita - 2023-02-24 18:19:11

5id,

I have seen the thread you posted.  I can remember seeing it when I first joined the PM Club.  

I think if I only suffered from intermittent swallow syncope. while "sitting" eating a meal, I would not have gone down the pacemaker route.  However electrical disturbances of the heart are something else and really de-stabilise me.  Disturbances like heart block, pausing, bradycardia or rapid heart rhythm disturbances requiring high doses of a rate control medication to control heart rate, may well need treating with a pacemaker.

I see you have had a TAVR.  Conduction abnormalities, Atrial Fibrillation and development of a new left bundle branch block remain the most common TAVR complications and may eventually require a pacemaker.

It is such a huge decision, I know, since any procedure carries a certain amount of risk, so I do wish you all the very best and hope that you come to the right decision.   And yes, we have many members who still haven't decided whether a pacemaker is for them.  My EP told me it was a shared decision and I was an equal partner and I had to be happy with my decision.