An uncommon case of right-sided throat pain and swallow syncope.
A 63-year-old man presented with recurrent syncopal attacks associated with swallowing and right-sided throat pain. Immediately after admission, he presented a 16-s asystolia. The patient's clinical history was unremarkable except for previous postimplant periodontitis. Several episodes of severe bradycardia and sinus pauses, always associated with painful deglutition, were recorded subsequently. X-ray orthopanthomography and magnetic resonance imaging of the neck confirmed several areas of periodontitis around the previous dental implants and right mastoid inflammation. A barium swallow and fibre-optic endoscopy also revealed a small sliding hiatus hernia and distal chronic oesophageal inflammation. Despite complete dental curettage, antibiotics and antigastro-oesophageal reflux therapy, only partial relief of the pain and incomplete resolution of the arrhythmic disorder were obtained after 3 weeks, and the patient underwent pacemaker implantation. At 1-month follow-up, however, he reported the complete relief of the throat pain; subsequent Holter monitoring showed normal sinus rhythm, without pacemaker-induced electrical activity.
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Enrico
E
Favaretto
Nella
N
Schenal
Nicola
N
Russo
Gianfranco
G
Buja
Sabino
S
Iliceto
Claudio
C
Bilato
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001919:Bradycardia / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D003680:Deglutition Disorders / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015716:Electrocardiography, Ambulatory; D005764:Gastroesophageal Reflux / Q000150:complications; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008417:Mastoiditis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010518:Periodontitis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D010612:Pharyngitis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D011862:Radiography, Panoramic; D012008:Recurrence; D054138:Sinus Arrest, Cardiac / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013357:Subgingival Curettage; D013575:Syncope / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents