title: Deglutition syncope: a manifestation of vagal hyperactivity following carotid endarterectomy.
abstract: A 61-year-old man with left amaurosis fugax and bilateral >80% internal carotid artery stenoses underwent a left carotid endarterectomy. On the first postoperative day, he developed hypotension, bradycardia, and chest pain with food ingestion. He was diagnosed as having deglutition syncope and was treated with oral anticholinergics. Similar symptoms occurred when he underwent a right carotid endarterectomy. Deglutition syncope is a neurally mediated situational syncope resulting from vagus nerve over-activity. This is the first report of deglutition syncope associated with carotid endarterectomy. It is important to recognize and differentiate these symptoms from other causes of postendarterectomy hemodynamic instability.
authors.affiliation: Department of Surgery, Section of Vascular Surgery, University of Kentucky College of Medicine and Veterans Administration Hospital, Lexington, Ky 40536, USA. edende0@uky.edu
authors.forename: Eric D
authors.initials: ED
authors.lastname: Endean
authors.forename: William
authors.initials: W
authors.lastname: Cavatassi
authors.forename: Joseph
authors.initials: J
authors.lastname: Hansler
authors.forename: Ehab
authors.initials: E
authors.lastname: Sorial
mesh_terms: D000284:Administration, Oral; D016893:Carotid Stenosis / Q000601:surgery*; D018680:Cholinergic Antagonists / Q000008:administration & dosage; D003679:Deglutition / Q000187:drug effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D018680:Cholinergic Antagonists