Transient swallow syncope during periods of hypoxia in a 67-year-old patient after self-extubation

Objective: To describe the case of an adult patient with swallow syncope af ter bypass surgery, possibly related to hypoxia. Design: Case report. Setting: University hospital, medical-cardiologic intensive care unit. Patient A 67-yr-old patient after second aortocoronary bypass operation for unstable angina. Main Results: After the patient managed to extubate himself, he was in a bo rderline respiratory condition with an oxygen mask, When drinking for the f irst time after extubation, asystole was observed coincidentally with inter ruption of oxygen insufflation. During the next days, similar events occurr ed during food ingestion or when drinking liquids after a fall of oxygen sa turation. The bradyarrhythmia was readily reversible on administration of a tropine and ventricular backup pacing via temporary pacing wires. After nor malization of gas exchange, no more episodes of swallowing-associated asyst ole were observed and the patient was discharged without a permanent pacema ker. There was no esophageal or gastrointestinal disease. Pre- and postoper ative PR and QRS durations were normal. Conclusion: Extrinsic and transient mechanisms, rather than intrinsic condu ction system disease, seem to have been operative in this case. It is sugge sted that hypoxia reinforced the vagal pharyngocardiac reflex as described in pediatric patients.