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A case series on swallow syncope – patient education and empowerment as the mainstay of management
Dr Melanie Dani, Dr Patricia Taraborrelli, Mr Andreas Dirksen, Dimitrios Panagopoulos, Miriam Torocastro, Professor Richard Sutton, Dr Boon Lim
Imperial Syncope Unit, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
Our syncope unit places high value on patient education and empowerment, and we strive to reflect this in all our consultations, investigations, and treatments. We describe three patients in our service with swallow syncope — a form of reflex neural syncope occurring on swallowing. By understanding the underlying pathophysiology and the triggers and modifiers for their syncope, all three patients were able to ameliorate or abolish their symptoms; thus, avoiding invasive medical interventions and retaining a sense of control. We have recently described this management strategy in a journal publication, as we wish to share the importance of patient education with our wider community of colleagues.
A 25-year-old woman reported light-headedness when eating sandwiches and sausage rolls. Continuous cardiac monitoring while eating these trigger foods revealed pauses lasting four seconds, and crucially showed her the direct effects of eating these foods on her cardiac conduction system, prompting diet modification. Cardioneuroablation was discussed, but she was satisfied that she could control her symptoms by diet and bite size modification. She remains well to date.
A 46-year-old woman described light-headedness upon eating for 18 months. Investigations revealed bradycardia and a three-second pause occurring during eating. She also considered ganglionic plexus ablation but following comprehensive education about conservative measures between her appointments, she modified her diet to the extent that her symptoms almost completely resolved.
A 54-year-old woman reported a sensation of food getting stuck in her throat followed by sudden unheralded collapse. Conservative strategies were emphasised, and she modified her diet to choose soft foods, and adopted “slow cooking” methods. She had successfully modified her diet by time she had her cardiac investigations, which were normal, and she remains asymptomatic to date.
All three of these patients had a rare form of reflex neural syncope occurring during a vital action — eating. The consequences of this condition can be significant and can require potentially invasive therapies such as pacemaker implantation and cardioneuroablation.
We place a strong emphasis on patient education, information, and empowerment. This short case series emphasises this and highlights the fact that these individuals improved with effective conservative care, avoiding invasive medical procedures — resulting in high satisfaction. We strive to make patients’ wellbeing at the centre of our service, and we believe that this short case series reflects this.