The Case of a Heartfelt Swallow

Abstract

Deglutition tachycardia is a rare disorder. There have been less sixty cases reported since it was first described in 1925 by Kasai et al. Here we present a case of deglutition tachycardia. The patient is a 56 year old man who presents with 2 weeks of palpitations associated with swallowing solids. He has no prior cardiac history. He reports transient (5-10 seconds) episodes of palpitations that would occur while swallowing solid food. He denied having symptoms when not eating, or swallowing liquids alone. His other past medical history includes hypothyroidism and myopia requiring retinal detachment 3 weeks prior to presentation. He reports only taking levothyroxine daily for hypothyroidism. On the day of presentation, while eating he began having palpitations that did not resolve and after 30 minutes he sought medical attention at the emergency department. In the emergency department he was found to have atrial fibrillation with rapid ventricular rate of 176 beats per minute. He was treated with diltiazem drip and metoprolol which converted his rhythm to normal sinus. Laboratory results were normal including hemoglobin and TSH. While admitted on continual telemetry he had short, 6-10 beats, bursts of atrial fibrillation with aberrant ventricular conduction (AVR) that occurred only during meal time. Echocardiogram and stress test during admission were normal. Gastroenterology recommended a barium esophagogram which showed no structural abnormalities but found that on 4 consecutive swallows a rhythm strip taken simultaneously revealed atrial fibrillation with AVR when the bolus passed the left atrium. He was discharged on metoprolol and had no further episodes. He later revealed that he was taking an anticholinergic eye drop for his retinal repair that he had started 3 weeks prior to presentation, and stopped shortly after discharge.Figure 1This patient experienced deglutition tachycardia from a combined effect of mechanical stimulation of the left atrial focus by the food bolus and the increased automaticity of the focus from the anticholinergic eye drop. Deglutition tachycardia though rare is important to recognize in a patient presenting with tachycardia associated with swallowing.