Syncope on swallowing.

Reflex stimulation of the vagus produced by swallowing and leading to ventricular asystole was observed in the patient reported herein.The results of investigations designed to delineate the reflex pathway are reported.The efferent impulses have been shown to travel in both vagi.Surgical denervation of the affected segment of the oesophagus abolished the reflex in our patient.A variety of abnormalities of cardiac rhythm can lead to cerebral ischaemia and syncope.Perhaps the least well known of these are the reflex changes in the origin and spread of excitation in the heart appearing in relation to swallowing.In view of the rarity of the con- dition and somewhat interesting clinical and physiological implications, the following patient's case is reported.Case report A 29-year-old housewife had for about four years experienced several ' dizzy' attacks while swallow- ing.The attacks were essentially stereotyped but varied in duration.She first noticed blurring of vision followed rapidly by a sensation of fainting, and she would collapse to the floor if standing.