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Introduction: The syncope is a frequent problem for Emergency Room,in part of cases it is difficult to find the exact mechanism. Gastrointestinal (GI) disoprders – like achalasia, hiatus hernia (HH) or some dysphagias – lead to inappropriate activation of the parasympathic autonom nervous systhem results in periferial vascular dilatation or bradycardia (The other mechanism is the compression of the cardiac structure and leads to haemodinamical instability).
Aim: To present a clinical case that provides example for a rare but potentially treatable condition which can cause syncope
Patient/Case: There were emmol.cer., strumectomy, hypertonia, osteoporotic vertebral compression and idiopathic Parkinson-disease in the history of a 75 ys old woman. She had a syncope-without any afterward tenebrosity. She had GI hypomotility and vomiting (average 2 times per week). HH and GERD were first diagnosed at 2003 (Kútvölgyi Clin., Budapest). She had sometimes difficulties in swallowing big size medicaments (eg. Stalevo). She suffered 2 syncopes during a 2.5 months long period. Physical examination (among neur. status and rectal dig. examination), laboratory and glucose burden test, cardiac examinations (ECG, Holter, ABPM, ECHO cardiogram), EEG, carotis-duplex scan and massage, Shallong test etc. have been done. Large HH on X-ray and gastroscopy plus narrowed lumen of left ventricule (44×24mm) on echocardiogramm were positive findings. Authors supposed that the first finding may be significant in this case. There was no oesophageal stricture, that can be widened, so authors decide to use PPI therapy (counting the possible side-effects of prokinetics). The lady is in good condition during the five month long period of her observation. If that event happens more often, cardial electrophysiology and thoracic CT scan can be done, for more precise differenzial diagnosis and HH operation can be taken under consideration, too.
Conclusion: The exact reason of syncope in 29% of cases is unknown despite of detailed examinations according to recent papers. The co-existance of HH and syncope is a rare condition,but it is important to keep it in mind,especially if any other causes of syncope are excluded.