["Coffee swallowing syncope"].

HISTORY: A 38-year-old man was admitted with recurrent syncope. Remarkably the patient had lost consciousness after drinking hot coffee. A vasovagal syncope was considered as the most likely diagnosis.

INVESTIGATIONS AND DIAGNOSIS: Following various investigations no pathological findings were revealed. Event-monitoring (R-test) showed high grade atrioventricular block (2 Mobitz and 3 ) induced by swallowing with subsequent syncope.

TREATMENT AND COURSE: A two-chamber pacemaker was implanted and the antihypertensive therapy was changed from a beta-blocker to an AT II receptor antagonist.

CONCLUSION

Typical vasovagal symptoms during or shortly after meals followed by syncope should point towards an oesophago-cardia reflex mechanism; including a cardiac arrhythmia. Known to be usually triggered by cold meals, vasovagal reflex after hot meals is rare.