An unusual cause of dysphagia

Causes of cardiovascular dysphagia left atrial enlargement aberrant left or right subclavian artery tortuous atherosclerotic aorta thoracic aortic aneurysm Cardiovascular dysphagia (left atrial enlargement) occurs in rheumatic heart patients with mitral valve disease and enlarged left atrium is caus...

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Veröffentlicht in:Postgraduate medical journal 1999-10, Vol.75 (888), p.629-631
Hauptverfasser: Gotsman, Israel, Mogle, Paul, Shapira, Michael Y
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Sprache:eng
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Zusammenfassung:Causes of cardiovascular dysphagia left atrial enlargement aberrant left or right subclavian artery tortuous atherosclerotic aorta thoracic aortic aneurysm Cardiovascular dysphagia (left atrial enlargement) occurs in rheumatic heart patients with mitral valve disease and enlarged left atrium is caused by luminal obstruction due to oesophageal compression by an enlarged left atrium Diagnosis: barium swallow: posterior displaced oesophagus, a smoothly compressed oesophageal lumen, delayed passage of barium endoscopy: pulsatile bulging mass in the mid-oesophagus, normal mucosa oesophageal manometry: elevated mid-esophageal base line pressure with superimposed cyclic pressure waves simultaneous with the ECG Other suggested mechanisms for cardiovascular dysphagia include deranged peristalsis due to local ischaemia of the oesophageal mucosa and nerve plexus caused by the elevated external pressure (which was not evident in our case). Prolonged exposure of the distal oesophagus to a high external pressure may cause proximal oesophageal muscle fatigue and dysphagia.
ISSN:0032-5473
1469-0756
DOI:10.1136/pgmj.75.888.629