58-year-old showed sustained atrial tachycardia on the electrocardiogram while speaking
Patients may experience specific symptoms, secondary to arrhythmias when performing actions, such as, speaking, coughing and even swallowing. Although the findings are rare, it may have a debilitating impact on the patient. The arrhythmias are generally captured when the patient is undergoing an electrocardiographic monitoring. There are several factors leading to the symptoms and disease process. This article highlights the case of a patient with demonstrable speech-induced atrial tachycardia.
The 58-year-old patient presented to the emergency department with intermittent dizziness and palpitations with a history of 1 month. The patient’s heartbeat increased every time he spoke and spontaneously subsided after he stopped speaking. Doctors advised continuous electrocardiographic monitoring, the findings of which were consistent with atrial premature beats when he would be speaking isolated words. Subsequently, when speaking full sentences, the monitoring showed sustained atrial tachycardia, up to 167 beats per minute. The arrhythmias subsided when the patient stopped talking.
It was seen that the arrhythmias were triggered by any spoken syllable, however, not during deep breathing, inspiratory breath hold and soundless mouth movement.
The patient was further referred for a transthoracic echocardiogram which showed a structurally normal heart. A computed tomography of the chest was also performed, findings of which were unremarkable.
The case study demonstrated the interaction between the cardiac and autonomic nervous system on the rhythm of the heart. Till date, several cases of atrial tachycardia, secondary to speaking, coughing and swallowing have been reported. Studies have postulated that this may be because of an anomalous efferent input from the recurrent laryngeal nerve to the left atrial ganglionic plexuses.
Speech-induced tachycardia is a representation of vagal stimulation from the recurrent laryngeal nerve to the autonomic ganglia. This results in triggered activity or abnormal automaticity. In this case, the patient’s symptoms promptly resolved through treatment with oral metoprolol. موقع 365 Doctors advised the patient to continue the medication for 3 months. الرهان على سباق الخيل Similarly, the need for catheter ablation did not arise because the symptoms did not recur. The patient remained asymptomatic at 3 years follow-up. بيت365
References
Speech-Induced Atrial Tachycardia https://www.nejm.org/doi/full/10.1056/NEJMicm2030596
