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Case Reports
. 2023 Sep 1;62(17):2517-2520.
doi: 10.2169/internalmedicine.1028-22. Epub 2022 Dec 28.

Speech-induced Atrial Tachycardia with Presyncope

Shunichi Doi  1 , Toshiyuki Furukawa  1   2 , Haruka Kameshima  1 , Osamu Tanaka  1 , Tomoo Harada  3 , Yoshihiro J Akashi  3
Affiliations
Case Reports

Speech-induced Atrial Tachycardia with Presyncope

Shunichi Doi et al. Intern Med. .

Abstract

Speech-induced atrial tachycardia (AT) with presyncope is extremely rare. A 52-year-old woman employed at a supermarket reported recurrent presyncope while speaking out loud at her job. Holter electrocardiography revealed AT while swallowing without presyncope. The patient's blood pressure decreased during AT, and she experienced presyncope while saying "IRASSHAIMASE" loudly during a tilt table test. Accordingly, bisoprolol 1.25 mg was prescribed, and the patient did not experience episodes of presyncope with recurrence of AT for 2 years. This case suggests that provocation of arrhythmia in the tilting position may be useful for demonstrating a relationship between arrhythmia and presyncope and/or syncope.

Keywords: presyncope; speech-induced atrial tachycardia; tilt table test.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Twelve-lead electrocardiography. A 12-lead electrocardiograph showed a normal sinus rhythm and incomplete right bundle block.
Figure 2.
Figure 2.
Holter electrocardiography. A 24-hour Holter electrocardiograph showed atrial tachycardia (AT) occurring for a few seconds during a meal. During AT with swallowing, the patient only felt palpitations and experienced no presyncope.
Figure 3.
Figure 3.
Electrocardiography and blood pressure measured using the head-up tilt test. AT caused a drop in blood pressure just after saying “IRASSHAIMASE” (black arrow). The blood pressure was 120/77 mmHg and the pulse rate 84 beats/min in the supine position. The blood pressure was 118/85 mmHg and the pulse rate 146 beats/min just before atrial tachycardia (AT). The blood pressure was 121/91 mmHg and the pulse rate 144 beats/min just after AT.
See this image and copyright information in PMC

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