Blog
Heart Disease & Surgery Effects on Swallowing
By: Cara Kennedy
Heart Issues & Dysphagia
- Cardiovascular Dysphagia
- Ortner’s Syndrome (Cardiovocal Syndrome)
- Paralysis of laryngeal nerve/recurrent laryngeal nerve palsy secondary to cardiovascular issues
- Hoarse vocal quality
- Chronic Mitral Valvular Lesions/Mitral Valve Disease/Mitral Stenosis
- Elongation/kinking/coiling of carotid artery due to atherosclerosis or fibromuscular dysplasia
- Global heart failure
- Echocardiography-Left & right atrial and right ventricular enlargement
- Esophageal manometry- “hypotonic peristaltic contractions of the esophageal body & a lower than normal resting pressure of lower esophageal sphincter” (Kress et al., 1997)
- Esophageal dysmotility
- Dysphagia lusoria- aberrant right subclavian artery/compression of esophagus
- Milder cases can be treated through diet modification & aspiration precautions
More severe cases may need surgical intervention
- Associated with “old age, women with short stature, hypertension, kyphosis”; mild case intervention- diet modification, more severe intervention- surgical intervention
- Surgical intervention- “transposition of the distal esophagus, separation of the distal esophagus from the aorta, esophagomyotomy, division of the right crus of the diaphragm, aortic resection, and repair of an aneurysm” or potentially PEG tube placement
Effects of Surgery on Swallowing
- Dysphagia is common after surgery & can cause other issues like weight loss, bronchitis, pneumonia, and potentially malnutrition
- “Malnutrition, dehydration, defects in surgical wound repair, poor patient compliance to therapy, and increased incidence of aspiration pneumonia” (Verzaro, 2020)
- Anesthesia (Propofol)- can “depress swallow reflex, but complete recovery is rapid” (~21 minutes) (Rimaniol et al., 1994)
- Intubation- post-extubation swallowing disorders
- Mostly seen in trauma care, critical care, & after cardiac surgery
- Can result in “aspiration pneumonia, chemical pneumonitis, transient hypoxemia, bronchospasm, or mechanical obstruction with atelectasis,” (Rassameehiran et al., 2015)
- Treatment- diet modification, compensatory strategies/postural changes, & neuromuscular stimulation
References
- ALMEIDA, T. M. de, GOMES, L. M. S., AFONSO, D., MAGNONI, D., MOTA, I. C. P., FRANÇA, J. Í. D., & SILVA, R. G. da. (2020, May 11). Risk factors for oropharyngeal dysphagia in cardiovascular diseases. Journal of Applied Oral Science. Retrieved March 16, 2022, from https://www.scielo.br/j/jaos/a/6BqrkngCqnrHgHGNkxdn5yP/?lang=en
- ABadila, E., Bartos, D., Balahura, C., & Daraban, A. M. (2014, March). A rare cause of dysphagia – dysphagia aortica – complicated with intravascular disseminated coagulopathy. Maedica. Retrieved March 16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268299/#:~:text=Dysphagia%20aortica%20is%20a%20difficulty,stature%2C%20hypertension%2C%20and%20kyphosis.
- ABehl, P. R., & Holden, M. P. (1984, November). Mitral valve disease and dysphagia. European heart journal. Retrieved March 16, 2022, from https://pubmed.ncbi.nlm.nih.gov/6241564/
- ABennett, A. L., Cock, C., Heddle, R., & Morcom, R. K. (2013, April 21). Dysphagia Lusoria: A late onset presentation. World journal of gastroenterology. Retrieved March 16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631998/
- AKress S, Martin WR, Benz C, Riemann JF. Dysphagia secondary to left atrial dilatation. Z Gastroenterol. 1997 Nov;35(11):1007-11. PMID: 9429286.
- ARassameehiran, S., Klomjit, S., Mankongpaisarnrung, C., & Rakvit, A. (2015, January). Postextubation dysphagia. Proceedings (Baylor University. Medical Center). Retrieved March 16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264700/
- ARimaniol, J. M., D’Honneur, G., & Duvaldestin, P. (1994, November). Recovery of the swallowing reflex after propofol anesthesia. Anesthesia and analgesia. Retrieved March 16, 2022, from https://pubmed.ncbi.nlm.nih.gov/7978400/
- AVerzaro, R. (2020, September 4). Understanding post-surgery dysphagia. UniCamillus. Retrieved March 16, 2022, from https://www.unicamillus.org/understanding-post-surgery-dysphagia/#:~:text=Dysphagia%20is%20a%20clinical%20condition,oral%20cavity%20to%20the%20stomach.
