Dysphagia megalatriensis, also known as cardiovascular dysphagia or cardiac dysphagia, is an impairment of swallowing due to esophageal compression from a dilated left atrium.
Presentation is generally with mild dysphagia, although a minority of patients will have dysphagia severe enough to develop weight loss and nutritional imbalances 1-5. The most serious complication is development of an atrio-esophageal fistula resulting in fatal hematemesis 2.
Esophageal compression and resultant dysphagia secondary to left atrial enlargement is considered to be very uncommon 1,3,5. This is likely because when the left atrium enlarges posteriorly, the esophagus is usually able to 'slip' to either side of the vertebral bodies and thus, avoid being compressed until the left atrium is very large 3.
Due to the rarity of this condition, it is important to exclude other commoner causes of dysphagia before settling on this diagnosis 5.
Chest radiographs demonstrate features consistent with left atrial enlargement 1-5.
Barium swallow or esophagography of the esophagus reveals delayed transit and demonstrates an indentation in the esophageal wall by the dilated left atrium 1-4.
These cross-sectional modalities will allow the best visualization of a dilated left atrium compressing the esophagus 4,5.
Treatment and prognosis
Treatment is necessary only if symptomatic, and generally patients will require a nasogastic tube for enteric feeding 1,4. Management of the underlying cause of left atrial enlargement (e.g. mitral stenosis or chronic mitral regurgitation) is also pertinent.
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- 4. Heng JS, Elghamaz A. Atrial enlargement associated with non-valvular atrial fibrillation: an unusual cause of dysphagia and weight loss. BMJ Case Reports. 2015: bcr2014209213. doi:10.1136/bcr-2014-209213 - Pubmed
- 5. Mönkemüller K, Feldmann K, Ulbricht LJ. Electronic image of the month. Cardiac dysphagia. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 8 (4): e41-2. doi:10.1016/j.cgh.2009.12.014 - Pubmed
- 6. Haziz SRA, Bickle I, Chong VH. Dysphagia aortica: a rare cause of dysphagia. BMJ Case Reports. 2015: bcr2015211726. doi:10.1136/bcr-2015-211726 - Pubmed
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