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Swallow syncope is a relatively rare cause of syncope that belongs to the neurally-mediated reflex syncopal syndromes. It occurs due to a vagal reflex during deglutition causing inhibition of the cardiac conduction system. Since the first reported case of swallow syncope in 1773 by Spens,1 there have been only about 80 case reports of swallow syncope in the literature to date. In most cases there was an underlying abnormality in the esophageal or cardiac conduction system. However, there have been reported cases without any esophageal or cardiac abnormality. In this article, we report a case of swallow syncope and review the literature. Case report A woman, aged 60 years, was admitted to the hospital with a history of recurrent episodes of lightheadedness and one episode of syncope. She reported having several episodes of lightheadedness while eating solid food for the last six months. During these episodes she would usually stop eating, and the feeling of lightheadedness would spontaneously subside. She was admitted for further evaluation after she lost consciousness while eating a peanut butter sandwich. Her past medical history was significant for hypertension and hyperlipidemia. She had been on treatment with atenolol since 2004 and was taking 100 mg once daily since 2005. Her family history was unremarkable for any arrhythmias or syncope. On admission, her heart rate was 54 beats per minute (bpm) and blood pressure was 160/94 mmHg with no evidence of orthostatic hypotension. The remainder of the physical examination, including a comprehensive neurological examination, was normal. Hematological and biochemical tests were normal.