Transient Complete Heart Block Occurring during Nasal Irrigation

CARDIAC stanldstill and sudden death have been reported in operative proce-dures of the eyes, ears, nose, and throat and in intubation procedures.'13 The exact mech-anism and cause of these episodes are not entirely clear. The question of vagal effect with inhibition of the heart beat has been considered as a factor. The present case is reported because of the possibility of cardiac inhibition by vagal reflex. The stimulating factor in this patient was a high pressure spray of isotonic saline solution in the area of the sphenoid sinuses. Case Report The patient was a 54-year-old white woman who was admitted to St. Joseph's Infirmary in collapse on February 3, 1959. In her past history there was a rather marked psychoneurotic background after a surgical menopause in 1930. The chief symptom was headache, which had been related on occasion to sinusitis requiring frequent local treat-ments. Another symptom was substernal pain not typical of, but considered to be consistent with coronary artery insufficiency. This view was sup-ported by minor electrocardiographic changes (fig. 1A) in January 1959. On February 3, 1959, the patient collapsed in the chair of an otolaryngologist while receiving a forceful jet spray of isotonic saline solution into the area of the sphenoid sinus. She quickly be-came eyanotic and lost consciousness. She was placed in the recumbent position, and oxygen was administered by catheter orally. When examined 5 minutes later, she was unconscious, ashen, per-spiring profusely, and had slow gasping respira-tions. The neck veins were distended but the lungs were clear. The blood pressure was unobtainable, and the pulse was faint and extremely slow. The heart beat was regular, with a rate of 32. Durin