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Dysphagia secondary to left atrial dilatation.

Dysphagia, of a cardiac origin, is a generally accepted, yet rarely diagnosed symptom. A 84-year-old female patient with left atrial dilatation, presenting with dysphagia and weight loss, was treated for global heart failure. Esophagography revealed compression of the distal esophagus. Echocardiography showed a left atrial, right atrial and right ventricular enlargement. Esophageal manometry revealed hypotonic peristaltic contractions of the esophageal body and a lower than normal resting pressure of the lower esophageal sphincter. After medical treatment for myocardial insufficiency and of esophageal motility, the clinical signs of global heart failure were improved and the dysphagia disappeared. Following the exclusion of common causes of dysphagia in patients with heart failure, dysphagia due to left atrial dilatation should be considered.