SHM Converge Scientific Abstract ePoster Gallery-Pins, Needles, and a Pounding Heart: A Post-Lap(band) Surprise

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A 51-year-old woman with rheumatoid arthritis and a prior laparoscopic gastric band presented with right-sided paresthesias, tachycardia, and palpitations after eating. Her heart rate ranged from 90 to 160 bpm, while blood pressure and oxygenation remained stable. Extensive evaluation for neurologic and infectious causes was largely unrevealing: CSF studies were non-diagnostic, infectious testing was negative, and CT/MRI showed chronic left MCA occlusion and convexity meningeal enhancement without an acute explanation. She was initially treated empirically with acyclovir and ampicillin for possible meningitis, but these were stopped after negative workup.<br /><br />Although the paresthesias resolved, she continued to have persistent postprandial tachycardia. A transthoracic echocardiogram showed normal systolic function with a possible PFO, but no clear cause for her symptoms. The team concluded that her symptoms were due to vagal nerve stimulation related to the gastric band, since the anterior vagal nerve lies near the typical surgical site and can be irritated by the band.<br /><br />The management was removal of 4.2 cc of fluid from the gastric band, effectively decompressing it. After this adjustment, she was able to tolerate oral intake without symptoms.<br /><br />This case highlights that gastric banding can cause vagal nerve stimulation, presenting with sinus tachycardia, vasovagal symptoms, and paresthesias. In patients with a history of lap band surgery who develop postprandial neurologic or cardiovascular symptoms, band decompression should be considered as an effective treatment.

Asset Subtitle

Kyra Beckman

Meta Tag

Author List Anne Yan Ting Chua, Kyra Beckman, Maxwell Bressman MD

Category Clinical Vignettes

Concept Adjustable Gastric Band

Concept Vagal Stimulation

Concept Postprandial Symptoms

Concept Band Decompression

Concept Anterior Vagal Nerve

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital

Presenting Author Kyra Beckman

Track Adult

Keywords

rheumatoid arthritis

gastric band

postprandial tachycardia

vagal nerve stimulation

paresthesias

sinus tachycardia

laparoscopic banding

band decompression

palpitations

vasovagal symptoms

Adjustable Gastric Band

Vagal Stimulation

Postprandial Symptoms

Band Decompression

Anterior Vagal Nerve