The patient: A 29-year-old man in Queens, New York
The symptoms: As the man was walking home one night, he suddenly started feeling heart palpitations — accelerated heartbeats at irregular intervals — that alarmed him, prompting an immediate visit to the emergency room.
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Medication usually restores the heart’s normal rhythm within hours — but in this case, the rectal exam achieved a similar result instantly.
Notably, during the rectal exam, the patient was instructed to bear down and strain without exhaling, a technique called the “Valsalva maneuver.” It’s also used to clear pressure from the middle ear and is known to increase activity in the vagus nerve.
Stimulation of the vagus nerve is known to increase activity in the parasympathetic nervous system and slow electricity conduction in heart tissue, the patient’s doctor wrote in the report. In this patient, stimulation of his vagus nerve likely counteracted the signals causing the arrhythmia, the doctor suspected.
This type of rectal procedure could be an additional method for treating some patients with AFib, the author concluded, though he added that it should not replace more traditional treatments. More research would be needed to justify adding the procedure to standard practice.
For more intriguing medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and is not meant to offer medical advice.
Ruan C. H. (2010). Instantly Converting Atrial Fibrillation into Sinus Rhythm by a Digital Rectal Exam on a 29-year-Old Male. Clinical medicine insights. Case reports, 3, 51–54. PMID: 21769254
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