Dysphagia Megalatriensis: A Case Report of Potentially Treatable Etiology of Dysphagia.

Background - Dysphagia is commonly associated with structural or neuromuscular disorders of the oesophagus, but cardiovascular causes are rare. Dysphagia megalatriensis is an unusual condition characterized by oesophageal compression due to an enlarged left atrium, often secondary to decompensated heart failure. Timely recognition of this rare etiology can prevent unnecessary interventions and enable targeted therapy. Case Presentation - A 78-year-old male with a history of coronary artery disease and chronic heart failure with reduced ejection fraction presented with breathlessness and chest discomfort for 3 days. He also reported progressive difficulty swallowing solids over the past 20 days. Examination revealed hypoxia and bilateral pitting pedal oedema, while imaging demonstrated cardiomegaly with significant left atrial dilation compressing the oesophagus. The patient was diagnosed with dysphagia megalatriensis, a rare form of cardiac dysphagia. He was treated with diuretic therapy and nasogastric tube feeding, resulting in symptomatic improvement. Conclusions - Dysphagia megalatriensis, though rare, should be considered in the differential diagnosis of dysphagia, particularly in patients with significant cardiac comorbidities. This case highlights the role of non-invasive imaging and individualized management strategies, including medical optimization of heart failure, in addressing this unique condition.