Have you seen cough syncope?
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Cardiology
Have you seen cough syncope?
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I have just seen a lady who I believe has cough syncope - she has asthma and smokes and over the past few months has been having syncopal episodes after coughing bouts. She takes losartan for hyperten
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Forums » Open clinical » Cardiology » Have you seen cough syncope?
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Have you seen cough syncope?
posted at 25/7/2012 6:08 PM BST
on bmj.com
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Posts: 875
First: 17/6/2011 Last: 20/5/2013 |
I have just seen a lady who I believe has cough syncope - she has asthma and smokes and over the past few months has been having syncopal episodes after coughing bouts. She takes losartan for hypertension and has a normal 12 lead ecg and cardiac examination. I've asked her to stop smoking and increase her fluid intake and sent her for a tilt table test - any suggestions please on how else I might manage her? sadian |
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Re: Have you seen cough syncope?
posted at 25/7/2012 8:41 PM BST
on bmj.com
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Posts: 958
First: 15/7/2011 Last: 15/5/2013 |
Sadian I am not a medic but my father had cough syncope and suffered greatly with it. Several times a day. Ultimately his Cardiologist stopped the Losartan and started him on another medication. He never had cough syncope again - that was 4 years ago and he is still going strong. He is an ex smoker. Thats my two penneth worth!! |
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Re: Have you seen cough syncope?
posted at 16/8/2012 8:54 PM BST
on bmj.com
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Posts: 3
First: 10/7/2012 Last: 9/9/2012 |
Any non infectious cough whether with or without syncope is very often drug induced and/or acid reflux. The most common drugs causing debilitating cough are ACE inhibitors and ARBs. Withdrawing the affending drugs and few doses of antihistamine brings great relief. For GERD and associated cough, proton pump inhibitors and raising of head end of the bed to atleast 10 degrees and avoidance of spices is all that is required. Recently I had a case with cough syncope, a known asthmatic who needed nebulisation and above measures with pholcodeine syrup and became alright in a week. My advice to these patients is whenever they feel like coughing, they should either sit or lie down and should not stand so as to avoid falls and head injuries. |
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Re: Have you seen cough syncope?
posted at 16/8/2012 11:40 PM BST
on bmj.com
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Posts: 3037
First: 27/3/2012 Last: 18/5/2013 |
Cough syncope is not an uncommon phenomenon. The syndrome of cough syncope has until recently been considered a rare form of fainting. Earlier investigators have suggested that this form of syncope is an epileptic equivalent or the result of a laryngeal reflex. These theories, however, have generally been abandoned in favor of a circulatory mechanism producing cerebral anoxia. It has been suggested that the cerebral anoxia might be the result of marked reflex peripheral vasodilation or a decreased cardiac output secondary to a reduced inflow or marked pulmonary vasoconstriction. These theories fail to explain completely certain unique features of this form of syncope. For example, syncope may develop with remarkable rapidity (3 to 5 seconds) after the onset of cough. With the cessation of cough, consciousness is rapidly recovered without vasomotor or other sequelae. The syndrome is rarely observed in women and syncope may occur in the supine or standing subject. Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. |
Forums » Open clinical » Cardiology » Have you seen cough syncope?
