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Tussive Syncope

Cough Syncope

Tussive syncope is the loss of consciousness following prolonged episodes of vigorous coughing. Patients recover spontaneously a few seconds to minutes later. This condition is associated with overweight middle-aged males with a history of smoking and chronic obstructive lung disease. The diagnosis is based on a detailed history, physical exam, and the appropriate studies.


Presentation

Tussive syncope, a well-recognized condition, is characterized by a brief loss of consciousness following vigorous coughing [1] [2]. This syndrome is typically observed in middle-aged men who are overweight smokers with underlying chronic obstructive lung disease (COPD) [3] [4]. Tussive syncope can also occur in children with asthma as well [5] [6]. The exact mechanism of tussive syncope is not fully elucidated [1] [2]. It is important to note, however, that since tussive syncope and adult tussive cough are common [1] [2], it is likely that pertussis is underdiagnosed in this age group [1] [2] [7]. Moreover, tussive syncope may also be associated with underlying diseases of respiratory, cardiovascular, and central nervous systems [8].

Patients with tussive syncope experience intense and prolonged episodes of coughing prior to losing consciousness, The syncope is rapid, lasts for a very short duration, and resolves spontaneously and completely [1] [2]. In addition to a paroxysmal cough, other features may include cyanosis and signs related to congestion of the face [2]. Furthermore, the syncope may be accompanied by movement disorders without postictal confusion and loss of bladder or bowel control [3] [9] [10]. Also, visual disturbance and lightheadedness may precede the syncopal episode [3] [9]. Antitussive medications and management of chronic obstructive lung disease will cause the decrease of syncope episodes [3] [11].

Vital signs may be normal [2]. Notable findings may include wheezing [3].

Movement Disorder
  • Furthermore, the syncope may be accompanied by movement disorders without postictal confusion and loss of bladder or bowel control. Also, visual disturbance and lightheadedness may precede the syncopal episode.[symptoma.com]
Intravenous Drugs
  • Description Journal of the Louisiana State Medical Society CLINICAL CASE OF THE MONTH Post-Tussive Syncope in a 39-Year-Old Intravenous Drug User Matt McElveen, MD; Dana Walters, MD; John R. Amoss, MD; Fred A.[pdffiller.com]
Ecchymosis
  • The physical examination of the left periorbital region revealed 2 mm of enophthalmos, left orbital ecchymosis and pupils that were equal and reactive to light and accommodation. He had evidence of restriction of ocular gaze on upward movement.[omicsonline.org]
Throat Irritation
  • Post nasal drip : Cough is due to throat irritation, saline nasal wash to clear your nasal passages frequently together with cough drops to soothe your throat would help, if not you need to see your doctor for possible need for prescription medications[healthtap.com]
  • In the present scenario a natural demulcent been evaluated in checking cough reflex and throat irritation with 3 years of vigil follow up to adjudge the efficacy and safety profile.[clinical-epigenetics.imedpub.com]
Allergic Cough
Hiccup
  • A case of sinus arrest and post-hiccup cough syncope in medullary infarction.[dizziness-and-balance.com]
  • This article will focus on cough syncope; hiccup syncope ( Funakawa and Terao 1998 ) and sneeze syncope ( Corbett et al 1976 ) are less common but closely allied conditions that apparently operate through similar pathophysiologic mechanisms.[medlink.com]
Hypomimia
  • Facial Expression: 0 — Normal. 1 — Minimal hypomimia, could be normal "poker face. ‎[books.google.de]

Workup

Any patient with syncope needs a full workup consisting of the personal medical history, full physical exam, and the appropriate studies. Specifically, details surrounding the onset of the syncope and the overall clinical picture are necessary to differentiate tussive syncope from similar presentations such as seizures and other causes of syncope [3].

The initial workup should include the complete blood count (CBC), which is typically normal. Additionally, biochemical tests are important to rule out hypoglycemia or other metabolic abnormalities. Very importantly, cultures of the blood, sputum, and throat are usually negative for the typical offending organisms [2].

With regards to diagnosing pertussis, polymerase chain reaction (PCR) analysis of nasopharyngeal samples can detect Bordetella pertussis [1] [2]. Furthermore, serologic tests constitute a sensitive method for the identification of pertussis in adult patients [1]. Pertussis has been discovered in patients with prolonged coughing which highlights the notion that adult cases of pertussis are probably not diagnosed or reported adequately [12].

Chest radiography, which is likely to be normal, should be performed in these patients [1]. Moreover, syncope associated with a cough requires assessment with pulmonary function tests (PFTs) to determine the presence of lung disease [3].

During further evaluation of syncope, the workup should include an electrocardiogram (ECG), echocardiogram, and a 24 hour ECG monitoring, which are all unremarkable [1] [2].

Neurologic workup includes computed tomography (CT) scan of the head and electroencephalography (EEG), which will exclude seizures or some other central nervous system (CNS) causes [1] [3].

Pericardial Effusion
  • It is an uncommon presentation for pericardial effusion and less likely to be associated with pericardial tamponade. Pericardial effusion is the most common complication associated with metastases to the heart and pericardium.[stlukes.com.ph]

Treatment

  • Tussive syncope is a rare condition that often responds to treatment of the underlying cause of coughing. Therefore, the workup and diagnosis of the cause is essential. However, at times, the cough is refractory to conventional treatment.[ncbi.nlm.nih.gov]
  • Most significantly, his startling cough syncopal episodes did not resolve with any treatment.[rc.rcjournal.com]
  • Home Chat with a doctor Cough syncope treatment 1 year ago i was diagnosed with tb i took 8 month treatment after that i was fine but now i feel like my throat is full of cough and in the morning my saliva is light red with blood sometimes little blood[practo.com]
  • Conclusion: All patients who are diagnosed with cardiac tamponade in the Emergency Department should be closely monitored and admitted to the Intensive Care Unit until prompt medical treatment and management is delivered.[stlukes.com.ph]
  • In this situation, one approach to treatment would be to give anti-tussive (anti-cough) therapies. Some examples would be dextromethorphan (found in some cough syrups) or codeine.[answers.yahoo.com]

Prognosis

  • The long-term prognosis of cough syncope depends largely on the prognosis of the underlying condition, but cough syncope itself can result in severe bodily injury, including vertebral artery dissection.[medlink.com]

Etiology

  • Introduction: Cough syncope may result from various etiologies such as profound arterial hypotension, cerebral hypoperfusion secondary to the corresponding increase in intracranial pressure, pulmonary vasoconstriction and hypoxemia or even reflex cardiac[stlukes.com.ph]
  • Respiratory, cardiac, and neurological assessments are essential to ascertain an underlying etiology.[rc.rcjournal.com]
  • […] consciousness, either with momentary premonitory symptoms or without warning, due to cerebral anemia caused by ventricular asystole, extreme bradycardia, or ventricular fibrillation. neurocardiogenic syncope a particularly serious type of vasovagal attack ; the etiology[medical-dictionary.thefreedictionary.com]
  • […] either with momentary premonitory symptoms or without warning, due to cerebral anemia caused by ventricular asystole , extreme bradycardia , or ventricular fibrillation . neurocardiogenic syncope a particularly serious type of vasovagal attack ; the etiology[medical-dictionary.thefreedictionary.com]
  • If a benign etiology is not clear, driving and use of machinery should be prohibited until the etiology is determined and treated—the next manifestation of an unrecognized cardiac cause may be fatal. Click here for Patient Education[msdmanuals.com]

Pathophysiology

  • Overview In this article, the author explains the clinical presentation, pathophysiology, diagnostic workup, and management of cough syncope.[medlink.com]
  • Although the exact pathophysiology remains uncertain and debated, the hemodynamic theory seems to be the most established: the increase in intrathoracic pressure during coughing acutely lowers venous return and consequently cardiac output, leading to[amjmed.org]
  • SYN: Morgagni Adams Stokes s.. cardiac s. fainting with unconsciousness of any … Medical dictionary Laughter-induced syncope — is an unusual but recognized form of situational syncope (fainting) likely to have a similar pathophysiological origin to tussive[medicine.academic.ru]
  • Although many studies have been published in the medical literature, the mechanism and pathophysiology for cough syncope has not been well established.[synapse.koreamed.org]
  • If JVR contributes to the pathophysiology, the question remains why only certain people with JVR have developed cough syncope.[bmcneurol.biomedcentral.com]

Prevention

  • To prevent tussive syncope, the origin of the cough must be researched and supported.[health.ccm.net]
  • Individuals with Tussive Syncope should learn to recognize the warning signs of an oncoming loss of consciousness and move accordingly to prevent injury when they lose consciousness.[novusbio.com]
  • The present therapeutic remain an obligatory therapeutics i.e., prevention of cough but incidence remain unchanged as allergic cough has no option.[clinical-epigenetics.imedpub.com]
  • .: Prevention of hip fracture in elderly people with use of a hip protector. ‎[books.google.de]

References

Article

  1. Kogana Y, Eliasa N, Slobodina G, Odeh M. Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literatur. J Med Cases. 2016; 7(7): 266-269.
  2. Dawood H, Eliasa N, Slobodina G, Odeh M. Recurrent Cough Syncope Due to Pertussis in an Adult: A
    Case Report and Review of the Literature. J Med Cases. 2015;6(1):33-35.
  3. Deshmukh A, Schuller D. Case Report: Cough syncope in a patient with severe chronic obstructive pulmonary disease. Respir Med CME. 2008; 1(2):120-122.
  4. Krediet CT, Wieling W. Edward P. Sharpey-Schafer was right: evidence for systemic vasodilatation as a
    mechanism of hypotension in cough syncope. Europace. 2008;10(4):486-488.
  5. Haslam RH, Freigang B. Cough syncope mimicking epilepsy in asthmatic children. Can J Neurol Sci. 1985;12(1):45-47.
  6. Katz RM. Cough syncope in children with asthma. J Pediatr. 1970;77(1):48-51.
  7. Gabutti G, Azzari C, Bonanni P, et al. Pertussis. Hum Vaccin Immunother. 2015;11(1):108-117.
  8. Dicpinigaitis PV, Lim L, Farmakidis C. Cough syncope. Respir Med. 2014;108(2):244-251.
  9. Kerr A, Jr., Derbes VJ. The syndrome of cough syncope. Ann Intern Med. 1953;39(6):1240-1253.
  10. Demaria A, Westmoreland B, Sharbrough F. EEG in cough syncope. Neurology, 1984; 34(3):371-374.
  11. Bekman TJ. Syncope in an adult with uncontrolled asthma. South Med J. 2002; 95(3):369-370.
  12. Syed MA, Bana NF. Pertussis. A reemerging and an underreported infectious disease. Saudi Med J. 2014;35(10):1181-1187.

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Last updated: 2018-06-22 08:56