SUMMARYA case of cough syncope due to A-V conduction block of the heart is reported in this paper. A-V conduction block and lightheadedness were induced by coughing but not by an Aschner test, carotid sinus massage, Valsalva maneuver, pharyngeal stimulation, and stimulation of systemic baroreceptors. Permanent right-ventricular pacing completely abolished the patient's symptoms. The results suggest that hypersensitivity of a broncho-pulmonary reflex to coughing was responsible for the A-V conduction block and resulting syncopes.
Additional Indexing Words: Atrial fibrillationA-V block Tussive syncope OUGH syncope is a conspicuous and well-defined syndrome. Clinically, the fainting fit is always associated with a paroxysm of coughing, often occurring after a few vigorous coughs. A very sudden onset of giddiness is followed by loss of consciousness. While many theories have been advanced concerning the mechanism of this syndrome since the first description of Charcot1) in 1876, recent investigations have paid particular attention to the hypotheses that cough syncope can be attributed to transmission of markedly elevated intrathoracic pressure to the cerebrospinal fluid2) or to reduction in venous return to the heart,3) resulting in cerebral anoxia and syncope. This report describes a patient who presented repeated episodes of loss of consciousness after coughing. Investigations revealed that the mechanism for this patient's syncope is probably a hypersensitive bronchopulmonary reflex which induces a complete A-V conduction block of the heart. Permanent right-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.