Diagnostic role of head-up tilt test in patients with cough syncope

Mereu, Roberto; Taraborrelli, Patricia; Sau, Arunashis; Toro, Alessandro Di; Halim, Sandra; Hayat, Sajad; Bernardi, Luciano; Francis, Dárrel P.; Sutton, Richard; Lim, Phang Boon

doi:10.1093/europace/euv283

Cited by 12 publications

(12 citation statements)

References 18 publications

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“…It more commonly occurs in middle-aged, obese smoker males with obstructive lung disease [1][2][3]. Until yet, more than 470 cases of cough syncope have been reported in the medical literature [1,[4][5][6]. This syndrome could be accompanied with significant increase of morbidity and mortality as with any syncope.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of disorders of the respiratory tract, of the central nervous system, cardiovascular system, gastrointestinal system, and other disorders have been associated with the occurrence of cough syncope [1]. To the best of our knowledge, until yet more than 470 adult cases of cough syncope have been reported in the medical literature [1,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

et al. 2016

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Cough syncope, also called "tussive syncope", is a well-recognized syndrome for about 70 years, in which loss of consciousness usually occurs immediately after a violent cough or prolonged bouts of violent coughing, lasting for seconds with rapid restoration of full consciousness. Its precise pathophysiologic mechanism is not fully understood and remains a matter of debate. Although pertussis is a frequent cause of prolonged cough in adults, still its burden in this age group is under-appreciated and under-diagnosed worldwide. This is well reflected by the fact that despite cough syncope is definitely not rare, until yet only six cases of cough syncope related to pertussis have been reported in the medical literature, one of them by us. We describe additional three adults with recurrent cough syncope due to pertussis who were diagnosed during a period of 3 months which completely resolved by treatment with azithromycin. Diagnosing four cases of cough syncope in adults due to pertussis during a short period in one Department of Internal Medicine, while only five cases were reported from the rest of the world, reflects the great lack of awareness on adult pertussis worldwide. Our four cases indicate that physicians should be much more aware of pertussis as a cause of cough and cough syncope in adults in order to terminate the attacks of cough and cough syncope and its serious complications by adequate antibiotic treatment, as happened with our four patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

et al. 2016

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“…Although some forms of reflex syncope, e.g. emotional VVS and cough syncope, primarily rely on other triggers, subjects with these forms are often also susceptible to orthostatic VVS [17,18]. TTT may therefore still help to provoke syncope in these cases.…”

Section: To Obtain a Pathophysiological Correlate For Orthostatic Intmentioning

confidence: 99%

“…A personally tailored provocation may be carried out in those with a specific and consistent trigger of TLOC. Examples include standing still following exercise [71,72], coughing [18] or bending forward [45]. It should, however, be noted that many specific triggers suggest situational reflex syncope with high confidence and usually do not require diagnostic confirmation.…”

Section: Tailored Provocationsmentioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

et al. 2021

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An expert committee was formed to reach consensus on the use of tilt table testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous events. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to the performance of (1) additional provocation tests, such as the active standing test, carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres.

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“…Each situational syncope must be investigated as usual by history-building in order draw a correct picture of the type of reflex involved. For example, cough syncope almost always involves vasodepression with little cardioinhibitory component [33] . Micturition syncope more often involves some cardioinhibition.…”

Section: Diagnosis Of Syncopementioning

confidence: 99%

Reflex syncope: Diagnosis and treatment

Sutton

2017

Journal of Arrhythmia

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For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED), the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years), tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient.

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Diagnostic role of head-up tilt test in patients with cough syncope

Abstract: Syncope during coughing is a result of hypotension, rather than bradycardia. Coughing during HUT is a useful test in patients suspected to have cough syncope but in whom the history is not conclusive.

Cited by 12 publications

References 18 publications

Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

Recurrent Cough Syncope Due to Pertussis in Adults: Report of Three Cases and Review of the Literature

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

Reflex syncope: Diagnosis and treatment

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