Smoking and Cough Syncope: Follow-up in 45 Cases

Bonekat, H. William; Miles, Robert M.; Staats, Bruce A.

doi:10.3109/10826088709027438

Cited by 22 publications

(13 citation statements)

References 4 publications

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“…Situational syncope is defined as syncope occurring only in certain distinct and usually memorable circumstances, including micturition syncope, defecation syncope, cough syncope, laugh syncope, and swallow syncope. [431][432][433][434][435][436][437] Appropriate investigations should be undertaken to determine an underlying etiology, including causes that may be reversible. 431,[433][434][435][436] Evidence for treatment is limited mainly to case reports, small case series, and small observational studies.…”

Section: Other Reflex Conditionsmentioning

confidence: 99%

“…[431][432][433][434][435][436][437] Appropriate investigations should be undertaken to determine an underlying etiology, including causes that may be reversible. 431,[433][434][435][436] Evidence for treatment is limited mainly to case reports, small case series, and small observational studies. 431,[433][434][435][436] Treatment of most types of situational syncope relies heavily on avoidance or elimination of a triggering event.…”

Section: Other Reflex Conditionsmentioning

confidence: 99%

See 1 more Smart Citation

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope

Shen¹,

Sheldon²,

et al. 2017

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Section: Other Reflex Conditionsmentioning

confidence: 99%

Section: Other Reflex Conditionsmentioning

confidence: 99%

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope

Shen¹,

Sheldon²,

et al. 2017

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“…Five articles reported series of adults presenting with syncope and provided the percentage of those in whom cough was determined to be the etiology [12,34,42,46,74]. In total, 3244 patients evaluated for syncope were described, among whom were 84 cases of cough syncope (2.6%; range 0.9e4.2%).…”

Section: Demographicsmentioning

confidence: 99%

“…Numerous motor vehicle accidents resulting from cough syncope have been reported [3,13,42,47,50,57,68,69,73]. These reports include the deaths of two drivers [68], in addition to three pedestrians [13,68].…”

Section: Conditions Associated With Cough Syncopementioning

confidence: 99%

Cough syncope

Dicpinigaitis

Lim

Farmakidis

2014

Respiratory Medicine

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Loss of consciousness following cough was first described in 1876 as "laryngeal vertigo" Since then, several hundred cases of what is now most commonly termed cough syncope have been reported, often in association with various medical conditions. Some early authors assumed this entity to be a form of epilepsy, but by the mid-20th century, general consensus reflected that post-tussive syncope was a consequence of markedly elevated intrathoracic pressures induced by coughing. A typical profile of the cough syncope patient emerging from the literature is that of a middle-aged, large-framed or overweight male with obstructive airways disease. Presumably, such an individual would be more likely to generate the extremely high intrathoracic pressures associated with cough-induced fainting. The precise mechanism of cough syncope remains a matter of debate. Theories proposed include various consequences of the marked elevation of intrathoracic pressures induced by coughing: diminished cardiac output causing decreased systemic blood pressure and, consequently, cerebral hypoperfusion; increased cerebrospinal fluid (CSF) pressure causing increased extravascular pressure around cranial vessels, resulting in diminished brain perfusion; or, a cerebral concussion-like effect from a rapid rise in CSF pressure. More recent mechanistic studies suggest a neurally mediated reflex vasodepressor-bradycardia response to cough. Since loss of consciousness is a direct and immediate result of cough, elimination of cough will eliminate the resultant syncopal episodes. Thus, the approach to the patient with cough syncope requires thorough evaluation and treatment of potential underlying causes of cough, as summarized in several recently published cough management guidelines.

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“…Therefore, ET-1 is one of determinants of CBF. Endothelial dysfunction with imbalanced releases of NO and ET-1 has also been recognized in chronic obstructive pulmonary disease (COPD); those populations have been found with more frequent cough syncope [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: a case control pilot study

et al. 2013

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BackgroundJugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope.MethodsSeventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements.ResultsMultivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p < 0.001).ConclusionsJVR and higher plasma levels of ET-1 are associated with cough syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings.

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Smoking and Cough Syncope: Follow-up in 45 Cases

Cited by 22 publications

References 4 publications

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope

Cough syncope

Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: a case control pilot study

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