Cough syncope

Peter Vytautas Dicpinigaitis, Leonard Lim, Constantine Farmakidis

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)244-251
Number of pages8
JournalRespiratory Medicine
Volume108
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Syncope
Cough
Cerebrospinal Fluid Pressure
Pressure
Unconsciousness
Brain Concussion
Vertigo
Bradycardia
Cardiac Output
Reflex
Epilepsy
Consensus
Perfusion
Guidelines
Blood Pressure

Keywords

  • Cough
  • Obstructive lung disease
  • Syncope

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Cough syncope. / Dicpinigaitis, Peter Vytautas; Lim, Leonard; Farmakidis, Constantine.

In: Respiratory Medicine, Vol. 108, No. 2, 02.2014, p. 244-251.

Research output: Contribution to journalArticle

Dicpinigaitis, PV, Lim, L & Farmakidis, C 2014, 'Cough syncope', Respiratory Medicine, vol. 108, no. 2, pp. 244-251. https://doi.org/10.1016/j.rmed.2013.10.020
Dicpinigaitis, Peter Vytautas ; Lim, Leonard ; Farmakidis, Constantine. / Cough syncope. In: Respiratory Medicine. 2014 ; Vol. 108, No. 2. pp. 244-251.
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