Cough syncope-a diagnosis under pressure

摘要

In December, 2008, a 54-year-old man presented to our emergency department after a syncopal episode while reversing his car. He had had no warning symptoms and the brief loss of consciousness was followed by full recovery. He gave a 6-week history of similar episodes, each lasting 2-5 minutes. All episodes were followed by rapid recovery; however, he had little recollection of the events. He also reported a recent unproductive cough, for which he had received a course of antibiotics. He was otherwise well, and had no chest pain, shortness of breath, or palpitations. Clinical examination was normal. There were no abnormalities on basic blood tests, and a 12-lead ECG was unremarkable. Carotid sinus massage showed no evidence of carotid sinus hypersensitivity, and erect and supine blood pressure showed no evidence of postural hypotension. Although the ECG was normal, we suspected that our patient had syncope caused by a paroxysmal arrhythmia, and transferred him to the coronary care unit for cardiac monitoring. He remained in sinus rhythm overnight.