Cough syncope in a patient with severe chronic obstructive pulmonary disease

Abstract

Cough syncope is a well-known entity which results in loss of consciousness during episodes of cough. It commonly occurs in patients with severe chronic obstructive lung disease (COPD) and asthma. We report a 50-year-old African American male who presented with a syncopal episode during vigorous bout of coughing. He was noted to have clonic movements with brief loss of consciousness during this episode. Initially, he was evaluated for seizures but careful history revealed that he had similar episodes in the past with coughing. Physical examination was remarkable for diffuse bilateral wheezing and tachycardia. Chest X-ray showed hyperinflation of the lungs. Transthoracic echocardiogram showed evidence of moderate pulmonary hypertension. EEG and CT scan of the head were unremarkable. His bronchodilator regimen was optimized. He was treated with antitussives for the cough and was advised to exhale before coughing. His syncopal episodes resolved on his follow up visits after the discharge. This case demonstrates that cough syncope is a known presentation of severe COPD. It can often be confused with a seizure episode but a careful history is helpful to differentiate it from seizures. Treatment of underlying COPD and cough is associated with resolution of syncopal episodes.