The Classification and Pathophysiology of Cough Syncope

Essay text:

ECG examination failed to show AV block, arrhythmia, and long Q-T interval. The differential diagnosis of cough syncope was made based on patient’s history and elimination of other probable causes, including: cerebrovascular causes such as stroke, tumor, or intracranial haemorrhage, and cardiovascular causes such as arrhythmia or myocardial infarction. Mr. KH's presentation during the attack was also consistent with criteria and symptoms of situational syncope, specifically cough syncope. Syncope is classified according to its suspected pathophysiology as follows: ? Neurally-mediated reflex syncopal syndrome referring to a reflex that, when triggered, gives rise to vasodilation and bradykardia (1) ? Orthostatic syncope occurring when the autonomic nervous system is incapacitated resulting in a failure of vasoconstrictor mechanisms and thereby in orthostatic hypotension (1) ? Cardiac arrhythmias causing a decrease in cardiac output (1) ? Structural heart disease causing syncope when circulatory demands outweigh the impaired ability of the heart to increase its output (1) ? Steal syndrome causing syncope when a blood vessel has to supply both part of the brain and an arm (1) Neurally-mediated reflex syncopal syndrome is the most common type (3) and is further subdivided, based on their causes, into vasovagal faint (common faint) and carotid sinus syncope including situational faint, acute haemorrhage, cough, sneeze, gastrointestinal stimulation, micturition, post-exercise, and others (1)...