Cough Syncope

SyncopeTo the Editor:Although cough is a common clinical symptom, the vasomotor effects on the heart and systemic circulation are often underappreciated.A healthy 42-year-old man without significant medical history presented with repetitive episodes of syncope during coughing.His examination, electrocardiogram, laboratory studies, and echocardiography results were normal, and carotid massage did not provoke any adverse response.During the hospitalization, the patient experienced new episodes of presyncope during coughing.Holter monitoring, at this time, documented transient episodes of complete atrioventricular block (Figure, note the presence of artefacts due to cough).In view of the presence of symptoms suggestive of pyrosis, a proton pump inhibitor and a prokinetic agent for gastroesophageal reflux were initiated.After one week of initiation of this treatment, there were no further episodes of cough or syncope, suggesting that the cough had been related to reflux.The syndrome of cough syncope, also called "laryngeal ictus" (from Latin ictus, which means "blow, stroke, or thrust") is characterized by paroxysmal cough, facial a