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April 6, 1984

Atypical Cough Syncope

Author Affiliations

From the Department of Medicine, University of Washington, Seattle (Drs Strauss and Longstreth); and the Department of Surgery, The Milton S. Hershey Medical Center, Hershey, Pa (Dr Thiele). Dr Strauss is a fellow in the Robert Wood Johnson Clinical Scholars Program. Dr Thiele was at the Seattle Veterans Administration Hospital during the evaluation and treatment of the patient described.

JAMA. 1984;251(13):1731. doi:10.1001/jama.1984.03340370063032

TUSSIVE or cough syncope is an uncommon but easily recognized syndrome. The typical case is benign and does not require extensive evaluation. We report an atypical case of cough syncope that was associated with marked stenoses of both common carotid arteries and that improved with surgery. We review the literature, with particular attention to cases with correctable lesions.

Report of a Case  A 51-year-old man complained of six months of cough syncope. During spontaneous and prolonged coughing, he would lose consciousness for seconds to minutes. His attacks occurred almost daily. He smoked but was receiving no medications. He had a medical history of hypertension, chronic alcoholism, and angina that led to a single-vessel coronary artery bypass.Physical examination of this normotensive man was remarkable for obesity and bilateral carotid bruits. Provocative maneuvers, such as forced coughing or Valsalva, could not reproduce the syncope. A chest roentgenogram was unremarkable. An ECG