Situational cough-related syncope: case report

Abstract

Introduction: Syncope is defined as the transient loss of consciousness resulting from cerebral hypoperfusion, characterized by loss of reaction and postural tone, with rapid onset, short duration and complete spontaneous recovery, that is, it does not require specific resuscitation interventions. It presents many clinical characteristics in common with other disorders, such as epilepsy, metabolic disorders (including hypoxia and hypoglycemia), intoxication and transient ischemic attack, therefore, it presents itself in many differential diagnoses. Objective: To report the case of a patient diagnosed with cough reflex syncope, whose syncopal reflex events, in addition to the present comorbidities, were precipitated by the occurrence of a productive cough, followed by fainting with loss of consciousness and involuntary movements, with spontaneous return, without the need for interventions. Methods: Information was obtained through medical record review, interview with the patient, photographic record of the diagnostic methods to which the patient was subjected and literature review. Results: The reported case and published publications bring to light the discussion of the diagnosis and therapy of a complex disease that is reflex syncope, showing that, although associated with low mortality, this disease has a high incidence in the general population, constituting one of the main causes of urgency in medical care, causing harm to the quality of life of individuals due to high rates of recurrence and complications, such as trauma, especially falls in the elderly, with repercussions on their functionality. Conclusion: Reflex syncope can have different etiologies, however in specific populations such as hemodialysis patients, triggers such as the cough reflex, associated with multiple comorbidities and factors inherent to the procedure, can lead to its occurrence, and its detection is important in reducing mortality, morbidity and recurrence of events. When possible, treatment should be focused on correcting the underlying cause, which may range from conservative measures, such as blood pressure control, glycemic control, ultrafiltration control, evaluation of associated medications, to the need for implantation of a permanent cardiac pacemaker.