Figures
- Figure 1
Slices from CT of the thorax.
- Figure 2
Lung function testing (Ref: reference value; Pre: measured value; Post: post-bronchodilator value, not performed). Results are shown in table 1.
- Figure 3
Results of 14-day cardiac monitoring, revealing occasional ventricular ectopics (VEs), and an unsustained episode of ventricular tachycardia (VT). HR: heart rate; WCT: wide complex tachycardia; SDNN: standard deviation of the normal-to-normal RR intervals; SVE: supraventricular ectopic beats; AF: atrial fibrillation.
- Figure 4
Proposed set of investigations in all patients reporting cough syncope.
Tables
- Table 1
Result of the lung function testing for this 54-year-old Caucasian male
Spirometry Measurement % of reference SR FEV1, L 2.66 82 –1.16 FVC, L 3.76 93 –0.45 FEV1/FVC, % 71 DLCO, mmol·min−1·kPa−1 9.1 100 0.02 KCO, mmol·min−1·kPa−1·L−1 1.67 120 1.02 TLC (box), L 5.51 85 –1.42 RV (box), L 1.63 74 –1.37 RV/TLC, % 29 SR: standard residuals (the deviation from predicted values (recorded−predicted)/residual standard deviation), FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; DLCO: diffusing capacity of the lung for carbon monoxide; KCO: transfer coefficient of the lungs for carbon monoxide; TLC: total lung capacity; RV: residual volume.
- Table 2
Bronchoalveolar lavage (BAL) results
Differential cell count Macrophages 83% Neutrophils 1% Lymphocytes 6% Eosinophils 1% Others 9% Microscopic description No malignant cells recognised Total cell count: 0.11 million cells per mL.
- Table 3
EU standards for driving with recurrent cough syncope and DVLA guidance for group 1 (motorcycles, passenger cars and other small vehicles) and 2 (vehicles over 3.5 tonnes or vehicles designed for the carriage of more than nine passengers) drivers for patients with cough syncope
EU standards [11] Group 1 drivers Driving allowed if no recurrence in 6 months Group 2 drivers Permanent ban UK DVLA guidelines [12] Group 1 Drivers Must not drive for 6 months following a single episode and for 12 months following multiple episodes and must notify DVLA Group 2 Drivers (bus and lorry) Must not drive for 12 months following a single episode and for 5 years following multiple episodes and must notify DVLA If more than one episode of cough syncope occurs within a 24-h period, this will be counted as a single event. However, if the episodes of cough syncope are more than 24 h apart, these are considered as multiple episodes. Adapted from [11, 12].
- Table 4
Adverse features in the history suggestive of alternative diagnoses
Chest pain Headache Palpitations Exertional onset Protracted loss of consciousness >1–2 min Syncope whilst supine or sitting Significant history of structural heart disease Polyuria/polydipsia Significant breathlessness Weight loss - Table 5
Conditions that may mimic or exacerbate cough syncope
Cardiac Atrioventricular block
Pulmonary hypertension
Constrictive pericarditis
Carotid sinus syndrome
Postural hypotension
Aortic stenosis
Structural heart disease [16]Neurological Epilepsy
Intracranial tumours [17]
Subclavian steel syndrome [18]
Autonomic dysfunctionOthers Drug induced (vasodilators, diuretics)
Diabetes (resulting in autonomic dysfunction)Information from [15].
