Cough syncope from constrictive pericarditis: A case report

Loss of consciousness associated in some people with coughing is likely due to the hemodynamic changes induced by this exaggerated Valsalva manoeuvre. Cough syncope classically occurs in people with obstructive pulmonary disorders and it is unusual to find a specific correctable lesion precipitating it. A previously healthy man who developed tussive syncope in association with constrictive pericarditis and subsequently was cured by pericardiectomy is described. Although cough is a recognized feature of this cardiovascular condition, associated cough syncope has not previously been reported. However, the hemodynamic changes induced by constriction of cardiac filling understandably may further reduce cerebral perfusion during coughing. Not only does this case present a novel cause of this interesting syncopal syndrome, but it supports the basic pathophysiology thought to underlie it.