Lege Artis Medicinae

[Cough syncope]

AVRAMOV Katalin, MAYER Péter, KISS Éva, PAPRIKA Dóra, ZÖLLEI Éva, VÉCSEI László, RUDAS László

MARCH 20, 2002

Lege Artis Medicinae - 2002;12(03)

[Cough syncope is an infrequently diagnosed form of situational syncope. Most of the reported cases occurs among middle-aged or elderly overweight males, suffering from chronic obstructive lung disease. In our report of four cases we demonstrate the underlying mechanism of cough syncope. Hemodynamic recordings at the time of simulated cough attacks demonstrated the equalisation of the arterial and central venous pressures with consequent cerebral hypoperfusion. The first case illustrates the difficulties of the diagnostic work-up and the confounding effects of the co-existing arrhythmia. The second and fourth cases draw attention to the relationship between cough syncope and accidents. All four patients suffered from chronic obstructive pulmonary disease resulting from heavy smoking which seems to be the most important underlying factor of this syndrome.]

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[A case of restrictive cardiomyopathy due to anthracycline treatment]

HELTAI Krisztina, SZABÓKI Ferenc

[INTRODUCTION - A case of restrictive cardiomyopathy with consecutive arrhythmia is presented which developed 20 years after adriablastin treatment CASE REPORT - A 30 years old women has already been treated for 3 years at an outpatient clinic for paroxysmal supraventricular tachycarcia (PSVT) and shortness of breath. All therapeutic interventions were ineffectual, since the patient refused to take the prescribed medicines because of feeling worse after taking them. This lack of compliance was first explained by vegetative neurosis, but later she was examined with the suspicion of dilatative cardiomyopathy and coronary heart disease. The patient was admitted to the Cardiology Intensive Care Unit with cardiogenic shock which developed after injection of propafenon that had been given due to PSVT. On admission sinus rhythm was seen, but later PSVT and non-sustained VT were recorded. Echocardiography showed diffuse hypokinesis, normal diameter of left ventricle and increased right ventricle pressure. Considering the low EF and the recurring high frequency arrhythmia, amiodarone treatment was introduced successfully. From the medical history of the patient it emerged, that in 1977, she underwent surgery due to neuroblastoma with consecutive combined chemotherapy containing adriablastin. CONCLUSION - It is presumed that the recurring arrhythmia was a consequence of restrictive cardiomyopathy resulting from anthracycline treatment. To prove the diagnosis of restrictive cardiomyopathy echocardiography, Swan-Ganz catheter insertion, coronarography and myocardium biopsy were performed to exclude other possible causes of restrictive cardiomyopathy and to verify the toxic effect of anthracycline.]

Lege Artis Medicinae

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[INTRODUCTION - Gastroesophageal reflux is known to cause chronic cough and it is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux disease in asthmatic patients with chronic cough, to analyse the temporal relationship between reflux events and coughing and to assess the effect of esomeprazole treatment on respiratory symptoms and lung function in these patients. PATIENTS AND METHODS - 126 asthmatic patients with chronic dry cough were studied. Diagnosis of gastroesophageal reflux disease was based on typical symptoms and the effectiveness of therapeutic test or on pH monitoring, while control group consisted of the patients without gastroesophageal reflux (negative pH results). The study group patients received the proton pump inhibitor esomeprazole (40 mg/day for three months) and standard treatment for asthma was continued. During the study pulmonary function tests (forced expiratory volume in one second and peak expiratory flow) were evaluated four times and the reflux symptom scores as well, using a questionnaire. RESULTS - The results of pH monitoring showed that 64% of cough episodes were related to acid reflux and in 91% of reflux events preceded coughing. Esomeprazole treatment (40 mg/day for three months) not only diminished gastroesophageal reflux symptoms but also improved asthma outcome measures. Baseline pulmonary function values increased significantly together with a decrease in symptom scores and the use of rescue medication. In most patients included in the extended part of the study for another three months, the dose of inhaled steroids could be reduced with sustained therapy against gastroesophageal reflux. CONCLUSION - Our data shows that reflux events preceded coughing in most cases and that treatment of gastroesophageal reflux disease caused an improvement in different outcome measures of asthma suggest that gastroesophageal reflux disease worsens asthma and its treatment is of clinical importance in the effective management of these patients.]