Impaired heart rate responses to cough and deep breathing in elderly patients with unexplained syncope

To test the hypothesis that elderly patients with unexplained syncope have impaired autonomic control of heart rate, chronotropic responses to deep breathing and cough were studied in 12 elderly patients (85 +/- 4 years), 14 elderly control subjects (82 +/- 7 years) and 10 young subjects (26 +/- 5 years). There was no difference in resting RR interval between elderly patients with syncope and control subjects. However, the ratio of the maximum RR/minimum RR (an index of heart rate variability) during deep breathing was significantly lower in patients than in control subjects (p less than 0.005). In the minute following cough, there was no difference in initial reflex tachycardia, but subsequent rebound bradycardia was blunted in the elderly patients with syncope. The predominant impairment in elderly patients with unexplained syncope was the bradycardia component of the responses to deep breathing and cough, suggesting that these patients may have impaired parasympathetic modulation of heart rate. Although not likely to be the cause of syncope in these patients, these findings may reflect an underlying autonomic defect.