Clinical features of cough syncope: a systematic review

Cough syncope (CS) is a rare subtype of syncope that remains underrepresented in evidence-based medicine. We aimed to characterize the clinical features of CS, with the aim of improving recognition and optimizing management strategies.

We present five cases of CS alongside a systematic review of its clinical characteristics based on published literature to improve recognition and optimize management. Reports of eligible patients were screened, and demographic, clinical, diagnostic, treatment, and outcome data were analyzed.

This study included 60 patients with a mean age of 56 ± 15 years, 91% of whom were male. The most common underlying triggers were respiratory diseases, including pulmonary infections (35%) and bronchitis (22%). Common comorbidities included hypertension (26%), bronchial asthma (18%), and diabetes mellitus (15%). CS episodes were directly triggered by severe coughing in 93% (26/28) of patients. Episodes occurred at least twice daily in 20% of patients, and limb convulsions accompanied syncope in 22%. Symptoms improved after treatment in 98% of cases. After a median follow-up of 3.75 months (Interquartile Range: 2-12 months), the recurrence rate of syncope was 11%. CS, predominantly triggered by severe coughing, primarily affected middle-aged and older men.

CS predominantly affects middle-aged and older men and is frequently associated with pulmonary infections. Acute pulmonary infections serve as a common underlying trigger for CS, and patients are at risk of recurrent syncope and falls. Disease management should be focused on treating chronic airway disease, particularly chronic obstructive pulmonary disease.