Diagnosis and management of premature ventricular complexes-associated chronic cough.
BACKGROUND
Chronic cough frequently remains unexplained. Although various cardiac arrhythmias have already been reported as a cause of chronic cough, this phenomenon has not been evaluated prospectively. Therefore, we studied the incidence and management of cough associated with premature ventricular complexes (PVCs) in a population of patients with this condition.


METHODS
Patients without organic heart disease who had been referred for the management of symptomatic PVC were evaluated prospectively. PVC-associated cough was recognized if cough episodes occurred just after spontaneous or induced PVC or observed in an ECG or a multichannel recording system that included ECG. A differential diagnosis of cough was performed according to the guidelines on cough. Afterward, antiarrhythmic therapy was instituted to eliminate PVC and cough.


RESULTS
Of the 120 patients who were referred for the management of PVC, 10 had a chronic cough. After extensive workup for the cause of chronic cough, the cough was thought to be solely due to PVC in one patient, partially due to PVC plus another cause in five patients, and not due to PVC but to nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and chronic sinusitis in four patients. Patients with PVC-associated cough reported more severe perception of symptoms associated with arrhythmia than patients without cough (mean [+/- SD] visual analog scale score, 8.2 +/- 0.5 vs 5.7 +/- 1.6, respectively; p < 0.01). PVC-associated cough disappeared after antiarrhythmic treatment (radiofrequency ablation [n = 4], oral antiarrhythmic agent [n = 1]), or after spontaneous remission of PVC (n = 1).


CONCLUSIONS
PVC may be a cause of chronic cough. Interdisciplinary cooperation is warranted for the proper diagnosis and management of PVC-associated cough.
Stec
Sebastian M
SM
Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland. Electronic address: smstec@wp.pl.
Grabczak
Elżbieta M
EM
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.
Bielicki
Piotr
P
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.
Zaborska
Beata
B
Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
Krenke
Rafał
R
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.
Kryński
Tomasz
T
Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
Dąbrowska
Marta
M
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.
Domagała-Kulawik
Joanna
J
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.
Domeracka-Kołodziej
Anna
A
Department of Otolaryngology, Warsaw Medical University, Warsaw, Poland.
Sikorska
Agnieszka
A
Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
Kułakowski
Piotr
P
Department of Cardiology, Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland.
Chazan
Ryszarda
R
Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland.