title: Diagnostic role of head-up tilt test in patients with cough syncope.
abstract: OBJECTIVE
  The aim of this study was to describe the head-up tilt (HUT) test and carotid sinus massage (CSM) responses, and the occurrence of syncope with coughing during HUT in a large cohort of patients.
  
  
  RESULTS
  A total of 5133 HUT were retrospectively analysed to identify patients with cough syncope. Head-up tilt followed by CSM were performed. Patients were made to cough on two separate occasions in an attempt to reproduce typical clinical symptoms on HUT. Patients with cough syncope were compared with 29 age-matched control patients with syncope unrelated to coughing. A total of 29 patients (26 male, age 49 ± 14 years) with cough syncope were identified. Coughing during HUT reproduced typical prodromal symptoms of syncope in 16 (55%) patients and complete loss of consciousness in 2 (7%) patients, with a mean systolic blood pressure reduction of 45 ± 26 mmHg, and a mean increase in heart rate of 13 ± 8 b.p.m. No syncope or symptoms after coughing were observed in the control group. The HUT result was positive in 13 (48%) patients with the majority of positive HUT responses being vasodepressor (70% of positive HUT). Carotid sinus massage was performed in 18 patients being positive with a vasodepressor response causing mild pre-syncopal symptoms in only 1 patient.
  
  
  CONCLUSIONS
  Syncope during coughing is a result of hypotension, rather than bradycardia. Coughing during HUT is a useful test in patients suspected to have cough syncope but in whom the history is not conclusive.
authors.affiliation: Emergency Department, G. Brotzu Hospital, Cagliari, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mereu
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Taraborrelli
authors.affiliation: Imperial College London, London, UK.
authors.forename: Arunashis
authors.initials: A
authors.lastname: Sau
authors.affiliation: Department of Internal Medicine, University of Pavia, Pavia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Toro
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Halim
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Sajad
authors.initials: S
authors.lastname: Hayat
authors.affiliation: Department of Internal Medicine, University of Pavia, Pavia, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Bernardi
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sutton
authors.affiliation: Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK pblim@imperial.ac.uk.
authors.forename: Phang Boon
authors.initials: PB
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000145:classification / Q000150:complications*; D002346:Carotid Sinus / Q000503:physiopathology; D016022:Case-Control Studies; D003371:Cough / Q000503:physiopathology*; D005260:Female; D006336:Heart Massage; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019462:Syncope, Vasovagal / Q000175:diagnosis*; D018667:Tilt-Table Test
keywords: Carotid sinus massage; Cough syncope; Head-up tilt test; Loss of consciousness; Sensitivity; Situational syncope