Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2017; 9(5): 466-469
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.466
Cough induced syncope: A hint to cardiac tamponade diagnosis
Roberto Ramirez, Glenmore Lasam
Roberto Ramirez, Glenmore Lasam, Department of Medicine, Atlantic Health System-Overlook Medical Center, Summit, NJ 07901, United States
Author contributions: Both authors contributed to the manuscript.
Institutional review board statement: As per the Institutional Review Board (IRB) of the Atlantic Health System, an IRB approval is not needed for case report.
Informed consent statement: The patient in the case report gave an informed verbal and telephone consent.
Conflict-of-interest statement: Both authors declare no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Glenmore Lasam, MD, Department of Medicine, Atlantic Health System-Overlook Medical Center, 99 Beauvoir Avenue, Summit, NJ 07901, United States. glenmore_md@yahoo.com
Telephone: +1-908-5222987 Fax: +1-908-5220804
Received: October 15, 2016
Peer-review started: October 19, 2016
First decision: November 14, 2016
Revised: January 10, 2017
Accepted: February 8, 2017
Article in press: February 13, 2017
Published online: May 26, 2017
Processing time: 217 Days and 4 Hours
Abstract

We report a case of a 75-year-old male with history of lung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis.

Keywords: Cardiac tamponade; Cough-induced syncope; Pericardial effusion

Core tip: Cough-induced syncope should be a hint towards the consideration of either pericardial effusion or cardiac tamponade. Aside from the medical history and the diagnostic imaging modalities to include echocardiogram and chest computed tomography, clinical evaluation to explore pulsus paradoxus is imperative which has a high sensitivity in the diagnosis of cardiac tamponade. Timely diagnosis of cardiac tamponade because of these clues translate into prompt intervention to prevent the deleterious complications associated with it.