SHM Converge Scientific Abstract ePoster Gallery-Copd With a Twist: A Rare Case of Cough Syncope

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This case describes an 85-year-old man with COPD and remote bladder cancer who presented with one week of viral-like symptoms, worsening dyspnea, and a syncopal episode triggered by coughing. He was initially found to be hypotensive in atrial fibrillation with rapid ventricular response and was treated as a possible COPD exacerbation.<br /><br />However, several findings raised concern for a cardiac cause: distant heart sounds, anemia, low-voltage QRS on EKG, and cardiomegaly on chest X-ray. An echocardiogram unexpectedly revealed a large pericardial effusion with tamponade physiology. Emergent pericardiocentesis removed 1.1 liters of hemorrhagic, exudative fluid with very high LDH. Cytology was negative for malignancy, and Gram stain/cultures were negative for infection. After drainage, the patient’s dyspnea improved, repeat echocardiography showed a smaller effusion, and he later returned to sinus rhythm. Follow-up imaging showed no recurrent effusion.<br /><br />The main teaching point is that cough syncope is classically linked to obstructive lung disease, but clinicians should not automatically attribute it to COPD. In this case, cough-induced increases in intrathoracic pressure likely worsened impaired venous return from tamponade, causing cerebral hypoperfusion and syncope. <br /><br />The authors emphasize maintaining a high index of suspicion for pericardial effusion or tamponade in patients with cough syncope, especially when accompanied by hypotension, arrhythmia, dyspnea, distant heart sounds, low-voltage EKG findings, or cardiomegaly.

Asset Subtitle

Tosin Adeyemi

Meta Tag

Author List Jaini M. Sutaria, Tosin Adeyemi

Category Clinical Vignettes

Concept Cough Syncope

Concept Cardiac Tamponade

Concept Pericardial Effusion

Concept Echocardiography

Concept Pericardiocentesis

Distinguished Non-Finalist

Presenter Organization Parkland Health and UT Southwestern Medical Center

Presenting Author Tosin Adeyemi

Track Adult

Keywords

cough syncope

pericardial effusion

cardiac tamponade

COPD

atrial fibrillation

low-voltage QRS

hemorrhagic pericardial fluid

pericardiocentesis

dyspnea

cardiomegaly

Cough Syncope

Cardiac Tamponade

Pericardial Effusion

Echocardiography

Pericardiocentesis