PASSING OUT

[ray]

LATELY I HAVE BEEN EXPERENCING BLACKOUTS WHEN I COUGH.  I HAVE BEEN TO SEE A DOCTOR AND HAVE BEEN MONITORED TO CHECK HEART AND OXYGEN LEVELS DURING AN OCCURRENCE.  IT STARTED OUT THAT I WOULD BLACKOUT WHEN I COUGHED EXCESSIVELY AND DEEPLY FROM WITHIN.  I HAVE BEEN TOLD THAT I AM EXPELLING ALL OF MY AIR WHICH IS CAUSING ME TO BLACKOUT.  I HAVE BEEN ON COUGH SUPRESSANTS THAT HAVE CUT DOWN ON THE SEVERITY OF MY COUGHS.  BUT RECENTLY I AM EXPERENCING THAT EVEN A SLIGHT 1 COUGH IS CAUSING ME TO BLACKOUT.  THIS IS HAPPENING WHILE I AM DRIVING ON THE INTERSTATE AND I DON'T HAVE TIME TO STOP.  I COULD UNDERSTAND THE EXPELLING ALL MY AIR WHEN I WAS COUGHING MY GUTS OUT BUT NOW A SLIGHT COUGH SHOULD NOT CAUSE ME TO PASSOUT.  ANY SUGGESTIONS.  I AM STILL SEENING MY DOCTOR BUT I WANT TO KNOW OPTIONS AVAILABLE.

[Cleveland Clinic, MD]

Dear Ray,

The medical term for fainting is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  Your type is probably "cough related syncope" and may be effectively treated with a beta-blocker medication.  This should be further evaluated however by a specialist in this area and you must stop driving until this is treated. Here is some additional information on syncope.

The most common cause is the common faint (neurocardiogenic or vasovagal syncope).  This is the typical faint caused by strong emotional factors (i.e. the sight of blood) and is usually brief in duration.  The person almost never harms themselves and the precipitating factor can usually be identified.  More serious forms of syncope are due to cardiac and neurologic causes.  

Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.

Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.  Tilt table testing is a simple test that is pretty much what it sounds like.  The patient is placed on a table and ECG and blood pressure monitoring are attached.  The table is then tilted upright so the person is in a vertical position and the heart rate and blood pressure are monitored.  People with certain types of syncope are more likely to have symptoms during this test.  The entire test lasts about a half hour.

Medications can sometimes be used for treatment of the "common faint".  A beta-blocker is the most typical medication used. Other treatments that may be recommended include liberalizing  salt intake, compression stockings and elevating the head of the bed with blocks 6 inches.  Finally, slowing rising and "bouncing" on one's toes when a faint feeling comes helps return blood circulation to the head.

As you can see the diagnosis is somewhat complex. Therefore, I would recommend that you see a specialist in the area of syncope.  Two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.

[Cleveland Clinic, MD]

The medical term for fainting is syncope (or near syncope if one dosen't actually pass out).  This is a common but complex condition that has many causes.  Your type is probably "cough related syncope" and may be effectively treated with a beta-blocker medication.  This should be further evaluated however by a specialist in this area and you must stop driving until this is treated. Here is some additional information on syncope.

Syncope due to bradyarrhythmias (slow heart rate) or tachyarrhythmias (fast heart rates) are often hard to document.  Holter monitors will only reveal the source if they are being worn during an event.  "Event monitors" are devices that can be worn for months at a time and when an event occurs a button is pressed that saves the heart rhythm for the last 5 minutes.  This can then be sent to the doctor over the telephone for a diagnosis.  Other less common cardiac causes are carotid sinus irritability which is due to an abnormal structure in the neck that results in syncope when pressed upon.

Neurologic forms of syncope include autonomic nervous system diseases and seizure disorders.  These are diagnosed with tilt table testing and seizures with an EEG.  Tilt table testing is a simple test that is pretty much what it sounds like.  The patient is placed on a table and ECG and blood pressure monitoring are attached.  The table is then tilted upright so the person is in a vertical position and the heart rate and blood pressure are monitored.  People with certain types of syncope are more likely to have symptoms during this test.  The entire test lasts about a half hour.

Medications can sometimes be used for treatment of the "common faint".  A beta-blocker is the most typical medication used. Other treatments that may be recommended include liberalizing  salt intake, compression stockings and elevating the head of the bed with blocks 6 inches.  Finally, slowing rising and "bouncing" on one's toes when a faint feeling comes helps return blood circulation to the head.

As you can see the diagnosis is somewhat complex. Therefore, I would recommend that you see a specialist in the area of syncope.  Two doctors that specialize in this area here are Dr. Fred Jaeger and Dr. Fetnat Fouad.  You can make an appointment with either of them by calling the number below.  Good luck.

[David Stevenson]

I also was diagnosed with cough syncope.  I spent two weeks in the hospital, with C-T for head and chest tests, EKG and EEG tests, and blood tests.  During the two weeks in hospital, I experienced on average 2-3 cough syncopal seisures per day.  I had a GP, neurologist and respiratory specialist working on me to find a cause.  The only thing they came up with was a diagnosis.  During an episode, here is what I experienced:

- Intense coughing spell of 3-5 seconds
- Losing consciousness for 3-5 seconds, causing coughing to stop
- 10-15 seconds to orient myself as to where I was and what had just happened

The episodes have happened at all times of the day.

During the two weeks in the hospital I eventually got to recognize that a certain intensity of cough was likely to result in passing out.

The doctors have me on Erythromycin, Ventalin, FloVent, Extended Dimetapp and Losec (Omeprozole Magnesium), and a narcotic cough medicine called Robidone.  This is to prevent the cough.

I would appreciate any ideas there might be on how to prevent these episodes, or what might cause them.  

I am not safe driving or even walking by myself until I am sure it won't happen, or I can predict the episode with enough advanced warning to prevent an accident.

Thanks

David Stevenson
***@****

[Cleveland Clinic, MD]

Cough syncope can be quite a problem when it occurs.  Sometimes medications such as beta-blockers may help.  I would look for a cardiologist with expertise in the area of syncope.

[Gene]

I too have situations where I faint... When I laugh at something funny I start to cough and eventually pass out for 10 seconds, I am told.  If I can avoid laughing or coughing I don't ever seem to faint.  But if someone says something I find funny... out I go! Can you help?
Gene

[Paul Tavernier]

Ray: I have exactly the same symptoms as you have (had).  I was admitted to the Georgetown Medical Center on May 6th and released on May 24th.  Initially , the doctors thought I was having seizures caused by coughing.  I went through the entire neuro testing (MRI,ECHO,EKG,EEG, etc.)  So far I've passed with a clean bill of health and relesed.  My problem is that I still have a fainting spell at least once a night.  They are not as intense as when they first started because at the start my eyes were hemmoranging and I had extreme pain.  Ray, If you can give me any advice it certainly would be welcomed. Please list any medications you are taking. Thanks.... [phone]

[Paul Tavernier]

Ray: I have exactly the same symptoms as you have (had).  I was admitted to the Georgetown Medical Center on May 6th and released on May 24th.  Initially , the doctors thought I was having seizures caused by coughing.  I went through the entire neuro testing (MRI,ECHO,EKG,EEG, etc.)  So far I've passed with a clean bill of health and relesed.  My problem is that I still have a fainting spell at least once a night.  They are not as intense as when they first started because at the start my eyes were hemmoranging and I had extreme pain.  Ray, If you can give me any advice it certainly would be welcomed. Please list any medications you are taking. Thanks.... [phone]