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Tuesday, December 10, 2013
Cough syncope with cystic fibrosis
Our daughter is 21 and has Cystic Fibrosis and Cough Syncopede. The episodes are weekly and she passes out and coughs up large amounts of blood. What can we do to help her? The Dr`s that we have talked to have made no suggestions as to what we can do besides putting her feet up and pushing her hands together to try and get out of the fainting. When she wakes up it is several hours later and has a migraine along with this. Help!!!!
Cough syncope is a very difficult problem. Basically, with severe episodes of cough (a coughing fit), some patients black out. Although several things can contribute to cough syncope, the basic problem in CF is one of prolonged cough episodes. During these events, the pressure in the chest is increased and blood cannot flow back to the heart. The heart has little blood to pump, resulting in decreased blood flow to the brain. This causes the patient to pass out.
This problem may be worse if the patient has pulmonary hypertension. For this reason, an echocardiogram should be considered, to determine whether pulmonary hypertension is present. Another contributing factor may be low blood pressure, so it is important not to become dehydrated.
There is no truly effective treatment. Putting the feet up helps blood return to the heart. For a patient with CF, it would not be wise to suppress the cough because an effective cough is essential to clear the typical airway secretions. However, control of the coughing episodes may help reduce the events.
Often, the long hard coughing fits are not very effective at clearing secretions. This type of cough is frequently the ones associated with syncope. Working on controlled breathing techniques and controlled cough with huff cough may be more effective in clearing secretions.
Furthermore, shortened duration of the coughing "fits" may help decrease the syncope. Unfortunately, there is no cure for the problem.
Patricia Joseph, MS, MD
Associate Professor of Medicine
College of Medicine
University of Cincinnati