cardiovascular-agents and Cough

A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.

Topics: Adrenergic alpha-2 Receptor Agonists; Adult; Benzazepines; Cardiovascular Agents; Clonidine; Cough; Drug Therapy, Combination; Dyspnea; Echocardiography; Electrocardiography; Humans; Inhalation; Ivabradine; Male; Syncope; Tachycardia; Tachycardia, Sinus; Treatment Outcome

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Cough; Cystic Fibrosis; Disease Management; Electrocardiography; Female; Humans; Middle Aged; Respiratory Function Tests; Risk Factors; Treatment Outcome; Vascular Diseases

Stress cardiomyopathy is described as acute myocardial infarction provoked by a stressful event with evidence of a significant focal wall motion but with little or no significant coronary artery disease. In this case report, a particularly bad bout of coughing resulted in chest pressure, troponin release, and evidence of antero-apical dyskinesis despite angiographic normal coronary arteries. The patient made a full recovery of function after an uncomplicated hospital stay.

Topics: Aged, 80 and over; Biomarkers; Cardiovascular Agents; Cough; Echocardiography; Female; Humans; Radionuclide Ventriculography; Stroke Volume; Takotsubo Cardiomyopathy; Treatment Outcome; Troponin T; Ventricular Function, Left

OBJECTIVE. This study examines cough recorded in Prescription-Event Monitoring (PEM) of four ACE-inhibitors. Particular attention was paid to the study of enalapril because the drug was monitored before the causal relationship between cough and ACE-inhibitors had been widely accepted. RESULTS. Several factors which had obscured the causal relationship in the individual cases were found to be also an obstacle in PEM. For example, cough was a common and non-serious event and was under-reported in the PEM study of enalapril and the rate was not strikingly different from that recorded for other drugs. Cough induced by ACE-inhibitors has several characteristics which reduce the chance of a recognisable "signal'. The original questionnaires returned from doctors in the PEM study of enalapril have been reexamined. The observation that the rate of cough diminished after enalapril had been stopped rather than increased after starting, provided the best evidence of causality, because this was not affected by many biases such as the publicity that had occurred prior to doctors participating in PEM completed later reports.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cohort Studies; Cough; Enalapril; Female; Humans; Indoles; Lisinopril; Male; Middle Aged; Perindopril; Product Surveillance, Postmarketing; Ramipril; Structure-Activity Relationship; Surveys and Questionnaires

Topics: Cardiovascular Agents; Child; Codeine; Cough; Drug Therapy; Expectorants; Humans; Infant; Morphine; Muscle Relaxants, Central; Toxicology

Topics: Cardiovascular Agents; Cough; Muscle Relaxants, Central

Topics: Cardiovascular Agents; Cough; Muscarinic Antagonists; Muscle Relaxants, Central; Muscle Spasticity; Parasympatholytics

Topics: Antitussive Agents; Cardiovascular Agents; Cough; Humans; Muscle Relaxants, Central