Cough Syncope, PH, Scleroderma

[hollywd]

My husband 49, has PH & Scleroderma.  In the last year has had episodes of cough syncope.  First they tried to take him off diovan, then eventually digitek.  They also suggested that his esophagheal dysfunction was creating the Gerd that was causing the coughing, sending the blood out of his lungs and making him pass out.  He has had more episodes lately, along with a lot of irregular heart beats.  He is taking bosentan 125 bid, which one of the side effects is cough syncope.  today, he fell down in the bathroom and hit the wall.  I don't know what else to do.

[hollywd]

Thank you for taking the time to response, He is terrible aabout drinking water, I will talk to the doctor about that.  They took him off one of his medicines for PH (tracleer) and have replaced it with Letairis, and he hasn't had an episode for 2 weeks.  He does have Esophageal dysfunction from the scleroderma.  He has had two stretchings and has been on protonix before, but now is on nexium 40 mg. 2x per day.  They are probably now going to start the digitek up again, and they did originally consider vaso-vagal, but it is strictly cough, related all the time to coughing.  Laying down, sitting, standing, it doesn't matter, if he coughs at all strenously, he goes out.  We see his PH doc this friday, so I'll ask about more water.  thanks.

[Artaud]

Hi,

I'm sorry I don't have anything significant to offer at this time, but there are some sharp people on this forum, I hope that they have something for you.

If your husband can anticipate the coughs, perhaps he should lower himself or sit before coughing to reduce the possibility of injury from the fall. Is the esophagheal dysfunction from the Scleroderma?

Does your Husband restrict his diet to foods unlikely to produce significant acid. Tomato Sauce does me in, talk about breathing fire. Even a little Pizza is enough to assure me that my stomach will be producing acid in epic proportions. When I have acid, since I have reflux, I have coughed from the acid vapors coming from my stomach. I could take Protonix which does a great job, but the last thing I need is another drug on top of the million or so I take now. Spicey foods are also a problem. People can actually produce enough Acid Vapors from Reflux to etch the teeth. Imagine what it does to the lungs.

I wonder if the syncope is caused by Vagal Nerve Stimulation caused by the coughing. See Vagus Nerve on Wikipedia. Elsewhere, I found this:

"Vagus Nerve Stimulation: Fainting may occur if the vagus nerve, which supplies the neck, chest, and intestine, is stimulated. When stimulated, the vagus nerve slows the heart. Such stimulation also causes nausea and cool, clammy skin. This type of fainting is called vasovagal (vasomotor) syncope. The vagus nerve is stimulated by pain, fear, other distress (such as that due to the sight of blood), vomiting, a large bowel movement, and urination."

If this were the case, you may seek treatments for Vaso-Vagal Syncope. One article said that Vaso-Vagal Syncope can be caused by low blood volume. If your Husband is coughing out blood and not drinking enough water, blood volume will be low. Consult with his Doctor to be sure that the increased water won't add to the Pulmonary Hypertension. More water will (should) increase the volume. This is a common method for some to obtain relief from PVCs (arrhythmia) due to Mitral Valve Prolapse. If your Husband is not on anti-acid medications, consider Protonix, it's very effective. Protonix is a Proton Pump Inhibitor, as is Prilosec. Ask his Doctor before starting medications.

I wish the best for you and your husband. I am sure that this is a trial for you as well. Make the best of the Holiday that you can.