SUMMARYA 72-year-old man was referred for further assessment of a chronic cough. He noticed an association between the episodes of coughing and palpitations. Electrocardiography (ECG) revealed normal sinus rhythm and sporadic unifocal ventricular premature contractions (VPCs). Each cough was preceded by a premature beat. Continuous wave Doppler echocardiography revealed a VPC-induced transient increase in the pulmonary artery blood flow. He was successfully treated for VPCs with oral disopyramide, resulting in subsidence of both the coughing and palpitations. We suspect that the VPC-induced hemodynamic changes in the pulmonary circulation might be responsible for coughing in our patient. Premature contractions should be considered as a possible cause of chronic dry cough in the clinical setting. ( 1) Odeh and Oliven were the first to report an association between atrial premature contractions and coughs.2) However, the underlying mechanisms as to why premature contractions cause cough reflex have not been elucidated. We present a case with cough reflex associated with ventricular premature contractions along with a possible explanation for the relationship between the two pathophysiological phenomena. CASE REPORTA 72-year-old man was referred by his family physician in April 2004 to our outpatient clinic for further assessment of a cough that had continued for 3 months. The cough was dry and sporadic over a 24 hour period. He noticed that the cough was associated with palpitations and that the episodes of coughing and palpitations increased and decreased simultaneously. Physical examination was normal except for skipped heart beats. There were no other symptoms and signs From the Division of

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Detailed observation of donor hearts by bedside echocardiograms upon the organ procurement is of clinical benefit.

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