Initial orthostatic hypotension and syncope due to medications in a 60 year old male: Difference between revisions

''W Wieling*, M.P.M. Harms*, R.A.M.  Kortz+  and M. Linzer#''<br />

''* Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam (The Netherlands); + Department of Cardiology, Flevoziekenhuis, Almere (The Netherlands); # Department of Medicine, University of Wisconsin. Madison, Wisconsin (USA).''<br /><br />   

{{case_present|

A 60-year old man presented with six months of recurrent unexplained syncope. The spells occurred suddenly, usually upon standing up. The patient was taking pipamperon (a neuroleptic), fluvoxamine (an antidepressant) and clobazam (a benzodiazepine) for depression, and sotalol and acenocoumarol for paroxysmal atrial fibrillation <cite>Wieling</cite>. The patient had been recently hospitalized after an episode of transient loss of consciousness, which occurred upon standing from the squatting position, while doing a painting job. The spell was accompanied by myoclonic jerks and the fall caused a large hematoma in the lumbar region. During his two weeks hospital stay, he had an entirely negative evaluation including physical examination, electrocardiography, echocardiography and blood analysis. During 24-hrs ECG monitoring sinus rhythm was observed during episodes of near-syncope. His blood pressure at one time decreased from supine values around 100/70 mmHg to values around 80 mmHg systolic after 2-3 min standing, but there were no accompanying symptoms of near-collapse and this finding could not be reproduced. He was referred to the syncope unit of the Academic Medical Centre for tilt-table testing.