Initial orthostatic hypotension as a cause of syncope in an adolescent: Difference between revisions

A 17 year old man was referred for evaluation of complaints of light-headedness and muscle weakness shortly (5-10 sec) after standing up or when standing still after physical exercise. He had fainted on numerous occasions just after standing up. The complaints existed already for 8 years. He had visited 5 different medical specialists and was referred for psychiatric evaluation, but no diagnosis had been made.   

The patient was tall (197 cm) and slender (73 kg). He was examined using a Finapres model 5 (TNO Biomedical Instrumentation, Amsterdam, The Netherlands), which measures rapid changes in blood pressure continuously, accurately and non-invasively<cite>Wieling2</cite>. In supine position finger arterial pressure was 105/60 mmHg with a heart rate of 70 bpm. The initial drop in blood pressure (Fig 1. left panel) upon active standing was abnormally large (-65 mmHg systolic and -30 mmHg diastolic; normally blood pressure does not drop for more than -40 mmHg systolic and -20 mmHg diastolic). During the drop in blood pressure the patient had recognizable symptoms. His complaints disappeared within 20 seconds after standing up. After 1 and 5 minutes the patient’s blood pressure were 80/55 mmHg and 100/65 respectively and his heart rate was 120 bpm. During head-up tilt there was no drop in blood pressure and the patient expressed no symptoms (Fig. 1, right panel).