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orthostatic syncope
Etiology:
- hypovolemia
- medications
- alcohol intoxication
- parkinsonism (less common)
- autonomic insufficiency
Epidemiology:
- occurs in older patients
Clinical manifestations:
- rapid onset syncope after positional changes
- prodrome of lightheadedness common
- orthostasis:
- sustained reduction in systolic BP of >= 20 mm Hg or diastolic BP of >= 10 mm Hg within 3 minutes of assuming upright position
Special laboratory:
- tilt table testing
- slow progressive decrease in blood pressure associated with increased upward tilt [2]
- abrupt fall in blood pressure associated with syncope may be more characteristic of vasovagal syncope [2]
Differential diagnosis:
- vasovagal syncope
- syncope associated with prolonged standing consistent with vasovagal syncope
- with orthostatic syncope, autonomic dysfunction is more prevalent [2]
Management:
- volume expansion
- liberalization of salt intake
- medication reconciliation
- compression stockings
- education on postural changes
General
syncope
References
- Medical Knowledge Self Assessment Program (MKSAP) 18, 19.
American College of Physicians, Philadelphia 2018, 2021
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022