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

Diagnostic procedures

• tilt table testing
  • slow progressive decrease in blood pressure associated with increased upward tilt
  • abrupt fall in blood pressure associated with syncope may be more characteristic of vasovagal syncope

Differential diagnosis

• vasovagal syncope
  • syncope associated with prolonged standing consistent with vasovagal syncope
  • with orthostatic syncope, autonomic dysfunction is more prevalent

Management

• volume expansion
• liberalization of salt intake
• medication reconciliation
• compression stockings
• education on postural changes

More general terms

• syncope