Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6073
Peer-review started: March 18, 2021
First decision: April 23, 2021
Revised: May 6, 2021
Accepted: May 15, 2021
Article in press: May 15, 2021
Published online: July 26, 2021
Syncope presents with diagnostic challenges and is associated with high heal
We describe a case of syncope caused by nOH in Parkinson's disease and review the literature. A 70-year-old man with Parkinson's disease had uncontrolled blood pressure for 1 mo, with blood pressure ranging from 70/40 to 220/112 mmHg, and once lost consciousness lasting for several minutes after getting up. Ambulatory blood pressure monitoring indicated nocturnal hypertension (up to 217/110 mmHg) and morning orthostatic hypotension (as low as 73/45 mmHg). Seated-to-standing blood pressure measurement showed that the blood pressure dropped from 173/96 mmHg to 95/68 mmHg after standing for 3 min from supine position. A diagnosis of nOH with supine hypertension was made. During the course of treatment, Midodrine could not improve the symptoms. Finally, the patient's blood pressure stabilized with simple strategies by strengthening exercises, reducing the duration of lying in bed in the daytime, and consuming water intake before getting up.
nOH is one of the causes of syncope. Ambulatory blood pressure monitoring is a cost-effective method for its diagnosis, and non-pharmacological measures are still the primary management methods.
Core Tip: Syncope presents with diagnostic challenges and is associated with high healthcare costs. For syncope caused by a change in position, neurogenic orthostatic hypotension (nOH) should be considered to reduce missed diagnosis and misdiagnosis. Paying attention to comorbidities, such as Parkinson's disease and diabetes which could cause can autonomic dysfunction, also helps in the diagnosis of the cause of syncope. Ambulatory blood pressure monitoring can assist in diagnosing nOH. It is very challenging for clinicians to manage patients with nOH and supine hypertension. Increasing physical activity and reducing the amount of time in bed are still the primary management methods.