Li Y, Wang M, Liu XL, Ren YF, Zhang WB. Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope: A case report. World J Clin Cases 2021; 9(21): 6073-6080 [PMID: 34368329 DOI: 10.12998/wjcc.v9.i21.6073]
Corresponding Author of This Article
Wen-Bin Zhang, PhD, Associate Chief Physician, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, No. 3 Qinchundong Road, Hangzhou 310016, Zhejiang Province, China. 3313011@zju.edu.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2021; 9(21): 6073-6080 Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6073
Neurogenic orthostatic hypotension with Parkinson's disease as a cause of syncope: A case report
Ya Li, Min Wang, Xiang-Lan Liu, Ya-Fei Ren, Wen-Bin Zhang
Ya Li, Min Wang, Xiang-Lan Liu, Wen-Bin Zhang, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Ya-Fei Ren, Department of Rehabilitation Medicine, Qilu Institute of Technology, Jinan 250200, Shandong Province, China
Author contributions: Li Y and Ren YF reviewed the literature and contributed to manuscript drafting; Wang M and Liu XL were the patient’s cardiologists; Zhang WB was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bin Zhang, PhD, Associate Chief Physician, Department of Cardiovascular Diseases, Sir Run Run Shaw Hospital, College of Medicine of Zhejiang University, No. 3 Qinchundong Road, Hangzhou 310016, Zhejiang Province, China. 3313011@zju.edu.cn
Received: March 18, 2021 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 Processing time: 124 Days and 23.7 Hours
Abstract
BACKGROUND
Syncope presents with diagnostic challenges and is associated with high healthcare costs. Neurogenic orthostatic hypotension (nOH) as one cause of syncope is not well established. We review a case of syncope caused by nOH in a patient with Parkinson's disease.
CASE SUMMARY
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.
CONCLUSION
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.
