Case Challenge

Which Drug Is Causing This Woman's Syncope?

Douglas S. Paauw, MD

Disclosures

May 16, 2017

Case Presentation

An 85-year-old woman is brought to the emergency department after a syncopal episode. Her care providers reported a similar episode 2 weeks ago, but she recovered so quickly they did not seek an evaluation for her. Her medications include donepezil 20 mg daily, pravastatin 40 mg daily, citalopram 10 mg daily, albuterol 10 mg daily, isosorbide mononitrate 16 mg daily, and a calcium supplement.

On exam, the patient's blood pressure while seated was 100/60 mm Hg, with a heart rate of 55 beats/min. Her blood pressure while standing was 95/60 mm Hg, with a heart rate of 60 beats/min. An ECG showed bradycardia with normal intervals.

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