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Valve disease, endocarditis and syncope
A practice question in the style of the MCCQE MCQ exam. Choose your answer to see the explanation.
A 72-year-old man on tamsulosin and hydrochlorothiazide fainted after getting out of bed at night to urinate. His lying blood pressure is 134/80 and his standing pressure after 2 minutes is 104/66. What is the most likely cause?
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The answer is B: Orthostatic hypotension from medications.
A systolic drop of 30 mmHg on standing is orthostatic hypotension, with alpha-blockers and diuretics as likely contributors, plus nocturia and volume depletion. Review and adjust medications, encourage fluids and slow positional changes. Every syncope patient still needs an ECG.
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