Initial orthostatic hypotension as a cause of recurrent syncope: a case report

A 60-year-old male patient with recurrent unexplained syncope on standing w as studied. During continuous, noninvasive blood pressure (BP) recording wi th a Finapres device, an abnormally large and symptomatic initial decrease in systemic BP was documented. After 2 minutes of standing, BP had recovere d. The transient decrease in BP was attributed to the use of a combination of antidepressants known to interfere with sympathetic function. This case shows the importance of continuous, noninvasive BP measurement on standing: routine intermittent BP recording would have missed the abnormality. In pa tients using medications such as antidepressants, initial transient hypoten sion should be considered as the cause of falls and syncope.