Question

A 74-year-old man is brought to your office by his concerned

wife. At about 2:30 this morning he got up to go
to the bathroom, feeling a little light-headed. He sat on
the toilet, but even as he did so he could feel himself
blacking out. His wife heard a thud and found him unconscious.
He became conscious in about 10 to 15 seconds.
He did not feel chest pain or palpitations before or after
the episode, and he was not incontinent. On further
questioning, he states that he has had a cold for the past
4 days, for which he has taken a combination medication
containing pseudoephedrine and chlorpheniramine.
Rarely an alcohol drinker, he admits to having a few beers
last evening while watching Monday night football with
his son, who is visiting. He does not have a history of
seizures. Four months ago, he had a normal cardiac treadmill
test performed by his cardiologist as part of a routine
evaluation. Other than the cold preparation and one aspirin
a day, he is not taking medication. Which of the
following conditions contributed to this episode of vasovagal
dizziness and syncope?
a. History of alcohol intake last night
b. Common cold for 4 days, probably viral illness
c. Use of medications containing pseudoephedrine and
chlorpheniramine
d. Postural hypotension secondary to rapidly getting up
from lying-down position
e. All of the above

Answer 1

The 74-year-old man's syncope was likely caused by a combination of alcohol intake, effects of a common cold, medications containing pseudoephedrine and chlorpheniramine, and postural hypotension from standing up too quickly.

The 74-year-old man's episode of vasovagal dizziness and syncope is likely multifactorial. Each of the factors listed in the question could have contributed to the event. The history of alcohol intake the previous night could have effects on his vasculature and hydration status; the common cold he's been suffering from may be causing systemic effects such as dehydration; the medications containing pseudoephedrine and chlorpheniramine could contribute to both dehydration and blood pressure changes; and lastly, postural hypotension secondary to rapidly getting up from a lying-down position can lead to a decrease in cerebral perfusion, especially in older adults and considering the other factors at play.

Therefore, the final answer is e. All of the above, as they all could contribute to vasovagal dizziness and syncope.