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Abstract
A 62-year-old man presented with a 2-year history of syncope, collapse and fluctuating blood pressure (BP). His medications included midodrine (10 mg, three times per day) and fludrocortisone (0.1 mg, two times per day), but neither treatment afforded symptomatic relief. Autonomic testing was performed. Head-up tilt table testing revealed a supine BP of 112/68 mm Hg (heart rate, 74 beats per minute (bpm)) after 6 min, which dropped to 76/60 mm Hg (83 bpm) within 2 min of 80° head-up tilt. Findings from a heart rate with deep breathing test and a Valsalva test were consistent with autonomic dysfunction. The patient was diagnosed with neurogenic orthostatic hypotension and treated with droxidopa (100 mg, two times per day; titrated to 100 mg, one time per day). After initiating treatment with droxidopa, the patient no longer reported losing consciousness on standing and experienced improvement in activities of daily living. These improvements were maintained through 1 year of follow-up.
- clinical diagnostic tests
- cardiovascular system
- neurology (drugs and medicines)
- medical management
- clinical neurophysiology
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Contributors SBA, WA and AS contributed to the acquisition, analysis and interpretation of data; participated in drafting the manuscript; critically revised the manuscript for intellectual content and approved the final version of the manuscript for publication. All authors agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SBA received support from Lundbeck for travel and registration fees. WA has nothing to disclose. AS has received honoraria for serving on advisory boards for Lundbeck.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.