lisinopril and Syncope

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Antihypertensive Agents; Atorvastatin; Atrial Fibrillation; Bone Density Conservation Agents; Deprescriptions; Digoxin; Diltiazem; Diuretics; Drug Overdose; Factor Xa Inhibitors; Female; Furosemide; Heart Failure; Histamine H1 Antagonists, Non-Sedating; Histamine H2 Antagonists; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Ibandronic Acid; Lisinopril; Loratadine; Metoprolol; Polypharmacy; Pyrazoles; Pyridones; Ranitidine; Syncope

Head-up tilt testing is an important tool in the diagnosis of syncope. Several different protocols are in use. We describe the case of a 70-year-old Italian woman admitted to our observation. The patient was in antihypertensive treatment with carvedilol and with a combination of lisinopril and hydrochlorothiazide. A simplified Italian protocol head-up tilt testing was performed. A 4.10 s pause with syncope and a profound hypotension (blood pressure values were 65/50 mm Hg) were observed after 3 min in the provocation phase. Second-degree atrioventricular Block of the 2:1 form, advanced second-degree atrioventricular block and junctional escape rhythm (28 bpm) were observed. A simplified Italian protocol head-up tilt testing was performed after 40 days of withdrawal of carvedilol. A 2 s pause with presyncope and a hypotension (blood pressure values were 80/70 mm Hg) were observed after 2 min in the provocation phase. ECG revealed a bradycardic sinusal rhythm with heart rate of 42 bpm. This case assesses the importance of a pharmacological washout for the correct evaluation of the head-up tilt testing.

Topics: Aged; Antihypertensive Agents; Carbazoles; Carvedilol; Diagnostic Errors; Drug Therapy, Combination; Electrocardiography; Female; Humans; Hydrochlorothiazide; Hypertension; Hypotension, Orthostatic; Lisinopril; Propanolamines; Syncope; Tilt-Table Test