Approach to syncope Quiz: Ace Your Exams

A 72-year-old man is brought to the emergency department due to a syncopal episode that occurred at home while gardening. According to the patient, he stood up from gardening, immediately felt light-headed, and fell to the ground. The patient’s spouse reports that he awoke immediately following the fall and seemed slightly disoriented, but was able to answer questions appropriately. He did not hit his head and there was no shaking movement of the limbs during the incident. The patient had a recent gastrointestinal illness with vomiting and diarrhea that ended this morning. He has a past medical history of hypertension and coronary artery disease. Medications include aspirin, atorvastatin, carvedilol, and losartan. Temperature is 37°C (98.6°F), pulse is 68/min, and respirations are 20/min. His blood pressure is 132/84 mmHg while seated and drops to 102/62 mmHg after standing for two minutes. His heart rate increases from 68/min while seated to 82/min upon standing. The patient is awake, alert, and oriented, with normal speech. Dry mucous membranes are noted. Heart and lung examinations are normal. Strength is 5/5 in the upper and lower extremities, and gait is normal. ECG shows normal sinus rhythm. Which of the following is the best next step in management?