A 60-year-old woman comes to the hospital because of an episode of losing consciousness for several seconds. She appeared pale afterwards but was not confused, and fingerstick blood glucose was normal. Medical history includes hypertension, type 2 diabetes mellitus, renal calculas , and Alzheimer disease. Her blood pressure is 130/87 mm Hg in the supine position and 100/76 mm Hg 30 seconds after standing up. Cardiac examination shows no abnormalities. The patient is hospitalized for observation and is found to have an episodic bradyarrhythmia and atrioventricular block. If this patient's condition is due to a medication, which of the following is the most likely cause?

Question

A 60-year-old woman comes to the hospital because of an episode of losing consciousness for several seconds. She appeared pale afterwards but was not confused, and fingerstick blood glucose was normal. Medical history includes hypertension, type 2 diabetes mellitus, renal calculas , and Alzheimer disease. Her blood pressure is 130/87 mm Hg in the supine position and 100/76 mm Hg 30 seconds after standing up. Cardiac examination shows no abnormalities. The patient is hospitalized for observation and is found to have an episodic bradyarrhythmia and atrioventricular block.  If this patient's condition is due to a medication, which of the following is the most likely cause?

Quizplus · Accepted Answer

Eductional Objective: Syncope results from a transient loss of cerebral perfusion, and numerous medications can cause or contribute to syncope. Acetylcholinesterase inhibitors (eg, donepezil, rivastigmine) may cause syncope due to enhanced parasympathetic tone that leads to bradycardia and atrioventricular block with reduced cardiac output.

A 60-Year-Old Woman Comes to the Hospital Because of an Episode