III. Symptoms

IV. Signs

  1. Prevent Bradyarrhythmia with Atropine
  2. Carotid Sinus Massage
    1. Systolic Blood Pressure falls 50 mmHg
    2. Differentiates from Cardioinhibitory Syncope

V. Differential Diagnosis

VI. Management

  1. Discontinue Beta Blockers
  2. Discontinue other Antihypertensive medications
  3. Consider support stockings
  4. Consider Fludrocortisone (water and salt retention)
  5. Consider alpha Agonists such as Midodrine (Vasoconstrictor)
  6. Avoid Pacemaker (not effective)

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