To the Editor.—
The problem of near syncope in elderly patients may pose diagnostic challenges. For my cost-conscious colleagues, I am reporting an unusual cause that was self-diagnosed by an alert 82-year-old man whose moderate hypertension was controlled by methyldopa and Dyazide (combination product of hydrochlorothiazide and triamterene).
Report of a Case.—
The patient complained of recent repeated attacks of faintness and hissing tinnitus. His blood pressure was 138/88 mm Hg, and no carotid bruits were present during an unremarkable routine examination.
Rather than undergo extensive testing, the patient chose to analyze carefully the circumstances under which he experienced light-headedness. Three days later, he found the answer.
For Christmas, he had been given a zip-up turtleneck shirt. Upon donning the garment, he was aware that the neck portion, although comfortable, was tight. On several occasions, during the period of analysis, he precipitated near-syncopal attacks by fully zipping the collar. He
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