ACP InternistMKSAP Quiz: Syncopal and Near-Fainting Events

Can you determine the appropriate case management for a 68-year-old man who is evaluated for an episode of syncope and repeated episodes of near-fainting when standing and working on his tractor? On physical examination, vital signs are normal. Supine blood pressure is 124/78 mm Hg, and pulse rate is 76/min. After the patient stands for three minutes, standing blood pressure is 88/68 mm Hg, and pulse rate is 94/min. The remainder of the examination is normal. How would you proceed?