case_images: PMC5331769_01
case_images: Tilt test registration. The figure shows the recording of systolic blood pressure, diastolic blood pressure, and heart rate in clinostatic and sitting position (passive orthostatic position not performable because of severe presyncopal symptoms) during a tilt test. In sitting position, an immediate reduction in systolic blood pressure to 55 mmHg and diastolic blood pressure to 28 mmHg is evident, without any change in the heart rate, which remains stable at 76 beats/min
case_images: JRMS-21-117-g001.jpg
case_images: PMC5331769_01_JRMS-21-117-g001.jpg
case_images: F1
case_images: A tilt table test demonstrated the absence of autonomic reflexes with severe blood pressure drop (SBP up to 55 mmHg and diastolic blood pressure [DBP] up to 28 mm Hg) without HR modification when reaching upright position [Figure 1].
case_images: Electrocardiogram (a) and cardiac ultrasound, (b) The figure shows the 12-lead electrocardiogram pointing out the first-degree atrioventricular blockage (panel A). In panel B, cardiac ultrasound (parasternal long-axis view) depicts left ventricle wall thickness, diffuse myocardial hyperechogenicity, and mild pericardial effusion
case_images: JRMS-21-117-g002.jpg
case_images: PMC5331769_01_JRMS-21-117-g002.jpg
case_images: F2
case_images: In particular, an electrocardiogram showed the first-degree atrioventricular blockage and frequent supraventricular extrasystole [Figure 2a], and a cardiac ultrasound pointed out a thickness of the left ventricle wall, diffuse myocardial hyperechogenicity, and mild pericardial effusion [Figure 2b].