An Elderly Man with a Fall
An 87-year-old man is admitted to the hospital following a fall at home. He says that he stood up quickly to answer the telephone, then felt dizzy and subsequently blacked out. His wife saw what happened; she said he just fell to the floor but made a quick recovery. He did not injure himself, but she was unable to get him off the floor so she called emergency medical services. He has had several similar episodes of dizziness at home when walking around the house but has not previously passed out. He denies chest discomfort, palpitations, shortness of breath, or diaphoresis accompanying the dizzy episodes.
He was recently discharged from the hospital after a 5-day admission for poor oral intake and weakness and has been gradually regaining strength at home. His past medical history is notable for paroxysmal atrial fibrillation, type 2 diabetes mellitus (DM), hypertension, benign prostate hypertrophy (BPH), and heart failure (HF) with preserved ejection fraction. He takes metformin 850 mg BID, losartan 25 mg daily, metoprolol succinate 25 mg daily, apixaban 5 mg BID, furosemide 40 mg daily, and tamsulosin 0.4 mg daily (started during his recent hospitalization).
Clinical examination reveals a regular rate and rhythm, clear lungs, no jugular venous distention, and trace ankle edema. He has already taken all his morning medications today. His blood pressure (BP) is 158/55 mm Hg with heart rate (HR) 74 bpm while supine and 122/60 mm Hg with HR 89 bpm within 3 min of standing. Electrocardiography shows normal sinus rhythm with first-degree atrioventricular block. Other intervals are normal. Bloodwork is notable for creatinine 1.2 mg/dL (consistent with his baseline) and hemoglobin 12.9 g/dL.
Which one of the following is the appropriate next step in management?