A man in his 70s with a history of orthotopic heart transplant presented with dizziness. The heart transplantation had been performed using the biatrial surgical technique to treat advanced dilated cardiomyopathy. His posttransplant course was notable for grade 1 cardiac allograft vasculopathy, toxic multinodular goiter status postthyroidectomy, and associated tremors treated with propranolol. At presentation, the patient reported new-onset dizziness that occurred while sitting. He recalled episodes of near-syncope but no loss of consciousness. Two weeks prior to this visit, his cardiologist had measured a low blood pressure and stopped amlodipine treatment, after which symptoms improved. At presentation, he was normotensive, and cardiac examination and electrocardiogram (ECG) results were unremarkable. He was prescribed a 14-day Zio XT (iRhythm Technologies) continuous ambulatory ECG monitor (Figure).

一位70多岁的原位心脏移植史患者头晕。使用二尖瓣外科手术技术进行了心脏移植，以治疗晚期扩张型心肌病。他的移植后病程主要表现为1级心脏同种异体移植血管病，甲状腺切除术后毒性多结节性甲状腺肿状态以及普萘洛尔治疗相关的震颤。在报告中，患者报告了坐下时出现的新发头晕。他回忆起几近晕厥的发作，但并没有失去知觉。在就诊前两周，他的心脏病专家测量了血压，并停止了氨氯地平治疗，此后症状得到改善。在介绍中，他血压正常，心脏检查和心电图（ECG）结果均不明显。