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The longest pause
  1. Iain G Matthews,
  2. Michael Norton,
  3. Ahmed F Jaafar
  1. Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  1. Correspondence to Dr Iain G Matthews, Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; igmatthews{at}doctors.org.uk

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A 64-year-old woman with a history of syncope when standing associated with urinary incontinence, prolonged recovery and subsequent exhaustion, was referred to our service for evaluation.

She underwent a 20:15 glyceryl trinitrate head-up tilt test. This was unremarkable in the first 20 min but 90 s after the administration of glyceryl trinitrate her blood pressure fell from 125/82 mm Hg to unrecordable at 120 s …

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