Introduction: In elderly people the frequency of syncopal episodes is higher, with atypical symptoms and difficult to differentiate to faintness, orthostatic hypotension or vertigo. The etiology is tough to establish, for the most part of cases multiple factors being involved. Methods: We are presenting the case of a patient with multiple comorbidities, hospitalized for episodes of loss of conscious that appear in rest and occur with the use of phone on the right side. The cardiovascular investigations showed orthostatic hypotension and right carotidian systolic murmur. ECG revealed trifascicular block and ST depression in V5 – V6. Holter monitoring did not show any sinusal pause or arrhythmia, and ABPM monitoring showed non-dipper tensional profile. The coronarography showed 90% LAD stenosis and 80% LCX, and the carotidian angiography showed 80% stenosis of right internal carotid artery and ostial occlusion of right vertebral artery. Results: In this clinical case, the lesions of the right carotid artery were considered the main cause of the loss of conscious. Conclusions: The elderly patients can have multiple causes for the loss of conscious and establishing the etiology and treatment can be difficult in some cases. It can be determined by association between nervous central system lesions, orthostatic hypotension and the presence of multiple comorbidities like diabetes mellitus, neurovegetative imbalance and eluding the primary cause can be difficult in some clinical situations, thus being necessary a wide range of investigations.