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carotid sinus syndrome; carotid sinus hypersensitivity; carotid sinus syncope

Etiology: - precipitated by pressure on the carotid sinus a) tight collar b) sudden turning of head [3] Epidemiology: 1) 40% of patients > 65 years old 2) most common cause of syncope & common cause of falls in the elderly [2] Pathology: - hypersensitivity of the carotid sinus Clinical manifestations: 1) with carotid sinus massage a) > 3 second pause in ventricular activity* b) drop in blood pressure of > 50 mm Hg c) a (35%), b (15%), both (60%) 2) most of these patients do not have spontaneous syncope * > 7 second pause in ventricular activity [2] drop in systolic blood pressure > 70 mm Hg [2] Special laboratory: - no further workup indicated [3] Management: 1) permanent pacing for cardio-inhibitory component - does nothing for vasodepressor component 2) elastic stockings for vasodepressor component 3) anticholinergic agents may be of some value

Related

carotid sinus massage carotid sinus; carotid bulb

General

neurocardiogenic vasopressor dysfunction; neurally-mediated syncope; reflex syncope (NVD) syndrome

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 72
  2. Kerr SR, Pearce MS, Brayne C, Davis RJ, Kenny RA. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med. 2006 Mar 13;166(5):515-20. PMID: 16534037 - Coplan NL. Carotid sinus hypersensitivity and syncope: cause/effect or true/true/unrelated. Arch Intern Med. 2006 Mar 13;166(5):491-2. No abstract available. PMID: 16534033
  3. Medical Knowledge Self Assessment Program (MKSAP) 14, 19 American College of Physicians, Philadelphia 2006, 2023