New Insights Into the Pathophysiology of Carotid Sinus Syndrome

Tea, Say Hak; Mansourati, Jacques; L’heveder, G.; Mabin, D; Blanc, Jean‐Jacques

doi:10.1161/01.cir.93.7.1411

Cited by 55 publications

(10 citation statements)

References 18 publications

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“…Debate has often centered on whether the peripheral receptor is indeed "hypersensitive" or whether the fault lies centrally in the manner in which the afferent signals are processed [19]. The latter argument has been supported by the findings of Tea et al [23]. These investigators have suggested that the electromyographic analysis of the sternocleidomastoid (SCM) muscle differed significantly between the groups.…”

Section: Relationships Between Hbes and Syncopal Reactionsmentioning

confidence: 99%

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Song

Roh

2012

Korean J Anesthesiol

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Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.

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Section: Relationships Between Hbes and Syncopal Reactionsmentioning

confidence: 99%

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Song

Roh

2012

Korean J Anesthesiol

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“…We do not believe this invalidates our findings for two reasons: firstly, we did not provide an afferent stimulus to any other muscle groups during our CSM protocol so they presumably did not ameliorate the impact of our intervention; secondly, prior research has shown that only reductions in EMG of the sternocleidomastoid muscles, and not other neck muscles (such as styloglossus and upper trapezius) were associated with CSH (Tea et al 1996). …”

Section: Limitationsmentioning

confidence: 77%

“…One leading idea postulates that, in healthy individuals, stimulation of the sternocleidomastoid muscles near the carotid baroreceptors (during neck turning or carotid sinus massage), as well as the carotid baroreceptors themselves, leads to central integration of the two signals as “external” stretching of the sinus, and thus does not elicit a baroreflex response (Tea et al. 1996). Loss of this central integration due to sternocleidomastoid denervation might lead to hypersensitive responses during daily activities, such as neck turning, as well as during CSM (Blanc et al.…”

Section: Introductionmentioning

confidence: 99%

Carotid sinus hypersensitivity: block of the sternocleidomastoid muscle does not affect responses to carotid sinus massage in healthy young adults

et al. 2017

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The arterial baroreflex is crucial for short‐term blood pressure control – abnormal baroreflex function predisposes to syncope and falling. Hypersensitive responses to carotid baroreflex stimulation using carotid sinus massage (CSM) are common in older adults and may be associated with syncope. The pathophysiology of this hypersensitivity is unknown, but chronic denervation of the sternocleidomastoid muscles is common in elderly patients with carotid sinus hypersensitivity (CSH), and is proposed to interfere with normal integration of afferent firing from the carotid baroreceptors with proprioceptive feedback from the sternocleidomastoids, producing large responses to CSM. We hypothesized that simulation of sternocleidomastoid “denervation” using pharmacological blockade would increase cardiovascular responses to CSM. Thirteen participants received supine and tilted CSM prior to intramuscular injections (6–8 mL distributed over four sites) of 2% lidocaine hydrochloride, and 0.9% saline (placebo) in contralateral sternocleidomastoid muscles. Muscle activation was recorded with electromyography (EMG) during maximal unilateral sternocleidomastoid contraction both pre‐ and postinjection. Supine and tilted CSM were repeated following injections and responses compared to preinjection. Following lidocaine injection, the muscle activation fell to 23 ± 0.04% of the preinjection value (P < 0.001), confirming neural block of the sternocleidomastoid muscles. Cardiac (RRI, RR interval), forearm vascular resistance (FVR), and systolic arterial pressure (SAP) responses to CSM did not increase after lidocaine injection in either supine or tilted positions (supine: ΔRRI −72 ± 31 ms, ΔSAP +2 ± 1 mmHg, ΔFVR +4 ± 4%; tilted: ΔRRI −20 ± 13 ms, ΔSAP +2 ± 2 mmHg, ΔFVR +2 ± 4%; all P > 0.05). Neural block of the sternocleidomastoid muscles does not increase cardiovascular responses to CSM. The pathophysiology of CSH remains unknown.

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“…Performance of advanced tests is appropriate in patients when no specific syncope etiology could be revealed by patient history, physical examination and ECG. Recent studies have reported that a detailed history taking and meticulous physical examination may be sufficient for determining a specific syncope etiology in 49-85 % of patients 17 . Sheldon et al reported that 86 % of cases could not be diagnosed 14 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Approach and Evaluation of Syncope Etiology in Patients Presenting to Emergency Department With Syncope

Yapar¹,

Altınbilek²,

Öztürk³

et al. 2015

J Pharm Sci Innov

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Syncope is a rapidly developing and automatically recovering loss of consciousness and tonus, frequently seen in emergency services. We aimed that to evaluete syncope patients presenting to the emergency department and to create recommendations for rapid diagnozis and treatment at clinical approaches according to the results. The study evaluates a total of 310 patients administered to Şişli Hamidiye Etfal Hospital's Emergency Medical Clinic between 01/02/2014 and 31/07/2014 due to syncope. The information was recorded in study forms. Average, standard deviation, median, lowest, highest, ratio and frequency values were used in the descriptive statistics of the data. Distribution of variables was checked with Kolmogorov-Smirnov Test. Mann-Whitney U Test was used for the analysis of quantitative data. Chi-Squared Test was used for the analysis of qualitative data. SPSS 22.0 program was used in the Analyses. The syncope etiology was neurocardiogenic in 80 (25.8 %) patients, orthostatic in 46 (14.8 %), cardiogenic in 31 (10 %), neurogenic in 25 (8.1 %), metabolic in 24 (7.7 %) and hypovolemic in 15 (4.9 %). The remaining 89 (28.7 %) patients had syncope of unknown origin. A risk stratification based on SFSR showed that 228 (73.5 %) patients were in the non-risk group while 82 (26.5 %) were in the at-risk group. We believe that the low administration rate of patients, who were administered to our emergency service with high risks according to syncope risk scores, can increase by using risk-scoring systems, and that unnecessary administrations of low-risk patients can be prevented.

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New Insights Into the Pathophysiology of Carotid Sinus Syndrome

Abstract: This study strongly suggests that the neuromuscular structures surrounding the carotid mechanoreceptors are involved in the carotid sinus syndrome; however, the exact mechanism remains speculative.

Cited by 55 publications

References 18 publications

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

Carotid sinus hypersensitivity: block of the sternocleidomastoid muscle does not affect responses to carotid sinus massage in healthy young adults

Diagnostic Approach and Evaluation of Syncope Etiology in Patients Presenting to Emergency Department With Syncope

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