The usefulness of carotid sinus massage in different patient groups

Kumar, Narasimhan Pradeep; Thomas, A.; Mudd, Paul N.; Morris, Rob; Masud, Tahir

doi:10.1093/ageing/afg114

Cited by 38 publications

(15 citation statements)

References 17 publications

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“…7 8 The diagnostic yield of CSM in patients .65 years presenting with syncope or unexplained falls was up to 45%, in studies by Kenny et al [8][9][10] Subsequent studies that also included younger patients .50 or 60 years, however, have found lower prevalence rates of CSH, in the range of 17-21%. [11][12][13] Indeed, CSH was found to be rare in patients ,50 years in a recent study by Puggioni et al, 14 namely 4% in those aged ,41 years and 11% in those aged 41-50 years.…”

mentioning

confidence: 98%

Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged >40 years?

Humm

Mathias

2006

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To determine the frequency, age distribution and clinical presentation of carotid sinus hypersensitivity (CSH) among 373 patients (age range 15-92 years) referred to two autonomic referral centres during a 10-year period. Methods: Carotid sinus massage (CSM) was performed both supine and during 60˚head-up tilt. Beat-tobeat blood pressure, heart rate and a three-lead electrocardiography were recorded continuously. CSH was classified as cardioinhibitory (asystole >3 s), vasodepressor (systolic blood pressure fall >50 mm Hg) or mixed. All patients additionally underwent autonomic screening tests for orthostatic hypotension and autonomic failure. Results: CSH was observed in 13.7% of all patients. The diagnostic yield of CSM was nil in patients aged ,50 years (n = 65), 2.4% in those aged 50-59 years (n = 82), 9.1% in those aged 60-69 years (n = 77), 20.7% in those aged 70-79 years (n = 92) and reached 40.4% in those .80 years (n = 57). Syncope was the leading clinical symptom in 62.8%. In 27.4% of patients falls without definite loss of consciousness was the main clinical symptom. Mild and mainly systolic orthostatic hypotension was recorded in 17.6%; evidence of sympathetic or parasympathetic dysfunction was found in none. Conclusions: CSH was confirmed in patients .50 years, the incidence steeply increasing with age. The current European Society of Cardiology guidelines that recommend testing for CSH in all patients .40 years with syncope of unknown aetiology may need reconsideration. Orthostatic hypotension was noted in some patients with CSH, but evidence of sympathetic or parasympathetic failure was not found in any of them.

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confidence: 98%

Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged >40 years?

Humm

Mathias

2006

Journal of Neurology, Neurosurgery & Psychiatry

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“…Landmarks for the carotid sinus consisted of the midpoint between the temporalmandibular joint and the top of the thyroid cartilage (1). As per current guidelines, CSM was performed first on one and then on the other carotid sinus, with a positive on either side indicating hypersensitivity (14). Previous work has shown that CSM is quite reproducible (15), and that the sensitivity increases in the upright position (16).…”

Section: Carotid Sinus Massagementioning

confidence: 99%

Arterial stiffness and the response to carotid sinus massage in older adults

2010

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Background and aims-Carotid sinus hypersensitivity (CSH) is a common cause of fainting and falls in the older adult population and is diagnosed by carotid sinus massage (CSM). Previous work has suggested that age-related stiffening of blood vessels reduces afferent input from the carotid sinus leading to central upregulation of the overall arterial baroreflex response. We examined the differences in arterial stiffness and baroreflex function in older adults at high cardiovascular risk (advanced age, Type 2 diabetes, hypertension and hyperlipidemia) with and without CSH.

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“…5,6 This behavior occurs more frequently among subjects with a history of syncope, particularly the elderly and those with structural heart disease. 7,8,9 In Brazil, no studies have been published that evaluate the prevalence of cardioinhibitory response to CSM. In foreign literature, predictors of cardioinhibitory response have been described in only a few studies, most of which with a small number of patients.…”

Section: Introductionmentioning

confidence: 99%