carotid sinus syndrome; carotid sinus hypersensitivity; carotid sinus syncope

Etiology

• precipitated by pressure on the carotid sinus
  • tight collar
  • sudden turning of head

Epidemiology

• 40% of patients > 65 years old
• most common cause of syncope & common cause of falls in the elderly

Pathology

• hypersensitivity of the carotid sinus

Clinical manifestations

• with carotid sinus massage
  • > 3 second pause in ventricular activity*
  • drop in blood pressure of > 50 mm Hg
  • a (35%), b (15%), both (60%)
• most of these patients do not have spontaneous syncope

* > 7 second pause in ventricular activity drop in systolic blood pressure > 70 mm Hg

Diagnostic procedures

• no further workup indicated

Management

• permanent pacing for cardio-inhibitory component
  • does nothing for vasodepressor component
• elastic stockings for vasodepressor component
• anticholinergic agents may be of some value

More general terms

• neurocardiogenic vasopressor dysfunction
• syndrome

Additional terms

• carotid sinus massage
• carotid sinus; carotid bulb