CAROTID SINUS SYNCOPE

Dr. Jayashree

SJIC

History:

54 yr old gentleman presented with one episode of giddiness which lasted for a few seconds with complete recovery.

No h/o LOC No ass. symtoms

Supine (R)CSM

Standing (R)CSM

Carotid sinus massage

After a brief period of rest, gentle pressure is applied to the right carotid sinus for five seconds with continuous monitoring of heart rate and blood pressure.

If no response, or physiological responses only, are obtained, massage is performed once the heart rate and blood pressure have returned to baseline .

The left carotid sinus is then tested. Massage should then be repeated when tilted at 70 °.

Contraindications for CSM

Recent cerebral ischemia Carotid bruit Recent myocardial infarction H/O previous ventricular

tachydysrhythmia Digoxin, Diltiazem, Beta-blockers and

Alpha Methyldopa, increase carotid sinus sensitivity

Carotid sinus hypersensitivity is diagnosed when carotid sinus massage causes a three second, or longer, pause in the heart rate (cardio inhibition) - or lowering of the blood pressure by 50 mm Hg. or more (vasodepression). 

Carotid Sinus Syndrome is diagnosed when typical pre-syncopal or syncopal symptoms accompany carotid sinus massage.

 

56% of cases of unexplained syncope are found to have Carotid sinus hypersensitivity.

50 years age Carotid Sinus Syndrome is rare under.

Recommendations for Permanent Pacing in Hypersensitive Carotid Sinus Syndrome

Class I : Recurrent syncope caused by carotid

sinus stimulation;minimal carotid sinus pressure induces ventricular asystole of more than 3 seconds’ duration in the absence of any medication that depresses the sinus node or AV conduction.

Class IIa:

Recurrent syncope without clear, provocative events and with a hypersensitive cardioinhibitory response.

DDD permanent pacemaker is used particularly in conditions with typical cardioinhibitory responses.

Thank You