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Hypersensitive carotid sinus

Jean-Claude Deharo, Michele Brignole, Régis Guieu
Adenosine is a ubiquitous substance that is released under several physiological and pathological conditions and has cardiovascular effects including cardioinhibition and vasodilation. It has been shown to be an important modulator implicated in several forms of syncope. In patients with chronic low plasma levels of adenosine, a transient release of endogenous adenosine can be sufficient to block conduction in the atrioventricular node and induce prolonged asystole; conversely, when plasma adenosine levels are chronically high, adenosine release is responsible for vasodepression...
May 29, 2018: Herzschrittmachertherapie & Elektrophysiologie
Matthew G Lloyd, James M Wakeling, Michael S Koehle, Robert J Drapala, Victoria E Claydon
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...
October 2017: Physiological Reports
Zefferino Palamà, Ermenegildo De Ruvo, Domenico Grieco, Alessio Borrelli, Luigi Sciarra, Leonardo Calò
No abstract text is available yet for this article.
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
R B A van den Brink, F J de Lange
Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. There are safer interventions without neurologic complications, such as the modified Valsalva manoeuvre (efficacy 43%) and intravenous administration of adenosine (efficacy 75%)...
2017: Nederlands Tijdschrift Voor Geneeskunde
C E P van Munster, W J C van Ballegoij, J M Schroeder-Tanka, R M van den Berg-Vos
BACKGROUND: Carotid sinus massage is a widely used method for diagnosis and treatment of supraventricular tachycardia and carotid sinus hypersensitivity. Complications, mostly neurological, can occur but are rare. Carotid stenosis is a risk factor for complications. Hearing a carotid bruit on auscultation indicates stenosis, and is a contraindication for performing carotid sinus massage. However, the sensitivity of auscultation is insufficient. CASE DESCRIPTION: A 71-year-old man with a history of hypertension and hypercholesterolemia presented to the cardiology accident and emergency department with palpitations...
2017: Nederlands Tijdschrift Voor Geneeskunde
Eed Abu Zaid, Moti Haim, Hilmi Alnsasra, Yuval Konstantino
Swallow induced syncope is a rare clinical condition which is thought to result from an abnormal vagal reflex leading to bradycardia and cerebral hypoperfusion. It mostly occurs in patients with organic or functional disorders of the esophagus, and often requires permanent pacemaker implantation, along with treatment of the underlying esophageal pathology. In the following case, we report of a 71-year-old male with achalasia post per oral endoscopic myectomy, who presented with syncope and documented AV-block while eating solid food...
July 2017: Journal of Electrocardiology
Paul D Varosy, Lin Y Chen, Amy L Miller, Peter A Noseworthy, David J Slotwiner, Venkatesh Thiruganasambandamoorthy
OBJECTIVES: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined...
August 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Paul D Varosy, Lin Y Chen, Amy L Miller, Peter A Noseworthy, David J Slotwiner, Venkatesh Thiruganasambandamoorthy
OBJECTIVES: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope. METHODS: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined...
August 1, 2017: Journal of the American College of Cardiology
Emmanuel Lilitsis, Alexia Papaioannou, Aikaterini Hatzimichali, Konstantinos Spyridakis, Sofia Xenaki, George Chalkiadakis, Emmanuel Chrysos
BACKGROUND: We present a case of a patient with multinodular goiter disease who suffered asystole during head hyperextension for surgical positioning on the operational table. CASE PRESENTATION: Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome...
October 6, 2016: BMC Anesthesiology
Susan O'Callaghan, Rose Anne Kenny
Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. NCVI is common in patients with neurodegenerative disorders including dementia. This review discusses the various syndromes that characterize NCVI icluding hypotension, carotid sinus hypersensitivity, postprandial hypotension and vasovagal syncope and how they may contribute to the aetiology of cognitive decline...
March 2016: Yale Journal of Biology and Medicine
Inna Kleyman, Louis H Weimer
Syncope, or the sudden loss of consciousness, is a common presenting symptom for evaluation by neurologists. It is not a unique diagnosis but rather a common manifestation of disorders with diverse mechanisms. Loss of consciousness is typically preceded by a prodrome of symptoms and sometimes there is a clear trigger. This article discusses several cases that illustrate the various causes of syncope. Reflex syncope is the most common type and includes neurally mediated, vasovagal, situational, carotid sinus hypersensitivity, and atypical forms...
August 2016: Neurologic Clinics
Claire McDonald, Mark S Pearce, Julia L Newton, Simon R J Kerr
AIMS: Carotid sinus hypersensitivity (CSH) is arbitrarily defined as ≥3 s asystole or vasodepression of ≥50 mmHg in response to carotid sinus massage (CSM). Using this definition, 39% of older people meet the criteria for CSH. It has been suggested that current criteria are too sensitive. Krediet et al. [The history of diagnosing carotid sinus hypersensitivity: why are the current criteria too sensitive? Europace 2011;13:14-22] and Kerr et al. [Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls...
July 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Nicholay Teodorovich, Moshe Swissa
A tilt table test (TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions (e...
March 26, 2016: World Journal of Cardiology
Sofie Jansen, Jaspreet Bhangu, Sophia de Rooij, Joost Daams, Rose Anne Kenny, Nathalie van der Velde
OBJECTIVE: Cardiovascular disorders are recognized as risk factors for falls in older adults. The aim of this systematic review was to identify cardiovascular disorders that are associated with falls, thus providing angles for optimization of fall-preventive care. DESIGN: Systematic review. DATA SOURCES: Medline and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: studies addressing persons aged 50 years and older that described cardiovascular risk factors for falls...
March 1, 2016: Journal of the American Medical Directors Association
G Piccirillo, F Moscucci, D Magrì
Nowadays, syncope still generates complicated challenges for clinicians for the alarm it arises in patients and, at the same time, for the multiple causes it has determined by. In almost one third of cases, syncope is neuromediated, in young subjects in vasovagal, whereas in elderly is often determinated by carotid sinus hypersensitivity. These two kinds of syncope have two completely different diagnostic approach. In some cases pace-maker implantation will be suggested to avoid new syncope episodes. In a 20% of cases, the underlying cause is arrhythmic, most of all bradiarrhythmia which is treated with pace-maker implantation...
2015: La Clinica Terapeutica
Maw Pin Tan, Alan Murray, Terry Hawkins, Thomas J Chadwick, Simon R J Kerr, Steve W Parry
BACKGROUND: Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity. METHODS: Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited...
2015: PloS One
(no author information available yet)
INTRODUCTION: Carotid sinus syndrome is characterized by a hypersensitive carotid sinus and syncope. Although we have clear guidelines for the diagnosis and treatment of carotid sinus syndrome, the efficacy of pacing therapy with this indication has not been the subject of many studies. OBJECTIVE: This study aimed to assess the efficacy and safety of pacing therapy in the treatment of patients with carotid sinus syndrome and to determine the factors contributing to symp- toms recurrence after pacemaker implantation...
January 2015: Srpski Arhiv za Celokupno Lekarstvo
Rose M F L da Silva
Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1-39.7 per 1000 patients, with similar incidence between genders. The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. It presents a recurrence rate of 35% and 29% of physical injury. Among the causes of syncope, the mediated neural reflex, known as neurocardiogenic or vasovagal syncope, is the most frequent...
2014: Frontiers in Physiology
Richard Sutton
Carotid sinus syndrome (CSS) is a disease of the autonomic nervous system presenting with syncope, especially in older males who often have cardiovascular disease. The aetiology is unknown and epidemiological data is limited. Forty new patients/million population have been estimated to require pacing for CSS and these patients represent ∼9% of those presenting syncope to a specialist facility. CSS is defined as a response to carotid sinus massage (CSM) that includes reproduction of spontaneous symptoms. Cardioinhibitory CSS shows 3s asystole on CSM and vasodepressor CSS shows >50 mmHg fall in blood pressure (BP), there are mixed forms...
2014: Global Cardiology Science & Practice
Vaibhav Amin, Behzad B Pavri
Carotid sinus hypersensitivity, first described less than 65 years ago, is an important and often undiagnosed cause of syncope in the elderly. Its pathophysiology is complex and certain aspects are not completely understood. The timely diagnosis and treatment of this condition can improve morbidity and prevent complications in the elderly. In this article, the prevalence, risk factors, pathophysiology, diagnosis, aspects of carotid sinus massage, and treatment options for the different kinds of carotid sinus hypersensitivity are discussed...
May 2015: Cardiology in Review
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