Carotid sinus syncope

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  • 1. CAROTID SINUS SYNCOPE Dr. Jayashree SJIC
  • 2. 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
  • 3.  
  • 4. Supine (R)CSM
  • 5. Standing (R)CSM
  • 6. 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 °.
  • 7. 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
  • 8.
    • 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.
    •  
  • 9.
    • 56% of cases of unexplained syncope are found to have Carotid sinus hypersensitivity.
    • 50 years age Carotid Sinus Syndrome is rare under.
  • 10.
    • Recommendations for Permanent Pacing in Hypersensitive Carotid Sinus Syndrome
  • 11.
    • 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.
  • 12.
    • Class IIa:
    • Recurrent syncope without clear, provocative events and with a hypersensitive cardioinhibitory response.
  • 13.
      • DDD permanent pacemaker is used particularly in conditions with typical cardioinhibitory responses.
  • 14. Thank You