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Carotid sinus syncope


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Carotid sinus syncope

  2. 2. History: <ul><li>54 yr old gentleman presented with one episode of giddiness which lasted for a few seconds with complete recovery. </li></ul><ul><li>No h/o LOC </li></ul><ul><li>No ass. symtoms </li></ul>
  3. 4. Supine (R)CSM
  4. 5. Standing (R)CSM
  5. 6. Carotid sinus massage <ul><li>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. </li></ul><ul><li>If no response, or physiological responses only, are obtained, massage is performed once the heart rate and blood pressure have returned to baseline . </li></ul><ul><li>The left carotid sinus is then tested. Massage should then be repeated when tilted at 70 °. </li></ul>
  6. 7. Contraindications for CSM <ul><li>Recent cerebral ischemia </li></ul><ul><li>Carotid bruit </li></ul><ul><li>Recent myocardial infarction </li></ul><ul><li>H/O previous ventricular tachydysrhythmia </li></ul><ul><li>Digoxin, Diltiazem, Beta-blockers and Alpha Methyldopa, increase carotid sinus sensitivity </li></ul>
  7. 8. <ul><li>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).  </li></ul><ul><li>Carotid Sinus Syndrome is diagnosed when typical pre-syncopal or syncopal symptoms accompany carotid sinus massage. </li></ul><ul><li>  </li></ul>
  8. 9. <ul><li>56% of cases of unexplained syncope are found to have Carotid sinus hypersensitivity. </li></ul><ul><li>50 years age Carotid Sinus Syndrome is rare under. </li></ul>
  9. 10. <ul><li>Recommendations for Permanent Pacing in Hypersensitive Carotid Sinus Syndrome </li></ul>
  10. 11. <ul><li>Class I : </li></ul><ul><li>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. </li></ul>
  11. 12. <ul><li>Class IIa: </li></ul><ul><li>Recurrent syncope without clear, provocative events and with a hypersensitive cardioinhibitory response. </li></ul>
  12. 13. <ul><ul><li>DDD permanent pacemaker is used particularly in conditions with typical cardioinhibitory responses. </li></ul></ul>
  13. 14. Thank You