Cardioinhibitory Carotid Sinus Syndrome Research Articles

Diagnostic yield and development of a neurocardiovascular investigation unit for older adults in a district hospital.

Dizziness, syncope, and falls are common occurrences in elderly people. Neurocardiovascular investigation units aim to detect those patients who fall due to disturbances of blood pressure control or cardiac conduction. Specialist units have a high diagnostic yield in the investigation of these problems. Does this translate to less specialized centers? We report on the diagnostic findings of a district general hospital neurocardiovascular investigation unit. A total of 120 consecutive patients over the age of 65 presenting to a single geriatrician were assessed. After a full history and physical examination, patients underwent neurocardiovascular investigation: blood pressure and heart rate response to active stand, carotid sinus massage, and 30-minute head-up tilt. The 120 patients assessed had a mean age of 78 years (range 66-94 years); in this group, 85 were women. Of these patients, 23% presented with falls, 14% with blackouts, and 30% with dizziness. The remaining 33% had overlap of symptoms. Neurocardiovascular investigations produced a diagnosis in 57% of the patients: 22% had cardioinhibitory carotid sinus syndrome (CSS): 15% had vasodepressor CSS; 29% had orthostatic hypotension; and 3% had vasovagal syncope. Thirteen percent had more than one neurocardiovascular abnormality, and 18% had benign positional vertigo. Five patients had postural instability causing falls. Hyperventilation syndrome, aortic stenosis, dysrhythmia, cervical spondylosis, and epilepsy each accounted for one case. Seventeen percent of the subjects remained undiagnosed after integrated neurocardiovascular assessment. Management of falls requires access to neurocardiovascular assessment. It is feasible to provide such a service in the district general hospital setting, with a comparable diagnostic yield to tertiary referral centers.

B‐cell bradycardia: Carotid sinus massage by a high‐grade lymphoma

American Journal of HematologyVolume 64, Issue 3 p. 232-232 Letters and CorrespondenceFree Access B-cell bradycardia: Carotid sinus massage by a high-grade lymphoma Francisco F. Lopez, Francisco F. Lopez Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorAbeel A. Mangi, Abeel A. Mangi Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorRochelle Strenger, Rochelle Strenger Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorFred J. Schiffman, Fred J. Schiffman Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorRobert D. Meringolo, Robert D. Meringolo Department of Cardiology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this author Francisco F. Lopez, Francisco F. Lopez Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorAbeel A. Mangi, Abeel A. Mangi Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorRochelle Strenger, Rochelle Strenger Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorFred J. Schiffman, Fred J. Schiffman Department of Hematology/Oncology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this authorRobert D. Meringolo, Robert D. Meringolo Department of Cardiology, The Miriam Hospital, Brown University School of Medicine, Providence, Rhode IslandSearch for more papers by this author First published: 15 June 2000 https://doi.org/10.1002/1096-8652(200007)64:3<232::AID-AJH19>3.0.CO;2-ACitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Strasberg B, Sagie A, Erdman S, et al. Carotid sinus hypersensitivity and the carotid sinus syndrome. Prog Cardiovasc Dis 1989; 31: 379. 2Patel AK, Yap VU, Fields J, et al. Carotid sinus syncope induced by malignant tumors in the neck. Arch Intern Med 1979; 139: 1281– 1284. 3Bauer CA, Redleaf MI, Gartlan MG, Tsue TT, McColloch TM. Carotid sinus syncope in head and neck cancer. Laryngoscope 1994; 104: 497. 4McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardio-inhibitory and mixed carotid sinus syndrome in the elderly. Am J Med 1993; 95(2): 203– 208. Citing Literature Volume64, Issue3July 2000Pages 232-232 ReferencesRelatedInformation

Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitive cardioinhibitory reflex.

The study was designed to assess the outcome of treatment with permanent dual-chamber pacing of elderly patients with falls, dizziness and syncope associated with the demonstration of a hypersensitive cardioinhibitory...

Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly

purpose: Carotid sinus syndrome (CSS) is frequently overlooked as a cause of syncope in the elderly. It is diagnosed when carotid sinus massage (CSM) produces asystole exceeding 3 seconds (cardioinhibitory CSS), a reduction in systolic blood pressure exceeding 50 mm Hg independent of heart rate slowing (vasodepressor CSS), or a combination of the two (mixed CSS). Most published data pertain to the cardioinhibitory subtype. The recent availability of noninvasive phasic blood pressure monitoring has allowed accurate routine assessment of the vasodepressor response to CSM. The aim of this study was to assess the clinical characteristics of vasodepressor, cardioinhibitory, and mixed CSS. patients and methods: CSM was carried out on 132 consecutive patients over 65 years referred for investigation of dizziness, falls, or syncope. Massage was performed both supine and upright with continuous electrocardiographic and phasic blood pressure monitoring. Patients exhibiting greater than 1.5-second asystole were given 600 pg of intravenous atropine to abolish heart rate slowing and allow assessment of the pure vasodepressor response. results: Carotid sinus hypersensitivity was documented in 64 patients (mean age 81 ± 7 years, 31 male). The response was vasodepressor in 37%, cardioinhibitory in 29%, and mixed in 34%. Thirty-six patients had recurrent syncope, 17 presented with unexplained falls, and the remainder had dizziness alone. Symptoms had been present for a median of 24 months, and the median number of syncopal episodes was four. Twenty-five percent had sustained a fracture and, of these, 93% had not experienced a prodrome. Head movement precipitated symptoms in 47% and vagal stimuli in 73%. Episodes were unwitnessed in two thirds of patients. Twelve patients who presented with falls denied syncope but had witnessed loss of consciousness during CSM. Mean cardioinhibition was 5 ± 2 seconds and mean vasodepression 61 ± 9 mm Hg. The blood pressure nadir occurred rapidly at 18 ± 3 seconds after massage, and baseline values were regained at 30 ± 6 seconds. The clinical characteristics of patients with vasodepressor, cardioinhibitory, and mixed responses were similar. conclusion: CSS is an underdiagnosed cause of dizziness, falls, and syncope in the elderly. The vasodepressor form occurs more frequently than previously reported and has clinical characteristics similar to those of the cardioinhibitory and mixed subtypes. Elderly patients with this condition may deny syncope and present with recurrent unexplained falls. CSM, ideally with noninvasive phasic blood pressure monitoring, should be routinely performed in elderly patients with unexplained bradycardic or hypotensive symptoms.

Autonomic reflexes in patients with cardioinhibitory carotid sinus syncope

Autonomic reflexes were investigated in patients with the cardioinhibitory carotid sinus syndrome. Heart rate, blood pressure and forearm blood flow responses were recorded during prolonged head-up tilt, the Valsalva manoeuvre, lower body negative pressure and sequential respiratory cycles in ten patients and nine age-matched controls. The mean maximum R-R interval prolongation during carotid sinus massage was 4.4 s. Three patients had syncope during prolonged head-up tilt. Heart rate and blood pressure responses were similar for patients and controls who completed tilt. Responses to lower body negative pressure and Valsalva manoeuvre were similar for both groups. Respiratory sinus arrhythmia was significantly less marked in patients, 7 bpm (0 to 20 bpm) versus 15 bpm (6 to 35 bpm; p = 0.05). Therefore, neck massage and deep breathing produce abnormal cardiac vagal responses, whereas other reflexes, including response to lower body negative pressure and the Valsalva manoeuvre are within the normal range in cardioinhibitory carotid sinus syndrome.

The Clinical Characterstics of Vasodepressor and Cardioinhibitory Carotid Sinus Syndrome in the Elderly

The Clinical Characterstics of Vasodepressor and Cardioinhibitory Carotid Sinus Syndrome in the Elderly

Outcome of an Integrated Approach to the Investigation of Dizziness, Falls and Syncope, in Elderly Patients Referred to a ‘Syncope’ Clinic

Sixty-five consecutive elderly patients (mean age 78 years) referred to a 'syncope' clinic over a six-month period were prospectively studied. Initial evaluation included ambulatory electrocardiography, carotid sinus massage before and after atropine and prolonged head-up tilt. Diagnostic criteria for causes of syncope were assigned at the beginning of the study. Overall, a diagnosis was attributed to symptoms in 92% of patients; overlap was present in a quarter. Diagnoses were cardioinhibitory carotid sinus syndrome (CSS; 5%), vasodepressor CSS (26%), mixed CSS (14%), orthostatic hypotension (32%), vasodepressor vasovagal syncope (11%), cardiac arrhythmia (21%), epilepsy (9%), cerebrovascular disease (6%) and others (12.5%). Sixty per cent of patients with vasodepressor CSS also had orthostatic hypotension or vasodepressor vasovagal syncope suggesting a common aetiology. Using an integrated approach incorporating head-up tilt and carotid sinus massage in a selected group of elderly patients referred to a 'syncope' clinic, the diagnostic yield was high.

Ventricular and Dual Chamber Pacing for Treatment of Carotid Sinus Syndrome

Thirty-nine consecutive patients with recurrent syncope and either cardioinhibitory or mixed type carotid sinus syndrome were studied to determine the efficacy of ventricular (VVI) pacing in 16, and dual chamber (DDD/DVI) in 23 patients. Only those patients affected by the isolated vasodepressor form were excluded. Follow-up lasted 12 +/- 5 months. Symptoms were totally eliminated in 67% of patients and ameliorated with persistence of minor symptoms in 33%. All patients underwent an initial 2-month follow-up in the VVI mode. Evaluation of the 19 patients who remained symptomatic and the 20 who became asymptomatic with VVI pacing demonstrated that factors observed prior to pacemaker implant were related to failure of the VVI mode. These included symptomatic pacemaker effect (42% vs 0%), mixed carotid sinus syndrome (95% vs 65%), orthostatic hypotension (47% vs 15%), or ventriculoatrial conduction (68% vs 38%). In the 23 patients with dual chamber pacing, random 2 month comparisons were performed between VVI and DVI/DDD pacing. The dual chamber mode was preferred by 14 patients, none preferred the VVI mode and nine noted no difference. Comparison of the two groups found that the factors linked to DVI/DDD preference were symptomatic pacemaker effect (50% vs 0%), ventriculoatrial conduction (78% vs 44%), or orthostatic hypotension (50% vs 11%). VVI pacing is efficacious in a high proportion of patients affected by cardioinhibitory or mixed carotid sinus syndrome. The identification of causes of VVI pacing failure allows determination of those who will benefit from VVI pacing and those who should have DVI/DDD. VVI pacing is suggested for the cardioinhibitory type with no symptomatic pacemaker effect and for the mixed type with no symptomatic pacemaker effect or orthostatic hypotension or ventriculoatrial conduction. Dual chamber pacing should be used in all other instances.

Assessment of VVI Diagnostic Pacing Mode in Patients with Cardioinhibitory Carotid Sinus Syndrome

In this study, we used Holter pacemakers in a group of 13 patients affected by severe carotid sinus syndrome in order to evaluate its evolution. All the patients had one to three syncopal episodes and frequent other symptoms such as fainting, dizziness, lightheadedness and pre-syncope interferring with their daily activity so that pacemaker therapy was considered necessary. Patient selection criteria were: presence of the isolated cardioinhibitory type, absence of associated sinus dysfunction and absence of symptomatic VVI pacemaker effect. All the patients received a Micropacer 1 device; among special functions, bradycardia events counter was activated and programmed so that each sequence of three consecutive beats at a cycle length 1.5 sec (i.e., 4.5 sec total interval) could be recognized and stored in its memory. The follow-up lasted 13 +/- 7 months. Brady events occurred in eight out of 13 patients (62%), during this period. Syncope and major symptoms disappeared in all the patients; mild dizziness recurred rarely in two patients and were not linked to brady-events recording. In conclusion, disappearance of severe symptoms observed after pacemaker implant in cardioinhibitory carotid sinus syndrome seems to depend from pacing therapy, in most cases, yet from the benign natural course of the disease in some other cases.

Treatment of Carotid Sinus Syncope with Demand Pacemaker

We report a patient with cardioinhibitory carotid sinus syndrome treated with a demand pacemaker. Implantation of a demand pacemaker is suggested as an alternative to the previously reported modes of surgical or irradiation therapy. We believe that the treatment with a demand pacemaker may be preferable because of its reliability.

THE CARDIOINHIBITORY CAROTID SINUS SYNDROME

Excerpt Of interest for years as a readily demonstrable etiologic factor in certain cases of syncopal or convulsive attacks, the cardioinhibitory carotid sinus syndrome has itself fallen under susp...