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Rose Anne Kenny - One of the best experts on this subject based on the ideXlab platform.
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Carotid Sinus Syndrome—Clinical Characteristics in Elderly Patients
2016Co-Authors: Rose Anne Kenny, Gary TraynorAbstract:Carotid Sinus Massage was carried out on 130 consecutive patients referred for investigation of dizziness, syncope or unexplained falls. Carotid Sinus syndrome was diagnosed in 33 for whom no other cause of symptoms was identified. Right-sided hypersensitivity was more frequent than left-sided. Thirty per cent identified a prodrome before syncope and 30 % had retrograde amnesia for the event. In 52%, symptoms were precipitated by head movement and in 48 % by vagal stimuli. Seven described 'drop attacks ' but symptoms were reproduced with Carotid Sinus Massage during head-up tilt. Injuries, including fractured neck of femur, were sustained by the majority. Carotid Sinus Massage should be performed routinely on all elderly patients who have symptoms of unexplained dizziness, falls or syncope. Cardiac pacing relieves syncopal symptoms in those with a predominant cardio-inhibitory response and recurrent syncope
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cardioinhibitory Carotid Sinus syndrome a mathematical model
International Conference of the IEEE Engineering in Medicine and Biology Society, 2015Co-Authors: Ciaran Finucane, Rose Anne Kenny, Gerard BoyleAbstract:Carotid Sinus Massage (CSM) is a simple clinical test for stimulating the Carotid Sinus reflex. During CSM, firm longitudinal Massage is applied at the point of maximal pulsation over the Carotid bifurcation resulting in relative bradycardia. CSM is used to diagnose Cardioinhibitory Carotid Sinus Syndrome (CICSS). CICSS is an age-related disorder, characterized by profound symptomatic cardioinhibition (> 3 seconds pause) following CSM. CICSS prevalence increases with age and is responsible for 1 to 20% of all pacemaker implantations per year. Treatment options for CSS are limited and much debate still remains around its underlying etiology. In this paper we present a first computer simulation of Carotid Sinus Massage (CSM) in older adults and demonstrate its ability to simulate normal heart rate responses to CSM. Importantly we demonstrate that our mathematical model requires inclusion of model elements to simulate autonomic control of perinodal T-cell activity in order to replicate the profound cardioinhibitory response observed in CICSS. Our model findings implicate CSS as a candidate biomarker of biological aging and frailty.
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Carotid Sinus hypersensitivity in asymptomatic older persons implications for diagnosis of syncope and falls
JAMA Internal Medicine, 2006Co-Authors: Simon Kerr, Mark S Pearce, Carol Brayne, Richard J Davis, Rose Anne KennyAbstract:Background Carotid Sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Recent guidelines recommend 5 to 10 seconds of Carotid Sinus Massage in supine and upright positions with beat-to-beat monitoring. The aim of this study was to determine the prevalence of Carotid Sinus hypersensitivity in (1) an unselected community sample of older people and (2) a subsample with no history of syncope, dizziness, or falls using recently standardized diagnostic criteria. Methods One thousand individuals older than 65 years were randomly sampled from a single general practice register; 272 participants underwent supine and upright Carotid Sinus Massage with continuous heart rate and phasic blood pressure monitoring. Carotid Sinus hypersensitivity was defined as asystole of 3 seconds or greater and/or a drop in systolic blood pressure of 50 mm Hg or greater. Results Carotid Sinus hypersensitivity was present in 107 individuals (39%); 24% had asystole of 3 seconds or greater during Carotid Sinus Massage; and 16% had symptoms (including syncope) with Carotid Sinus hypersensitivity. Age (odds ratio, 1.05; 95% confidence interval, 1.00-1.09) and male sex (odds ratio, 1.71; 95% confidence intervals, 1.04-2.82) were the only predictors of Carotid Sinus hypersensitivity. In 80 previously asymptomatic individuals, Carotid Sinus hypersensitivity was present in 28 (35%) and accompanied by symptoms in 10. The 95th percentile for Carotid Sinus Massage response was 7.3 seconds' asystole and a 77–mm Hg drop in systolic blood pressure. Conclusions Carotid Sinus hypersensitivity is common in older persons, even those with no history of syncope, dizziness, or falls. The finding of a hypersensitive response should not necessarily preclude further investigation for other causes of syncope.
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2 bradyarrhythmias sick Sinus syndrome Carotid Sinus syndrome
Europace, 2005Co-Authors: Rose Anne Kenny, Clive Ballard, Ruth Pearce, J Hampton, Simon Kerr, M WiddringtonAbstract:Objectives To determine the prevalence of Carotid Sinus hypersensitivity (CSH) and define heart rate (HR) and blood pressure (BP) responses to Carotid Sinus Massage (CSM) in (a) an unselected community sample of older people and (b) a sub-sample with no prior history of syncope, dizziness or falls. Methods One thousand subjects were randomly sampled from a general practice database of 1517 patients over 65 years and stratified for age and gender. Consenting participants underwent detailed clinical assessment prior to supine and upright Carotid Sinus Massage CSM with continuous heart rate and phasic blood pressure monitoring. CSH was defined as asystole in excess of 3 seconds and / or a drop in SBP of greater than 50mmHg. Results 272 participants had CSM. CSH was present in 107 (39%); 27% had asystole >3 seconds during CSM; 16% had symptoms (including syncope) with CSH. Previous history of syncope falls or dizziness was not predictive of CSH. Age (OR 1.05 95%CI 1.00, 1.09) and male sex (OR 1.71; 95%CI 1.04, 2.82) were the only independent predictors of CSH. In a previously asymptomatic sub-sample of 80 participants, CSH was present in 28 (35%). The 95th percentile for response was 7.3 seconds' asystole and 77mmHg drop in systolic blood pressure (7.1 seconds and 74mmHg when supine; 5.6 seconds and 76mmHg when erect). Conclusion CSH is common in older persons, even those with no prior history of syncope, dizziness, or falls. Derived normal thresholds for heart rate and blood pressure responses are larger than previously reported in symptomatic groups. When present, CSH cannot be assumed to be the attributable cause in those presenting with syncope and further work is required to determine the factors which transform CSH into a symptomatic state.
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Carotid Sinus syndrome is common in dementia with lewy bodies and correlates with deep white matter lesions
Journal of Neurology Neurosurgery and Psychiatry, 2004Co-Authors: Rose Anne Kenny, F E Shaw, John T Obrien, Philip Scheltens, Raj N Kalaria, Clive BallardAbstract:Background: Carotid Sinus syndrome (CSS) is a common cause of syncope in older persons. There appears to be a high prevalence of Carotid Sinus hypersensitivity (CSH) in patients with dementia with Lewy bodies (DLB) but not in Alzheimer's disease. Objective: To compare the prevalence of CSH in DLB and Alzheimer's disease, and to determine whether there is an association between CSH induced hypotension and brain white matter hyperintensities on magnetic resonance imaging (MRI). Methods: Prevalence of CSH was compared in 38 patients with DLB (mean (SD) age, 76 (7) years), 52 with Alzheimer's disease (80 (6) years), and 31 case controls (73 (5) years) during right sided supine Carotid Sinus Massage (CSM). CSH was defined as cardioinhibitory (CICSH; >3 s asystole) or vasodepressor (VDCSH; >30 mm Hg fall in systolic blood pressure (SBP)). T2 weighted brain MRI was done in 45 patients (23 DLB, 22 Alzheimer). Hyperintensities were rated by the Scheltens scale. Results: Overall heart rate response to CSM was slower (RR interval = 3370 ms (640 to 9400)) and the proportion of patients with CICSH greater (32%) in DLB than in Alzheimer's disease (1570 (720 to 7800); 11.1%) or controls (1600 (720 to 3300); 3.2%) (p<0.01)). The strongest predictor of heart rate slowing and CSH was a diagnosis of DLB (Wald 8.0, p<0.005). The fall in SBP during Carotid Sinus Massage was greater with DLB (40 (22) mm Hg) than with Alzheimer's disease (30 (19) mm Hg) or controls (24 (19) mm Hg) (both p<0.02). Deep white matter hyperintensities were present in 29 patients (64%). In DLB, there was a correlation between magnitude of fall in SBP during CSM and severity of deep white matter changes (R = 0.58, p = 0.005). Conclusions: Heart rate responses to CSM are prolonged in patients with DLB, causing hypotension. Deep white matter changes from microvascular disease correlated with the fall in SBP. Microvascular pathology is a key substrate of cognitive impairment and could be reversible in DLB where there are exaggerated heart rate responses to Carotid Sinus stimulation.
S J Mcintosh - One of the best experts on this subject based on the ideXlab platform.
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a study comparing vvi and ddi pacing in elderly patients with Carotid Sinus syndrome
Heart, 1997Co-Authors: S J Mcintosh, J Lawson, R S Bexton, R G Gold, M Tynan, Rose Anne KennyAbstract:OBJECTIVE: To determine whether single chamber ventricular demand (VVI) pacing is adequate for elderly patients with Carotid Sinus syndrome. DESIGN: Prospective double blind randomised cross over study. SETTING: Tertiary referral centre. PATIENTS: 30 consecutive patients aged over 60 years with Carotid Sinus syndrome referred for cardiac pacing. INTERVENTION: Patients underwent dual chamber pacemaker implantation and were then randomised to two three-month periods of VVI and DDI pacing. MAIN OUTCOME MEASURES: Responses to cardiovascular tests (vasodepression during Carotid Sinus Massage, pacemaker effect, postural blood pressure measurements, and response to head up tilt), and symptoms. RESULTS: 11 patients developed profound hypotension during upright Carotid Sinus Massage while pacing VVI compared with only two while pacing DDI. The upright pacemaker effect was greater in VVI (VVI, -31 (SD 19) mm Hg v DDI, -4 (12) mm Hg; P < 0.001). Postural blood pressure measurements and responses to head up tilt did not vary. Eleven patients were unable to tolerate VVI pacing and had to be withdrawn early from this limb of the study (group A). Fourteen of the remainder completed diary cards and did not express a preference (group B). No patient preferred VVI. Group A patients were older (group A, 78 (6) years v group B, 70 (9) years; P < 0.05), were more likely to be female (group A, 73% v group B, 14%; P < 0.01), and were more likely to have orthostatic hypotension while pacing DDI (group A, 46% v group B, 0%; P < 0.01). Group A and B patients could not be differentiated by other prepacing clinical or haemodynamic variables. CONCLUSIONS: Elderly patients with Carotid Sinus syndrome are likely to develop symptomatic hypotension following VVI pacing. The optimum pacing mode for individual patients cannot be predicted by simple cardiovascular tests before pacing.
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heart rate and blood pressure responses to Carotid Sinus Massage in healthy elderly subjects
Age and Ageing, 1994Co-Authors: S J Mcintosh, J Lawson, Rose Anne KennyAbstract:The purpose of the study was to define heart rate and blood pressure responses to supine and upright Carotid Sinus Massage in healthy elderly subjects and thus to establish the validity of current diagnostic criteria for Carotid Sinus syndrome in this age group. Twenty-five healthy asymptomatic subjects (61-87 years) had Carotid Sinus Massage carried out following a standardized technique employing previously defined criteria for abnormal heart rate and blood pressure responses: 3 s asystole and a 50 mmHg fall in systolic blood pressure independent of any heart rate slowing (after intravenous atropine). No cardioinhibitory responses of greater than 3 s were documented. The mean maximal cardioinhibitory response was 1038 +/- 195 msec. Right-sided responses were more marked than left when upright (1040 +/- 202 vs. 946 +/- 135 msec; p < 0.01) but not when supine (1094 +/- 215 vs. 1073 +/- 194 msec; NS). After atropine three subjects (12%) had a significant vasodepressor response when upright, but none when supine. The mean maximal vasodepressor response was 21 +/- 14 mmHg. Right-sided blood pressure responses were more marked than left (p < 0.01). There was no fixed relationship between maximum heart rate slowing and the degree of vasodepression during Massage (range 2-80 msec/mmHg). The diagnostic criteria for heart rate and blood pressure responses in Carotid Sinus syndrome are appropriate for supine Carotid Sinus Massage in elderly subjects. Asymptomatic vasodepressor responses occur in a small proportion of healthy elderly when upright.
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outcome of an integrated approach to the investigation of dizziness falls and syncope in elderly patients referred to a syncope clinic
Age and Ageing, 1993Co-Authors: S J Mcintosh, David Da Costa, Rose Anne KennyAbstract: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. Language: en
Steve W Parry - One of the best experts on this subject based on the ideXlab platform.
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results of Carotid Sinus Massage in a tertiary referral unit is Carotid Sinus syndrome still relevant
Age and Ageing, 2009Co-Authors: Maw Pin Tan, Alan Murray, Thomas Chadwick, Julia L Newton, Pam Reeve, Steve W ParryAbstract:BACKGROUND Carotid Sinus hypersensitivity (CSH) is associated with syncope, drop attacks and unexplained falls in older people. However, a recent study has also reported a prevalence of 35% in asymptomatic community-dwelling older people. OBJECTIVE we conducted a retrospective observational study to investigate the haemodynamic and symptom responses of a large cohort of patients undergoing Carotid Sinus Massage (CSM). METHODS the electronically stored haemodynamic data of 302 consecutive patients, aged 71 +/- 11 years, investigated with CSM for unexplained falls and syncope was analysed. Bilateral sequential CSM was performed in the supine and upright positions with continuous electrocardiogram (ECG) and non-invasive beat-to-beat blood pressure monitoring (Taskforce, CN Systems, Austria). CSH (CSH) was defined by maximal R-R interval > or =3 s (cardioinhibitory) and/or a systolic blood pressure drop of > or =50 mmHg (vasodepressor). RESULTS a total of 74/302 (25%) subjects had CSH, 37 (50%) of which were cardioinhibitory (CI) and 37 (50%) were vasodepressor (VD) subtypes. Subjects with positive CSM were significantly older (75.2 vs 70.2 years, P < 0.001), and more likely to be male (32% vs 19%, P < 0.01). CSH was diagnosed with right-sided CSM alone in 45 (61%) subjects and erect CSM only in 36 (49%) subjects. Symptom reproduction was more likely with the CI than the VD subtypes (82% vs 28%; P < 0.001). CONCLUSION CSH was diagnosed in 25% of patients investigated with CSM at our specialist unit, lower than the prevalence of 39% reported for community-dwelling older individuals. This discrepancy may be explained by selection bias and demographic differences, but raises the possibility of CSH being an age-related epiphenomenon rather than a causal mechanism for syncope, drop attacks and unexplained falls. Our observations have important implications for clinical practice and the development of future research strategies.
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Carotid Sinus syndrome masquerading as treatment resistant epilepsy
Postgraduate Medical Journal, 2000Co-Authors: Steve W Parry, Rose Anne KennyAbstract:A 65 year old woman had a 12 year history of frequent, recurrent seizure-like episodes labelled as treatment resistant epilepsy after neurological evaluation and follow up and treatment with multiple antiepileptic medications. Carotid Sinus Massage provoked 5.6 seconds asystole with symptom reproduction, and she has remained symptom-free after permanent pacemaker implantation for her Carotid Sinus syndrome and withdrawal of antiepileptic medications.
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diagnosis of Carotid Sinus hypersensitivity in older adults Carotid Sinus Massage in the upright position is essential
Heart, 2000Co-Authors: Steve W Parry, D Richardson, D Oshea, B Sen, Rose Anne KennyAbstract:OBJECTIVE—To assess the diagnostic value of supine and upright Carotid Sinus Massage in elderly patients. DESIGN—Prospective controlled cohort study. SETTING—Three inner city accident and emergency departments and a dedicated syncope facility. PATIENTS—1375 consecutive patients aged > 55 years presenting with unexplained syncope and drop attacks; 25 healthy controls. INTERVENTIONS—Bilateral supine Carotid Sinus Massage, repeated in the 70° head up tilt position if the initial supine test was not diagnostic of cardioinhibitory and mixed Carotid Sinus hypersensitivity. MAIN OUTCOME MEASURES—Diagnosis of cardioinhibitory or mixed Carotid Sinus hypersensitivity; clinical characteristics of supine v upright positive groups. RESULTS—226 patients were excluded for contraindications to Carotid Sinus Massage. Of 1149 patients undergoing Massage, 223 (19%) had cardioinhibitory or mixed Carotid Sinus hypersensitivity; 70 (31%) of these had a positive response to Massage with head up tilt following negative supine Massage (95% confidence interval, 25.3% to 37.5%). None of the healthy controls showed Carotid Sinus hypersensitivity on erect or supine Massage. The initially positive supine test had 74% specificity and 100% sensitivity; these were both 100% for the upright positive test. The clinical characteristics of the supine v upright positive subgroups were similar. CONCLUSIONS—The diagnosis of Carotid Sinus hypersensitivity amenable to treatment by pacing may be missed in one third of cases if only supine Massage is performed. Massage should be done routinely in the head up tilt position if the initial supine test is negative. Keywords: Carotid Sinus; tilt table testing; syncope; elderly patients
J Lawson - One of the best experts on this subject based on the ideXlab platform.
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a study comparing vvi and ddi pacing in elderly patients with Carotid Sinus syndrome
Heart, 1997Co-Authors: S J Mcintosh, J Lawson, R S Bexton, R G Gold, M Tynan, Rose Anne KennyAbstract:OBJECTIVE: To determine whether single chamber ventricular demand (VVI) pacing is adequate for elderly patients with Carotid Sinus syndrome. DESIGN: Prospective double blind randomised cross over study. SETTING: Tertiary referral centre. PATIENTS: 30 consecutive patients aged over 60 years with Carotid Sinus syndrome referred for cardiac pacing. INTERVENTION: Patients underwent dual chamber pacemaker implantation and were then randomised to two three-month periods of VVI and DDI pacing. MAIN OUTCOME MEASURES: Responses to cardiovascular tests (vasodepression during Carotid Sinus Massage, pacemaker effect, postural blood pressure measurements, and response to head up tilt), and symptoms. RESULTS: 11 patients developed profound hypotension during upright Carotid Sinus Massage while pacing VVI compared with only two while pacing DDI. The upright pacemaker effect was greater in VVI (VVI, -31 (SD 19) mm Hg v DDI, -4 (12) mm Hg; P < 0.001). Postural blood pressure measurements and responses to head up tilt did not vary. Eleven patients were unable to tolerate VVI pacing and had to be withdrawn early from this limb of the study (group A). Fourteen of the remainder completed diary cards and did not express a preference (group B). No patient preferred VVI. Group A patients were older (group A, 78 (6) years v group B, 70 (9) years; P < 0.05), were more likely to be female (group A, 73% v group B, 14%; P < 0.01), and were more likely to have orthostatic hypotension while pacing DDI (group A, 46% v group B, 0%; P < 0.01). Group A and B patients could not be differentiated by other prepacing clinical or haemodynamic variables. CONCLUSIONS: Elderly patients with Carotid Sinus syndrome are likely to develop symptomatic hypotension following VVI pacing. The optimum pacing mode for individual patients cannot be predicted by simple cardiovascular tests before pacing.
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incidence of complications after Carotid Sinus Massage in older patients with syncope
Journal of the American Geriatrics Society, 1994Co-Authors: Neil C Munro, J Lawson, Shona Mclntosh, Chris A Morleyf, Rose Anne KennyAbstract:OBJECTIVE: To review the incidence of neurological complications occurring after Carotid Sinus Massage performed for diagnostic purposes. DESIGN: Case review and comparison with previously published work. SETTING: Syncope Clinic, Royal Victoria Infirmary, Newcastle-upon-Tyne, and Chelsea and Westminster Hospital, London. PARTICIPANTS: Patients undergoing investigation of dizziness, syncope, or unexplained falls. METHODS: Carotid Sinus Massage performed for 5 seconds in both supine and erect postures, both before and after atropine. Contraindications to Carotid Sinus Massage were the presence of Carotid bruits, recent myocardial or cerebral ischemia, or previous ventricular tachyarrhythmias. RESULTS: Two cases of neurological complications were reported from a total of 500 patients (2000 Massage episodes) investigated in one center, giving an incidence of 0.1%. Combining this data with another center performing investigations in a similar fashion, seven neurological complications arose from a total of 5000 Massage episodes, an incidence of 0.14%. Reported complications were pyramidal signs in five cases and visual field defects in two. Pyramidal weakness persisted in one case with a pre-existing stroke on the same side, and a visual field loss was permanent in one. CONCLUSIONS: Neurological complications following Carotid Sinus Massage for diagnosis of the Carotid Sinus syndrome are uncommon and usually transient. Contraindications to Carotid Sinus Massage should be respected and the standardized technique used.
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heart rate and blood pressure responses to Carotid Sinus Massage in healthy elderly subjects
Age and Ageing, 1994Co-Authors: S J Mcintosh, J Lawson, Rose Anne KennyAbstract:The purpose of the study was to define heart rate and blood pressure responses to supine and upright Carotid Sinus Massage in healthy elderly subjects and thus to establish the validity of current diagnostic criteria for Carotid Sinus syndrome in this age group. Twenty-five healthy asymptomatic subjects (61-87 years) had Carotid Sinus Massage carried out following a standardized technique employing previously defined criteria for abnormal heart rate and blood pressure responses: 3 s asystole and a 50 mmHg fall in systolic blood pressure independent of any heart rate slowing (after intravenous atropine). No cardioinhibitory responses of greater than 3 s were documented. The mean maximal cardioinhibitory response was 1038 +/- 195 msec. Right-sided responses were more marked than left when upright (1040 +/- 202 vs. 946 +/- 135 msec; p < 0.01) but not when supine (1094 +/- 215 vs. 1073 +/- 194 msec; NS). After atropine three subjects (12%) had a significant vasodepressor response when upright, but none when supine. The mean maximal vasodepressor response was 21 +/- 14 mmHg. Right-sided blood pressure responses were more marked than left (p < 0.01). There was no fixed relationship between maximum heart rate slowing and the degree of vasodepression during Massage (range 2-80 msec/mmHg). The diagnostic criteria for heart rate and blood pressure responses in Carotid Sinus syndrome are appropriate for supine Carotid Sinus Massage in elderly subjects. Asymptomatic vasodepressor responses occur in a small proportion of healthy elderly when upright.
Simon Kerr - One of the best experts on this subject based on the ideXlab platform.
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Carotid Sinus hypersensitivity in asymptomatic older persons implications for diagnosis of syncope and falls
JAMA Internal Medicine, 2006Co-Authors: Simon Kerr, Mark S Pearce, Carol Brayne, Richard J Davis, Rose Anne KennyAbstract:Background Carotid Sinus hypersensitivity is the most commonly reported cause of falls and syncope in older persons. Recent guidelines recommend 5 to 10 seconds of Carotid Sinus Massage in supine and upright positions with beat-to-beat monitoring. The aim of this study was to determine the prevalence of Carotid Sinus hypersensitivity in (1) an unselected community sample of older people and (2) a subsample with no history of syncope, dizziness, or falls using recently standardized diagnostic criteria. Methods One thousand individuals older than 65 years were randomly sampled from a single general practice register; 272 participants underwent supine and upright Carotid Sinus Massage with continuous heart rate and phasic blood pressure monitoring. Carotid Sinus hypersensitivity was defined as asystole of 3 seconds or greater and/or a drop in systolic blood pressure of 50 mm Hg or greater. Results Carotid Sinus hypersensitivity was present in 107 individuals (39%); 24% had asystole of 3 seconds or greater during Carotid Sinus Massage; and 16% had symptoms (including syncope) with Carotid Sinus hypersensitivity. Age (odds ratio, 1.05; 95% confidence interval, 1.00-1.09) and male sex (odds ratio, 1.71; 95% confidence intervals, 1.04-2.82) were the only predictors of Carotid Sinus hypersensitivity. In 80 previously asymptomatic individuals, Carotid Sinus hypersensitivity was present in 28 (35%) and accompanied by symptoms in 10. The 95th percentile for Carotid Sinus Massage response was 7.3 seconds' asystole and a 77–mm Hg drop in systolic blood pressure. Conclusions Carotid Sinus hypersensitivity is common in older persons, even those with no history of syncope, dizziness, or falls. The finding of a hypersensitive response should not necessarily preclude further investigation for other causes of syncope.
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2 bradyarrhythmias sick Sinus syndrome Carotid Sinus syndrome
Europace, 2005Co-Authors: Rose Anne Kenny, Clive Ballard, Ruth Pearce, J Hampton, Simon Kerr, M WiddringtonAbstract:Objectives To determine the prevalence of Carotid Sinus hypersensitivity (CSH) and define heart rate (HR) and blood pressure (BP) responses to Carotid Sinus Massage (CSM) in (a) an unselected community sample of older people and (b) a sub-sample with no prior history of syncope, dizziness or falls. Methods One thousand subjects were randomly sampled from a general practice database of 1517 patients over 65 years and stratified for age and gender. Consenting participants underwent detailed clinical assessment prior to supine and upright Carotid Sinus Massage CSM with continuous heart rate and phasic blood pressure monitoring. CSH was defined as asystole in excess of 3 seconds and / or a drop in SBP of greater than 50mmHg. Results 272 participants had CSM. CSH was present in 107 (39%); 27% had asystole >3 seconds during CSM; 16% had symptoms (including syncope) with CSH. Previous history of syncope falls or dizziness was not predictive of CSH. Age (OR 1.05 95%CI 1.00, 1.09) and male sex (OR 1.71; 95%CI 1.04, 2.82) were the only independent predictors of CSH. In a previously asymptomatic sub-sample of 80 participants, CSH was present in 28 (35%). The 95th percentile for response was 7.3 seconds' asystole and 77mmHg drop in systolic blood pressure (7.1 seconds and 74mmHg when supine; 5.6 seconds and 76mmHg when erect). Conclusion CSH is common in older persons, even those with no prior history of syncope, dizziness, or falls. Derived normal thresholds for heart rate and blood pressure responses are larger than previously reported in symptomatic groups. When present, CSH cannot be assumed to be the attributable cause in those presenting with syncope and further work is required to determine the factors which transform CSH into a symptomatic state.