This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (12)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Allergy  • Alert me on articles by topic  Social Bookmarking   What's this?

Implications for Diagnosis of Syncope and Falls

Simon R. J. Kerr, MB, MRCP; Mark S. Pearce, PhD; Carol Brayne, MD, FRCP; Richard J. Davis, MB, MRCGP; Rose Anne Kenny, MD, FRCP

Arch Intern Med. 2006;166:515-520.

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.

Author Affiliations: Institute for Ageing and Health (Drs Kerr and Kenny) and Paediatric and Lifecourse Research Group, School of Clinical Medical Sciences (Dr Pearce), University of Newcastle upon Tyne, Newcastle upon Tyne, England; Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (Dr Brayne); Bridge End Surgery, Chester-le-Street, England (Dr Davis); and Neurosciences Institute, Trinity College, Dublin, Ireland (Dr Kenny).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Carotid Sinus Hypersensitivity and Syncope: Cause/Effect or True/True/Unrelated
Neil L. Coplan
Arch Intern Med. 2006;166(5):491-492.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
Developed in collaboration with et al.
Eur Heart J 2009;30:2631-2671.
FULL TEXT  

Results of carotid sinus massage in a tertiary referral unit--is carotid sinus syndrome still relevant?
Tan et al.
Age Ageing 2009;38:680-686.
ABSTRACT | FULL TEXT  

Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomised, double-blind, placebo controlled crossover trial
Parry et al.
Heart 2009;95:405-409.
ABSTRACT | FULL TEXT  

Recurrent falls: pace now or wait for another fall?
Ermis and Benditt
Heart 2009;95:350-352.
FULL TEXT  

Psychiatric Assessment and Diagnosis in Older Adults
Meeks et al.
Focus 2009;7:3-16.
ABSTRACT | FULL TEXT  

CHAPTER 26 Syncope
Brignole et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Is it cardiac? Assessment of syncope with a scoring system
Romero-Ortuno and Kenny
Heart 2008;94:1528-1529.
FULL TEXT  

The relationship between carotid sinus hypersensitivity, orthostatic hypotension, and vasovagal syncope: a case-control study
Tan et al.
Europace 2008;10:1400-1405.
ABSTRACT | FULL TEXT  

Prevalence of positive carotid sinus massage and related risk of syncope in patients with Alzheimer's disease
Bordier et al.
Europace 2007;9:829-834.
ABSTRACT | FULL TEXT  

Coronary spasm: a case of transient ST elevation and syncopal ventricular tachycardia without angina
Postorino et al.
Europace 2007;9:568-570.
ABSTRACT | FULL TEXT  

Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged >40 years?
Humm and Mathias
J. Neurol. Neurosurg. Psychiatry 2006;77:1267-1270.
ABSTRACT | FULL TEXT  

Carotid sinus hypersensitivity: an age-related phenomenon
Masson
J. Neurol. Neurosurg. Psychiatry 2006;77:1207-1207.
FULL TEXT  

Carotid Sinus Hypersensitivity and Syncope in Elders
JWatch General 2006;2006:3-3.
FULL TEXT  

Carotid Sinus Hypersensitivity and Syncope in Elders
Journal Watch Cardiology 2006;2006:1-1.
FULL TEXT  

Carotid sinus hypersensitivity and syncope: cause/effect or true/true/unrelated.
Coplan
Arch Intern Med 2006;166:491-492.
FULL TEXT