Testing for Carotid Sinus Hypersensitivity
- Indicated in patients aged 60 and over with unexplained syncope.
- Contraindications include the presence of a carotid bruit, recent myocardial infarction, recent stroke or a history of ventricular tachycardia.
- Begin with the patient lying.
- Attach an ECG monitor with a printer and check the blood pressure.
- The carotid sinus lies at the level of the upper border of the thyroid cartilage just below the angle of the jaw.
- Perform carotid sinus massage for up to 15 s whilst recording a rhythm strip. Press posteriorly and medially over the artery (first on the right, and if this is negative on the left) with your thumb or index and middle fingers.
- If the test is negative, repeat with the patient sitting.
- An abnormal response is defined by a sinus pause >3 s or a drop in systolic blood pressure >50 mmHg. If these occur, discuss with a cardiologist whether pacemaker implantation is indicated.
|