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The usefulness of carotid sinus massage in different patient groups.
Age Ageing. 2003 Nov; 32(6):666-9.AA

Abstract

AIM

to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls.

DESIGN

observational study.

SETTING

teaching hospital.

METHODS

we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type).

RESULTS

we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that no women with unexplained dizziness had a positive carotid sinus massage test. None of the controls demonstrated a positive response. None of the subjects suffered any complications during or after the test.

CONCLUSION

the positive yield of carotid sinus massage in symptomatic patients was 17.6% with the yield in men being twice that in women. None of the asymptomatic control subjects demonstrated a positive response. The yields in unexplained syncope and unexplained falls patients were around 4-fold and 3-fold higher respectively than in unexplained dizziness patients. The positive yield in women with unexplained dizziness (without a definite history of syncope and falls) is zero. Hence, carotid sinus massage in older adults should particularly be targeted at patients with unexplained syncope and unexplained falls.

Authors+Show Affiliations

Kumar NP
Clinical Gerontology Research Unit, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
Thomas A
No affiliation info available
Mudd P
No affiliation info available
Morris RO
No affiliation info available
Masud T
No affiliation info available

MeSH

Accidental FallsAgedAged, 80 and overCarotid SinusDiagnosis, DifferentialDizzinessFemaleHeart ArrestHumansMaleMassageMiddle AgedRetrospective StudiesSyncopeSyncope, VasovagalSyndromeTilt-Table Test

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14600010

Citation

Kumar, Narasimhan Pradeep, et al. "The Usefulness of Carotid Sinus Massage in Different Patient Groups." Age and Ageing, vol. 32, no. 6, 2003, pp. 666-9.
Kumar NP, Thomas A, Mudd P, et al. The usefulness of carotid sinus massage in different patient groups. Age Ageing. 2003;32(6):666-9.
Kumar, N. P., Thomas, A., Mudd, P., Morris, R. O., & Masud, T. (2003). The usefulness of carotid sinus massage in different patient groups. Age and Ageing, 32(6), 666-9.
Kumar NP, et al. The Usefulness of Carotid Sinus Massage in Different Patient Groups. Age Ageing. 2003;32(6):666-9. PubMed PMID: 14600010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The usefulness of carotid sinus massage in different patient groups. AU - Kumar,Narasimhan Pradeep, AU - Thomas,Alan, AU - Mudd,Paul, AU - Morris,Robert O, AU - Masud,Tahir, PY - 2003/11/6/pubmed PY - 2004/4/22/medline PY - 2003/11/6/entrez SP - 666 EP - 9 JF - Age and ageing JO - Age Ageing VL - 32 IS - 6 N2 - AIM: to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls. DESIGN: observational study. SETTING: teaching hospital. METHODS: we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type). RESULTS: we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that no women with unexplained dizziness had a positive carotid sinus massage test. None of the controls demonstrated a positive response. None of the subjects suffered any complications during or after the test. CONCLUSION: the positive yield of carotid sinus massage in symptomatic patients was 17.6% with the yield in men being twice that in women. None of the asymptomatic control subjects demonstrated a positive response. The yields in unexplained syncope and unexplained falls patients were around 4-fold and 3-fold higher respectively than in unexplained dizziness patients. The positive yield in women with unexplained dizziness (without a definite history of syncope and falls) is zero. Hence, carotid sinus massage in older adults should particularly be targeted at patients with unexplained syncope and unexplained falls. SN - 0002-0729 UR - https://www.unboundmedicine.com/medline/citation/14600010/The_usefulness_of_carotid_sinus_massage_in_different_patient_groups_ DB - PRIME DP - Unbound Medicine ER -