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Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls.
Arch Intern Med. 2006 Mar 13; 166(5):515-20.AI

Abstract

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.

Authors+Show Affiliations

Kerr SR
Institute for Ageing and Health, University of Newcastle upon Tyne, England. s.r.j.kerr@ncl.ac.uk
Pearce MS
No affiliation info available
Brayne C
No affiliation info available
Davis RJ
No affiliation info available
Kenny RA
No affiliation info available

MeSH

Accidental FallsAgedAged, 80 and overBlood PressureCarotid Artery DiseasesCarotid SinusDiagnosis, DifferentialElectrocardiographyEnglandFemaleHeart RateHumansIncidenceMaleOdds RatioPrognosisRetrospective StudiesRisk FactorsSyncopeTilt-Table Test

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16534037

Citation

Kerr, Simon R J., et al. "Carotid Sinus Hypersensitivity in Asymptomatic Older Persons: Implications for Diagnosis of Syncope and Falls." Archives of Internal Medicine, vol. 166, no. 5, 2006, pp. 515-20.
Kerr SR, Pearce MS, Brayne C, et al. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med. 2006;166(5):515-20.
Kerr, S. R., Pearce, M. S., Brayne, C., Davis, R. J., & Kenny, R. A. (2006). Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Archives of Internal Medicine, 166(5), 515-20.
Kerr SR, et al. Carotid Sinus Hypersensitivity in Asymptomatic Older Persons: Implications for Diagnosis of Syncope and Falls. Arch Intern Med. 2006 Mar 13;166(5):515-20. PubMed PMID: 16534037.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. AU - Kerr,Simon R J, AU - Pearce,Mark S, AU - Brayne,Carol, AU - Davis,Richard J, AU - Kenny,Rose Anne, PY - 2006/3/15/pubmed PY - 2006/3/31/medline PY - 2006/3/15/entrez SP - 515 EP - 20 JF - Archives of internal medicine JO - Arch Intern Med VL - 166 IS - 5 N2 - 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. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16534037/Carotid_sinus_hypersensitivity_in_asymptomatic_older_persons:_implications_for_diagnosis_of_syncope_and_falls_ DB - PRIME DP - Unbound Medicine ER -