Symptomatic Presentation of Carotid Sinus Hypersensitivity Is Associated With Impaired Cerebral Autoregulation

Tan, Maw Pin; Chadwick, Tom; Kerr, Simon; Parry, Steve W.

doi:10.1161/jaha.113.000514

Cited by 8 publications

(5 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, any etiology that causes hypotension might result in symptoms similar to those determined by CSH, with the first symptoms of retinal and cerebral hypoperfusion expected in the upright position when SBP drops below 80 mmHg. An association between impaired cerebral autoregulation and the symptomatic presentation of CSH was demonstrated by Tan et al 27 in a study using transcranial Doppler ultrasonography during lower body negative pressure-induced systemic hypotension. 27 They have demonstrated that individuals with symptomatic CSH have lower cerebral blood flow than do asymptomatic individuals with CSH in response to comparable reductions in systemic blood pressure, and have suggested that symptomatic individuals have an increased susceptibility to syncope or falls compared with individuals with asymptomatic CSH due to a lower ability to maintain cerebral blood flow in the face of a hypotensive challenge.…”

Section: Discussionmentioning

confidence: 82%

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Hachul

Darrieux

et al. 2018

Arquivos Brasileiros De Cardiologia

View full text Add to dashboard Cite

BackgroundCarotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis.ObjectiveTo determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria.MethodsCSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg.ResultsNo differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below ≤ 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope.ConclusionThe response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.

show abstract

Section: Discussionmentioning

confidence: 82%

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Hachul

Darrieux

et al. 2018

Arquivos Brasileiros De Cardiologia

View full text Add to dashboard Cite

show abstract

“…However, the studies were small, uncontrolled, and provided no method of distinguishing cerebral autoregulatory derangements specific to carotid sinus stimulation from the effects of profound arterial hypotension, during which cerebral autoregulation falters and fails (60). We sought to overcome these limitations through a comparison of changes in cerebral autoregulation (as measured by TCD) in response to controlled lower body negative pressure-induced hypotension in subjects with CSS, those with asymptomatic CSH, and in healthy controls in a series of studies (61,62). In both studies, we found evidence of deranged cerebral autoregulation, in the first particularly through differences in cerebrovascular resistance and in the second in cerebral blood flow velocity between patients with CSS and controls (61,62).…”

Section: Is There a Pathophysiologic Rationale For Carotid Sinus Syndmentioning

confidence: 99%

“…We sought to overcome these limitations through a comparison of changes in cerebral autoregulation (as measured by TCD) in response to controlled lower body negative pressure-induced hypotension in subjects with CSS, those with asymptomatic CSH, and in healthy controls in a series of studies (61,62). In both studies, we found evidence of deranged cerebral autoregulation, in the first particularly through differences in cerebrovascular resistance and in the second in cerebral blood flow velocity between patients with CSS and controls (61,62). However, the findings have not been replicated elsewhere and suffer from the small sample sizes as well as the many limitations of the TCD method of estimating cerebral autoregulation.…”

Section: Is There a Pathophysiologic Rationale For Carotid Sinus Syndmentioning

confidence: 99%

Should We Ever Pace for Carotid Sinus Syndrome?

Parry

2020

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Carotid sinus syndrome has been associated with transient loss of consciousness for millennia, and while steeped in cardiovascular lore, there is little in the way of solid evidence to guide its main treatment modality, permanent cardiac pacing. This article reviews the history of the condition in the context of its contemporary understanding before examining three key concepts in the consideration of what constitutes a manageable disease: first, is there a pathophysiologic rationale for the disease (in this case carotid sinus syndrome)? Second, is there a good diagnostic test that will identify it reliably? And finally, is there a convincingly evidence-based treatment for the disease? Relevant literature is reviewed, and recommendations made in how we view pacing in the context of this intriguingly opaque condition.

show abstract

“…In addition to CSH, hypotensive disorders such as vasovagal syncope (VVS) and orthostatic hypotension (OH) may be more common following stroke due to primary autonomic nervous system involvement [27], the adverse effects of medication or the presence of other related diseases such as diabetes. Furthermore, the presence of stroke disease will increase the likelihood of development of symptoms with CSH and OH, which often occurs asymptomatically among older adults with manifestation of symptoms once cerebral autoregulation is impaired [28]. In addition, the individual may not recall prodromal or syncopal symptoms from OH, VVS or CSH due to lack of awareness or amnesia for loss of consciousness [29,30,31].…”

Section: Risk Factorsmentioning

confidence: 99%

Stroke and Falls—Clash of the Two Titans in Geriatrics

Tan

2016

Geriatrics

View full text Add to dashboard Cite

Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.

show abstract

Symptomatic Presentation of Carotid Sinus Hypersensitivity Is Associated With Impaired Cerebral Autoregulation

Cited by 8 publications

References 50 publications

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method

Should We Ever Pace for Carotid Sinus Syndrome?

Stroke and Falls—Clash of the Two Titans in Geriatrics

Contact Info

Product

Resources

About