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2017, Number 1

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Rev Mex Cardiol 2017; 28 (1)

Hypersensitivity of carotid sinus. A forgotten cause of syncope and falls in the elderly

Asensio LE, Barinagarrementería AF, Álvarez CSJE, Lara VS

Language: English
References: 28
Page: 29-34
PDF size: 195.84 Kb.


ABSTRACT

Carotid sinus syndrome is a cause of syncope and falls in the elderly that is frequently overlooked because of different reasons, nevertheless it might be present in up to 40% of subjects older than 80 years. Its physiopathology is not clear even if it has many common points with neutrally mediated syncope. Its main feature is that the trigger for the symptoms is the stimulation of the neck’s baro-receptors. The diagnosis is usually clinical and the carotid sinus massage confirms it by reproducing the symptoms when it induces longer than three second asystole or blood pressure drops higher than 50 mmHg. Its treatment has many controversial points and the options are limited when it comes to the vasodepressor variety. In the cardio-inhibitory variety, the most accepted treatment is a pacemaker implant, nonetheless, the recurrence rates still high.


REFERENCES

  1. The Task Force for the diagnosis and management of syncope of the European Society of Cardiology. Guidelines for the diagnosis and management of Syncope (Version 2009). Eur Heart J 2009; 30 (21): 2631-2671.

  2. Sutton R. Carotid sinus syndrome: Progress in understanding and management. Global Cardiology Science and Practice 2014: 18. Available in: http://dx.doi.org/10.5339/gcsp.2014.18

  3. Solari D, Maggi R, Oddone D, Solano A, Croci F, Donateo P et al. Clinical context and outcome of carotid sinus syndrome diagnosed by means of the “method of symptoms”. Europace. 2014; 16 (6): 928-934.

  4. Brignole M, Menozzi C. Carotid sinus syndrome: diagnosis, natural history and treatment. Eur J Card Pacing Electrophysiol. 1992; 2: 247-254.

  5. Healey J, Connolly SJ, Morillo CA. The management of patients with carotid sinus syndrome: is pacing the answer? Clin Auton Res. 2004; 14 (1): 180-186.

  6. Amin V, Pavri B. Carotid sinus syndrome. Cardiol Rev. 2015; 23 (3): 130-134.

  7. Wieling W, Krediet C, Solari D, De Lange F, van Dijk N, Thijs R et al. At the heart of the arterial barorreflex: A physiological basis for a new classification of carotid sinus hypersensitivity. J Intern Med. 2013; 273 (4): 345-358.

  8. Krediet C, Jardine D, Wieling W. Dissection of carotid sinus hypersensitivity: the timing of vagal and vasodepressor effects and the effect of body position. Clin Sci (Lond). 2011; 121 (9): 389-396.

  9. Tan MP, Chadwick TJ, Kerr SR, Parry SW. Symptomatic presentation of carotid sinus hypersensitivity is associated with impaired cerebral autoregulation. J Am Heart Assoc. 2014; 3: e000514. doi: 10.1161/JAHA.11300514.

  10. Chamsi-Pasha MA, Chamsi-Pasha H. Avicennas’s contribution to cardiology. Avicenna J Med. 2014; 4 (1): 9-12.

  11. Krediet CT, Parry SW, Jardine DL, Benditt DG, Brignole M, Wieling W. The history of diagnosing carotid sinus hypersensitivity: Why are the current criteria too sensitive? Europace. 2011; 13 (1): 14-22.

  12. Schoon Y, Olde-Rickkert M, Rongen S, Lagro J, Schalk B, Claasen J. Head turning-induced hypotension in elderly people. PLoS ONE. 2013; 8 (8): e72837. doi 10.1371/journal.pone.0072837.

  13. Van der Velde N. Falls in old age: pills, the heart and beyond. [Tesis de doctorado] Erasmus University, Rotterdam. ISBN 978-90-8559-297-2. 2007, pp. 9-18. http://repub.eur.nl/pub/10146/

  14. Tan MP, Newton JL, Reeve P, Murray A, Chadwick TJ, Parry SW. Results of carotid sinus massage in a tertiary referral unit-is carotid sinus syndrome still relevant? Age Ageing. 2009; 38: 680-686.

  15. Thomas JE. Hyperactive carotid sinus reflex and crotid sinus syncope. Mayo Clin Proc. 1969; 44 (2): 127-139.

  16. Brignole M, Sartore B, Barra M, Menozzi C, Lolli G. Ventricular and dual chamber pacing for treatment of carotid sinus syndrome. Pacing Clin Electrophysiol. 1989; 12 (4): 582-590.

  17. Munro N, McIntosh S, Lawson J, Morley CA, Sutton R, Kenny RA. Incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc. 1994; 42 (12): 1248-1251.

  18. Seifer C. Carotid sinus syndrome. Cardiol Clin. 2013; 31 (1): 111-121.

  19. McLeod CJ, Trusty J, Jenkins SM, Rea R, Cha Y, Espinosa R et al. Method of pacing does not affect the recurrence of syncope in carotid sinus syndrome. Pacing Clin Electrophysiol. 2012; 37 (7): 827-833.

  20. Ryan DJ, Nick S, Colette S, Roseanne K. Carotid sinus syncope, should we pace? A multicenter randomized control trial (Safepace 2). Heart. 2010; 96 (5): 347-351.

  21. Parry SW, Steen N, Bexton RS, Tynan M, Kenny RA. Pacing in elderly recurrent fallers with carotid sinus hypersensitivity: a randomized double-blind, placebo controlled crossover trial. Heart. 2009; 95 (5): 405-409.

  22. The task force on cardiac pacing and resynchronization therapy of the European society of cardiology. 2013 Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2013. doi:10:1093/eurheartj/eht150.

  23. Sachpekidis V, Vogiatzis I, Dadous G, Kanonidis I, Papadopoulos C, Sakadamis G. Carotid sinus hypersensitivity is common in patients presenting with hip fracture and unexplained falls. Pacing Clin Elelctrophysiol. 2009; 32 (9): 1184-1190.

  24. Madden KM, Lockhart C, Cuff D, Potter TF, Menelly GS. Aerobic training in older adults with type 2 diabetes and vasodepressive carotid sinus hypersensitivity. Aging Clin Exp Res. 2013; 25 (6): 651-657.

  25. Kauffman H, Norcliffe-Kaufmann L, Palma JA. Droxidopa in neurogenic orthostatic hypotension. Expert Rev Cardiovasc Ther. 2015; 13 (8): 875-891.

  26. Asensio E, Orea A, Castillo L, Fraga JM, Colín E, Prieto J. Síncope en el anciano: Hallazgos de pruebas complementarias en un Centro Hospitalario Universitario. Arch Cardiol Mex. 2009; 70 (3): 201-206.

  27. Asensio E, Aguilera A, Corral MA, Mendoza K, Nava PE, Rendón AL et al. Prevalence of orthostatic hypotension in a series of elderly mexican institutionalized patients. Cardiol J. 2011; 18 (3): 282-288.

  28. Asensio E, Alvarez JB, Lara S, Alvarez de la Cadena JE, Juárez D. Postprandial hypotension in the elderly: findings in a Mexican population. Arch Cardiol Mex. 2015; 85 (4): 284-291.




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