Heart 2000;83:22-23 ( January )

Cardiovascular medicine

Diagnosis of carotid sinus hypersensitivity in older adults: carotid sinus massage in the upright position is essential S W Parry^a, D A Richardson^a, D O'Shea^a, B Sen^b, R A Kenny^a

^a Cardiovascular Investigation Unit and Institute for the Health of the Elderly, University of Newcastle Upon Tyne, Ward 15 Offices, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK, ^b Accident and Emergency Department, Royal Victoria Infirmary

Correspondence to: Dr Parry email: s.w.parry{at}ncl.ac.uk

Accepted 19 July 1999

OBJECTIVETo assess the diagnostic value of supine and upright carotid sinus massage in elderly patients.
DESIGNProspective controlled cohort study.
SETTINGThree inner city accident and emergency departments and a dedicated syncope facility.
PATIENTS1375 consecutive patients aged > 55 years presenting with unexplained syncope and drop attacks; 25 healthy controls.
INTERVENTIONSBilateral supine carotid sinus massage, repeated in the 70° head up tilt position if the initial supine test was not diagnostic of cardioinhibitory and mixed carotid sinus hypersensitivity.
MAIN OUTCOME MEASURESDiagnosis of cardioinhibitory or mixed carotid sinus hypersensitivity; clinical characteristics of supine v upright positive groups.
RESULTS226 patients were excluded for contraindications to carotid sinus massage. Of 1149 patients undergoing massage, 223 (19%) had cardioinhibitory or mixed carotid sinus hypersensitivity; 70 (31%) of these had a positive response to massage with head up tilt following negative supine massage (95% confidence interval, 25.3% to 37.5%). None of the healthy controls showed carotid sinus hypersensitivity on erect or supine massage. The initially positive supine test had 74% specificity and 100% sensitivity; these were both 100% for the upright positive test. The clinical characteristics of the supine v upright positive subgroups were similar.
CONCLUSIONSThe diagnosis of carotid sinus hypersensitivity amenable to treatment by pacing may be missed in one third of cases if only supine massage is performed. Massage should be done routinely in the head up tilt position if the initial supine test is negative.


Keywords: carotid sinus; tilt table testing; syncope; elderly patients

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© 2000 by Heart
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