Carotid Sinus Hypersensitivity in Asymptomatic Older Persons: Implications for Diagnosis of Syncope and Falls
Open accessAbstract
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.
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Syncope was induced in only 5% of asymptomatic persons aged older than 65 years during carotid sinus massage.
“Syncope was induced in only 5% of asymptomatic persons aged >65 years. 89”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [89]
The diagnosis of carotid sinus syndrome requires both the reproduction of spontaneous symptoms during carotid sinus massage and clinical features of spontaneous syncope compatible with a reflex mechanism.
“There is strong consensus that the diagnosis of CSS requires both the reproduction of spontaneous symptoms during CSM and clinical features of spontaneous syncope compatible with a reflex mechanism.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [89]
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- Authors
- Kerr, S. R. J., Pearce, M. S., Brayne, C., Davis, R. J., & Kenny, R. A.
- Affiliations
- Newcastle University (GB)
- Trinity College Dublin (IE)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2006-03-13
- Volume
- 166
- Issue
- 5
- Pages
- 515
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2118452851
- Cited by
- 194
- References
- 36
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 8 · 2020: 10 · 2019: 7 · 2018: 6 · 2017: 4 · 2016: 8 · 2015: 10 · 2014: 14 · 2013: 10 · 2012: 16
- FWCI
- 13.44
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- carotid sinus hypersensitivity, carotid sinus massage, syncope, falls, older adults, asystole, blood pressure drop, prevalence, asymptomatic patients, sex differences, age differences
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Blood Pressure, Carotid Artery Diseases, Carotid Sinus, Diagnosis, Differential, Electrocardiography, England, Female, Heart Rate, Humans, Male, Prognosis, Retrospective Studies, Risk Factors, Syncope, Incidence, Odds Ratio, Tilt-Table Test
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