Carotid sinus massage for checking carotid sinus hypersensitivity

Carotid sinus massage for checking carotid sinus hypersensitivity



Carotid sinus hypersensitivity (Hypersensitive carotid sinus syndrome) can be checked by carotid sinus massage, but keep in mind the precautions and small potential risks. Here is a simple protocol, with warnings and precautions:

  1. Carotid arterial pulse is first located just below the thyroid cartilage.
  2. Right carotid sinus followed by left carotid sinus massage, with a pause between is usually done.
  3. Massage and not occlusion should be done.
  4. Done first in supine position and then in erect posture if there no positive response in the supine position. It is desirable to have the person strapped on a tilt table for carotid sinus massage in erect position, to avoid a fall. Otherwise results could be catastrophic in case of a positive response!
  5. Three seconds of asystole and / or 50 mm Hg fall in systolic pressure is taken as a positive response. It may be difficult to document fall in blood pressure by the non invasive blood pressure monitoring cuff because of the delay in getting readings and the minimum interval required between reading. Beat to beat finger plethysmographic blood pressure monitoring is better, but the equipment is quite expensive and often used for research purpose only. Radial arterial cannula with invasive blood pressure monitoring can be used, but then it becomes a very much more invasive procedure! ECG monitoring and recording is mandatory to record the pauses.
  6. Presence of a carotid bruit, recent stroke, transient ischemic attack and myocardial infarction are contraindications to carotid sinus massage.
  7. A very small risk of stroke / transient ischemic attack has to be borne in mind while going ahead with carotid sinus massage.

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