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Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls Kerr SR; Pearce MS; Brayne C; Davis RJ; Kenny RAArch Intern Med 2006[Mar]; 166 (5): 515-20BACKGROUND: 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.|*Accidental Falls/prevention & control/statistics & numerical data[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Blood Pressure[MESH]|Carotid Artery Diseases/*complications/physiopathology[MESH]|Carotid Sinus/*physiopathology[MESH]|Diagnosis, Differential[MESH]|Electrocardiography[MESH]|England/epidemiology[MESH]|Female[MESH]|Heart Rate/*physiology[MESH]|Humans[MESH]|Incidence[MESH]|Male[MESH]|Odds Ratio[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Risk Factors[MESH]|Syncope/*diagnosis/etiology/physiopathology[MESH]|Tilt-Table Test[MESH] |
