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Figure 2 Response to CSM in the supine and upright position. (Top) The response to right (R) and left (L) sided. Carotid sinus massage in the supine position. Right CSM elicited an asymptomatic drop in heart rate of 31 beats/min and a drop in systolic blood pressure of 25 mm Hg. (Bottom) The response to CSM in the upright 60° position. Right and left carotid massage reproducibly elicited a mean drop in heart rate of 60 beats/min with a mean drop in systolic blood pressure of 58 mm Hg. The patient became markedly symptomatic with syncope induced during the second right-sided massage. (L) Left carotid massage, (R) right carotid massage.