Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope
Carlos A. Morillo, MD ,
Maria E. Camacho, MD,
Mark A. Wood, MD, FACC*,
David M. Gilligan, MD, FACC and
Kenneth A. Ellenbogen, MD, FACC*
* Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virgnia, USA
Hunter Holmes Mc Guire Veterans Affairs Medical Center, Richmond, Virgnia, USA
Department of Cardiology, Fundación Cardiovascular del Oriente Colombiano, Bucaramanga, Colombia
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Figure 1 Mean baroreceptor slopes during pharmacologic intervention. Shown are the mean baroreflex slopes in patients with CSH (white bar), without CSH (dotted bar), control group (dark meshed bar) and with syncope not related to CSH (hatched bar). Baroreflex slopes obtained after bolus injections of nitroprusside and phenylephrine are shown for each group from left to right. *p = 0.001.
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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.
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Figure 3 Continuous ECG and blood pressure recording during right CSM (60°) in the same patient as in Figure 2. Right carotid massage elicited abrupt asystole lasting 5.1 s associated with syncope.
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