Role of carotid sinus syndrome and neurocardiogenic syncope in recurrent syncope and falls in patients referred to an outpatient clinic in a district general hospital
Abuzeid Eltrafia, Debra Kinga, Joseph H Silasb, Peter Currieb, Michael Lyec
a Wirral
Hospital, Merseyside, UK: Department of Geriatric Medicine, b Department of Cardiology, c University of
Liverpool, Merseyside, UK
Correspondence to: Dr Abuzeid E Eltrafi, 65 Dickinson Court, Wakefield, West Yorkshire WF1 3TU, UK
Submitted 28 April
1999;
Accepted 22 November 1999
Carotid sinus syndrome (CSS) and neurocardiogenic syncope (NCS)
are recognised as important causes of recurrent syncope and falls in
the elderly. In this study the role of CSS (diagnosed with carotid
sinus massage) and NCS (diagnosed with prolonged head-up tilt) in a
district general hospital were investigated.
Over 27 consecutive months carotid sinus massage was performed in 139 patients. Of these 29 (20.8%) patients (mean (SD) age of 78 (9) years)
showed a positive response. Of these 18 (62%) patients showed a
positive response only when carotid sinus massage was performed with
70° head-up tilt.
Thirteen (8.7%) of the 149 patients who had prolonged head-up tilt
testing were found to have NCS. The mean (SD) age for patients with NCS
was 59 (26) years and the mean (SD) time required to produce a positive
response during prolonged head-up tilt was 12 (5) minutes.
It is concluded that carotid sinus massage and head-up tilt
testing are useful in patients presenting with unexplained syncope and
falls in a district general hospital setting. Carotid sinus massage
should be repeated upon head-up tilt if a negative response is obtained
in the supine position.
Keywords: syncope; carotid sinus syndrome; neurocardiogenic syncope
© 2000 by The Fellowship of Postgraduate Medicine
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