Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Export

@article{citeulike:617147, abstract = {BACKGROUND: 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.}, address = {Institute for Ageing and Health, University of Newcastle upon Tyne, England. s.r.j.kerr@ncl.ac.uk}, author = {Kerr, S. R. and Pearce, M. S. and Brayne, C. and Davis, R. J. and Kenny, R. A.}, citeulike-article-id = {617147}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/archinte.166.5.515}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16534037}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16534037}, day = {13}, doi = {10.1001/archinte.166.5.515}, issn = {0003-9926}, journal = {Arch Intern Med}, keywords = {css, prevalence}, month = {March}, number = {5}, pages = {515--520}, posted-at = {2007-09-12 22:38:43}, priority = {3}, title = {Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls.}, url = {http://dx.doi.org/10.1001/archinte.166.5.515}, volume = {166}, year = {2006} }

TY - JOUR ID - citeulike:617147 L3 - citeulike-article-id:617147 N2 - BACKGROUND: 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. IS - 5 JF - Arch Intern Med SN - 0003-9926 AD - Institute for Ageing and Health, University of Newcastle upon Tyne, England. s.r.j.kerr@ncl.ac.uk EP - 520 TI - Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. VL - 166 SP - 515 KW - css KW - prevalence AU - Kerr, SR AU - Pearce, MS AU - Brayne, C AU - Davis, RJ AU - Kenny, RA PY - 2006/03/13/ UR - http://dx.doi.org/10.1001/archinte.166.5.515 ER -