What is the role of carotid sinus massage in the workup of syncope?

Updated: Jan 13, 2017
  • Author: Rumm Morag, MD, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Carotid sinus massage has been used with some success to diagnose carotid sinus syncope. Patients are placed on a cardiac monitor and beat-to-beat BP-monitoring device. Atropine is kept at the bedside.

Longitudinal massage lasting 5 seconds is initiated at the point of greatest carotid pulse intensity at the level of the thyroid cartilage on one side at a time.

The maximal response occurs after approximately 18 seconds, and a positive result is one that produces 3 seconds of asystole or syncope. If the result is negative, the process is repeated on the other carotid sinus.

Carotid sinus massage may theoretically precipitate an embolic stroke in persons with preexisting carotid artery disease.

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