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Carotid Sinus Syndrome

It has long been observed that pressure at the site where the common carotid artery bifurcates produces a reflex that leads to slowing in heart rate and fall in blood pressure. In some individuals an abnormal response to carotid massage (CSM) is observed. A ventricular pause lasting more than 3 seconds and/or a fall in systolic blood pressure of more than 50 mm/Hg defines carotid sinus hypersensitivity.  Precise methodology and results of CSM are reported in the guidelines on syncope (1). It should be emphasised that reproduction of symptoms during CSM is a strong argument for the diagnosis of carotid sinus syndrome (CSS) and not only carotid hypersensitivity. Increasing importance has been handed to the execution of the massage also in the upright position, usually using a tilt table (2).

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