TY - JOUR

T1 - Carotid sinus syndrome and cardiovagal regulation in elderly patients with suspected syncope-related falls

AU - Brinth, Louise

AU - Latif, Tabassam

AU - Pors, Kirsten

AU - Kjær, Andreas

AU - Mehlsen, Jesper

PY - 2014

Y1 - 2014

N2 - Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflexcontrol - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorlyunderstood.Methods: We studied the hemodynamic response to carotid sinus massage (CSM) and compared this to othermeasurements of autonomic cardiovascular control in patients suspected of syncope-related falls. One hundredpatients (≥80 years-old) referred to our syncope unit due to recurrent falls or possible syncope participated. CSMwas performed in the supine and head-up tilted (HUT) positions. A hypersensitive response was defined bycurrent guidelines.Results: In the supine position, heart rate (HR) and systolic blood pressure (SBP) decreased during CSM on theright side by 17.0 +/- 15.2 min-1 and 32.5 +/- 25.5 mmHg, and on the left side by 12.8 +/- 14.3 min-1 and 22.7 +/-20.7 mmHg, respectively. Changes in SBP were greater in the head-up tilted position (right side; p=0.029, leftside; p=0.007). Hypersensitive responses were elicited in 45 patients. We found orthostatic hypotension (OH)(r=-0.275, p=0.015), not CSS, to be inversely correlated to low frequency HR variability during HUT.Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to thestimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or diseaseentity but rather an acquired cardiovascular instability due to age-related degeneration and following mismatchbetween different components of cardiovascular regulation.

AB - Background: Falls and syncope in the elderly may be caused by hypersensitivity in the high-pressure baroreflexcontrol - carotid sinus syndrome (CSS). The pathophysiological process causing CSS remains poorlyunderstood.Methods: We studied the hemodynamic response to carotid sinus massage (CSM) and compared this to othermeasurements of autonomic cardiovascular control in patients suspected of syncope-related falls. One hundredpatients (≥80 years-old) referred to our syncope unit due to recurrent falls or possible syncope participated. CSMwas performed in the supine and head-up tilted (HUT) positions. A hypersensitive response was defined bycurrent guidelines.Results: In the supine position, heart rate (HR) and systolic blood pressure (SBP) decreased during CSM on theright side by 17.0 +/- 15.2 min-1 and 32.5 +/- 25.5 mmHg, and on the left side by 12.8 +/- 14.3 min-1 and 22.7 +/-20.7 mmHg, respectively. Changes in SBP were greater in the head-up tilted position (right side; p=0.029, leftside; p=0.007). Hypersensitive responses were elicited in 45 patients. We found orthostatic hypotension (OH)(r=-0.275, p=0.015), not CSS, to be inversely correlated to low frequency HR variability during HUT.Conclusions: The hemodynamic response to CSM has a well-defined pattern and differs both with respect to thestimulus site and patient position. We suggest that CSS is not a distinct pathophysiological process or diseaseentity but rather an acquired cardiovascular instability due to age-related degeneration and following mismatchbetween different components of cardiovascular regulation.

U2 - 10.12715/har.2014.3.6

DO - 10.12715/har.2014.3.6

M3 - Journal article

VL - 3

SP - 1

EP - 9

JO - Healthy aging research

JF - Healthy aging research

SN - 2261-7434

M1 - 6

ER -