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Topic: Carotid sinus

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	THE MERCK MANUAL OF GERIATRICS, Ch. 18, Syncope
		Carotid sinus hypersensitivitycan cause syncope when neck movement, a tight collar, or a tumor or other lesion at the carotid bifurcation stimulates baroreceptors in the carotid sinus, resulting in excessive slowing of the heart, vasodilation, or both.
		Carotid sinus syndrome refers to symptomatic carotid sinus hypersensitivity and is defined by a sinus pause that lasts > 3 sec (cardioinhibitory response) or a drop in systolic BP of > 50 mm Hg (vasodepressor response) during carotid sinus massage.
		Carotid sinus massage should be done to detect carotid sinus hypersensitivity when no other cause of syncope is apparent, but only in patients who have no evidence of cerebrovascular disease (eg, carotid bruit, previous stroke, transient ischemic attacks) or cardiac conduction abnormalities.
	www.merck.com /pubs/mm_geriatrics/sec2/ch18.htm (3398 words)

	eMedicine - Carotid Sinus Hypersensitivity : Article by Mevan N Wijetunga, MD
		Afferent impulses are transmitted by the carotid sinus, glossopharyngeal, and vagus nerves to the nuclei tractus solitarius and the para median nucleus in the brain stem.
		The term induced carotid sinus syndrome refers to a clinical situation in which a patient has no clear history of accidental mechanical manipulation of the carotid sinuses and has a negative result from workup for syncope, except for a hypersensitive response to carotid sinus massage, which can be attributed to the patient's symptoms.
		Permanent pacing is discouraged in patients with a hypersensitive cardioinhibitory response to carotid sinus stimulation in the absence of symptoms.
	www.emedicine.com /med/topic299.htm (2188 words)

	Tips from Other Journals - September 1, 2001 - American Academy of Family Physicians
		Carotid sinus massage is indicated in the elderly patient who has a history of unexplained falls, loss of consciousness and presyncope, and in whom results of the cardiac and neurologic work-up have been inconclusive.
		The carotid sinus is between the angle of the mandible and the superior border of the thyroid cartilage.
		The carotid sinus should be massaged firmly (editor's note: It has been described as the amount of pressure needed to indent a tennis ball) and should last five seconds.
	www.aafp.org /afp/20010901/tips/5.html (563 words)

	AANS.org \| Education and Meetings \| AANS Scientific Journals \| Neurosurgical Focus
		Although the sylvian vein entered the affected cavernous sinus, selective transvenous embolization of the fistulous parts of the cavernous sinus was successfully performed with preservation of the sylvian venous outflow pathway.
		The GDC that transiently occluded the inferior intercavernous sinus was retrieved because it significantly retarded wash-out of the contrast material in the superficial sylvian vein and cavernous sinus.
		After occluding the superior and medial parts of the sinus with a total of 20 GDCs, subsequent transarterial embolization was performed via the ipsilateral middle meningeal artery and the maxillary artery with platinum coils for a remnant shunt.
	www.aans.org /education/journal/neurosurgical/october98/5-4-11.asp (2542 words)

	Carotid sinus hypersensitivity - Patient UK
		Auscultation for a carotid artery bruit prior to carotid sinus massage is essential in the evaluation of carotid artery occlusion.
		Carotid sinus massage is contraindicated in patients with myocardial infarction, TIA or stroke in the previous 3 months, carotid artery occlusion, history of ventricular tachycardia or ventricular fibrillation, and if there has been a previous adverse reaction to carotid sinus massage.
		May be considered in cases where carotid sinus hypersensitivity is unilateral as a result of a mass or tumour in or near the carotid sinus.
	www.patient.co.uk /showdoc/40001974 (1281 words)

	Carotid sinus massage
		Carotid sinus massage involves rubbing the large part of the arterial wall at the point where the common carotid artery, located in the neck, divides into its two main branches.
		Sinus, in this case, means an area in a blood vessel that is bigger than the rest of the vessel.
		Carotid sinus massage will slow the heart rate during episodes of atrial flutter, fibrillation, and some tachycardias.
	www.lifesteps.com /gm/Atoz/ency/carotid_sinus_massage_pr.jsp (528 words)

	Carotid Sinus Syndrome -- eCureMe.com
		Carotid sinus is a slight dilation in the carotid artery at its bifurcation into external and internal carotid arteries.
		Attacks are the result of pressure on the carotid sinus, but may occur spontaneously as a result of a tight collar, shaving the neck area over the sinus, or even turning the head to the side.
		Unilateral carotid insufficiency is a different condition that may mimic the same symptoms as carotid sinus syndrome.
	www.ecureme.com /emyhealth/data/Carotid_Sinus_Syndrome.asp (201 words)

	Recurrent syncope: an unusual presentation of Brugada syndrome : Article : Nature Clinical Practice Cardiovascular ...
		A carotid sinus massage (CSM) revealed a sinus pause of almost 7 s when pressure was applied to the patient's left side (Figure 2).
		Repeat electrocardiography showed a sinus rhythm, incomplete right bundle branch block and slight elevation of the J point from V1 to V3, which was considered to be early repolarization (Figure 1B).
		Carotid sinus hypersensitivity has been described in up to 6.6–10% of asymptomatic patients, and is probably even more frequent among older patients.
	www.nature.com /ncpcardio/journal/v3/n10/full/ncpcardio0677.html (2073 words)

	The Journal of Invasive Cardiology
		An abnormal response on HUT was elicited in 18% of patients and carotid sinus syndrome was diagnosed in 13%.
		Mild carotid sinus sensitivity was found in 19 patients (14%), with pauses of 1.6 to 2.5 seconds in 16 (median, 2.0 seconds; mean, 2.0 Â± 0.3 seconds), bradycardia with or without a junctional rhythm in 2, and CSM-induced atrial fibrillation in one.
		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.
	www.invasivecardiology.com /article/732 (3036 words)

	DAN Divers Alert Network : Vasovagal and Carotid Sinus Syncopes
		Carotid sinus syncope is a related phenomenon: this mechanism also works through cranial nerves (the glossopharyngeal and vagus nerves).
		Medical students are taught very early on not to check both carotid pulses at the same time, especially in the elderly, who may have atherosclerosis in these arteries.
		And for the rare individuals with such sensitive carotid bodies that they experience a syncopal episode with the slightest pressure to the carotid artery, they should be thoroughly evaluated by a physician and likely discouraged from diving.
	www.diversalertnetwork.org /medical/faq/faq.asp?faqid=168 (497 words)

	Carotid artery Summary
		The internal carotids that arise from the common carotids supply blood to the brain, the orbit of the eye, the middle ear, and the hypophysis.
		Within what is termed the carotid triangle (an area of the anterior neck defined by muscles--specifically by the sternocleidomastoid, and portions of the omohyoid, stylohyloid, and digastric muscles) gentle pressure is often applied to the external carotid artery to determine the presence of a pulse.
		The left carotid arises from the arch of the aorta, while the right carotid arises as one of the branches of the bifurcation of the brachiocephalic artery (trunk) into the carotid and right subclavian artery.
	www.bookrags.com /Carotid_artery (1022 words)

	FightingArts.com Forums: Carotid Artery Pinch
		As you state, the carotid sinus is indeed the main reason for the KO to St9/10.
		This is basically due to the fact that the carotid sinus is a baroreceptor (a pressure sensitive mechanism inside the neck to monitor blood pressure).
		Unfortunately the dangers of hitting the carotid sinus are hardly ever taught at seminars etc. If nothing else, the danger of separating the sinus from the carotid sheath could certainly be unpleasant (sarcasm intended)for the poor willing victim at a seminar.
	www.fightingarts.com /ubbthreads/showflat.php?Number=230973&page=0 (926 words)

	Carotid sinus hypersensitivity associated with focal {alpha}-synucleinopathy of the autonomic nervous system -- ...
		The carotid sinus reflex is triggered by the carotid baroreceptors
		Exaggerated carotid sinus massage responses are related to severe coronary artery disease in patients being evaluated for chest pain.
		Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions.
	jnnp.bmj.com /cgi/content/full/77/9/1064?rss=1 (1426 words)

	Carotid Cavernous Fistula Information - carotid cavernous sinus fistula
		Carotid Cavernous Fistula is a abnormal connections between the carotid artery (or its branches) and a large vein (cavernous sinus) behind the eye that receives blood from the orbit, the pituitary gland, and the brain.
		A carotid cavernous fistula may result from trauma to the base of the skull or from the rupture of a saccular aneurysm.
		It is distinguished from a cavernous sinus thrombosis by the rapidity of symptoms.
	www.diseasesatoz.com /cardiovascular-conditions/carotid-cavernous-fistula.htm (199 words)

	retired doc's thoughts: Caveats regarding carotid sinus massage
		The article, itself,showed that among community dwelling older folks in England, carotid sinus hypersensitivity was seen in 35 % of the sample (n=1,000) who did not have a history of falls, syncope or even dizziness.
		So the point is that a positive result on CSM does not necessarily mean that the patient with syncope has carotid sinus hypersenstivity as the cause and other causes still need to be ruled out.
		Since carotid sinus hypersensitivity may be fairly common in the older population, a comment regarding safe use of stethoscope seems in order.
	mdredux.blogspot.com /2006/03/caveats-regarding-carotid-sinus.html (473 words)

	Carotid Arteries (Site not responding. Last check: 2007-11-04)
		The carotid arteries are the four principal arteries of the neck and head.
		At the base of the brain, the two internal carotids and the basilar artery join to form a ring of blood vessels called the "circle of Willis." The external carotid arteries have several branches which supply the tissues of the face, scalp, mouth and jaws.
		The cavernous sinus lies at the base of the brain, adjacent to the temporal and sphenoid bones of the skull.
	www.innerbody.com /text/card14.html (146 words)

	Cat naps: an elderly woman with recurrent syncope -- Singh et al. 169 (9): 940 -- Canadian Medical Association Journal
		The patient was admitted with a diagnosis of carotid sinus hypersensitivity.
		Diagnostic utility of mechanical, pharmacological, and orthostatic stimulation of the carotid sinus in patients with unexplained syncope.
		Carotid sinus hypersensitivity is common in older patients presenting to an accident and emergency department with unexplained falls.
	www.cmaj.ca /cgi/content/full/169/9/940 (576 words)

	Assessment of a Newly Recognized Association: Carotid Sinus Hypersensitivity and Denervation of Sternocleidomastoid ... (Site not responding. Last check: 2007-11-04)
		Carotid sinus syndrome is a well-established cause of syncope
		hypersensitive carotid sinus and chronic denervation of the
		response to carotid sinus massage and denervation of the sternocleidomastoid
	circ.ahajournals.org /cgi/content/full/95/11/2548 (2226 words)

	beta -Adrenoceptors in vascular capacitance responses to unloading of carotid baroreceptors in anesthetized dogs -- ...
		Vascularly isolated carotid sinus (CS) regions were perfused at constant pressure and flow with arterial blood from right common carotid artery.
		Carotid sinus pressure (CSP) was recorded by strain gauge (SG) and set at desired level by regulating outflow resistance using screw clamp (SC); blood from sinuses was returned to left external jugular vein.
		Epinephrine and the carotid sinus baroreceptor reflex influence on capacitance and reflex properties of the total systemic vascular bed of the dog.
	ajpheart.physiology.org /cgi/content/full/273/4/H1713 (3047 words)

	The optic nerve and the internal carotid artery in the sphenoid sinus - Rhinoscopic Clinic Ear, Nose & Throat ...
		These structures include (1) the optic nerve and the internal carotid artery in the superolateral wall, (2) the posterior ethmoid cells in the anterosuperior wall (the Onodi cell), (3) the maxillary nerve in the lateral wall, and (4) the canal of the vidian nerve in the floor.
		The internal carotid artery originates in the common carotid artery in the neck and ascends toward the brain.
		Palpation of the superolateral wall of the sphenoid sinus with a sharp, pointed instrument during surgery and during the postoperative period, when a sphenoidotomy is done, should be avoided to prevent injury to the exposed optic nerve or internal carotid artery.
	www.findarticles.com /p/articles/mi_m0BUM/is_9_81/ai_92281729 (640 words)

	sinusbrady
		Sinus bradycardia occurs when the hearts rate is slower than 60 beats per minute.
		The sinus bradycardia rhythm is similar to normal sinus rhythm, except that the RR interval is longer.
		If the SA node is unable to properly function due to sick sinus syndrome, the AV node (or ventricular tissue if the AV node is also not functioning) take over the initiation of the heart beat, but at a rate that is slower than the sinus rhythm.
	sprojects.mmi.mcgill.ca /cardiophysio/sinusbrady.htm (310 words)

	Lab Manual - Carotid Sheath, Pharynx, & Larynx
		These contents enter or exit the skull through the external opening of the carotid canal and the jugular foramen, and are located medially and dorsally (behind) the styloid process in a space referred to as the retrostyloid space.
		Vagus nerve: pharyngeal branch (anterior to internal carotid artery), superior laryngeal nerve, branches (medial to internal carotid artery), cardiac nerves.
		Ascending pharyngeal artery (a branch of the external carotid) distributing to the dorsal wall of the pharynx.
	www.med.umich.edu /lrc/coursepages/M1/anatomy/html/head/deepneck.html (1189 words)

	UpToDate Manifestations and causes of the sick sinus syndrome
		The term was later applied to a clinical syndrome characterized by chronic SA nodal dysfunction, a sluggish or absent SA nodal pacemaker after DC electroversion, frequently depressed escape pacemakers, and AV nodal conduction disturbances [2,3].
		Sinus pauses, arrest, and exit block with, and often without, appropriate atrial and junctional escape rhythms.
		Carotid sinus hypersensitivity (carotid sinus syndrome) may unmask SA nodal dysfunction [12,13].
	patients.uptodate.com /topic.asp?file=carrhyth/2319 (607 words)

	Respiratory responses to selective blockade of carotid sinus baroreceptors in the dog -- Hopp and Seagard 275 (1): 10 ...
		Synaptic connections of central carotid sinus afferents in the nucleus of the tractus solitarius of the rat.
		Excitation of expiratory neurons adjacent to the nucleus ambiguus by carotid sinus baroreceptor and trigeminal afferents.
		Projections of the carotid sinus nerve to the nucleus of the solitary tract in the cat.
	ajpregu.physiology.org /cgi/content/full/275/1/R10 (6007 words)

	Handbook of Ocular Disease Management - Carotid-Cavernous Sinus Fistula
		Arterialized episcleral and conjunctival vessels in low-flow dural carotid cavernous sinus fistula.
		A CCSF occurs when there is a rupture within the cavernous sinus of either the internal carotid artery (ICA) or one of its smaller dural branches, resulting in the mixing of high-pressure arterial blood into the low-pressure venous system.
		Many patients with low-flow, or dural sinus, CCSF are misdiagnosed and treated erroneously for infections and inflammations, often for months to years.
	www.revoptom.com /handbook/oct02_sec6_5.htm (1096 words)

	New Insights Into the Pathophysiology of Carotid Sinus Syndrome -- Hak Tea et al. 93 (7): 1411 -- Circulation
		Carotid sinus hypersensitivity: a cause of syncope in patients with tumors of the head and neck.
		Carotid sinus syndrome induced by malignant tumours in the neck: emergence of vasodepressor manifestations following pacemaker therapy.
		Usefulness of carotid sinus pressure in detecting the sick sinus syndrome.
	circ.ahajournals.org /cgi/content/full/93/7/1411 (3321 words)

	Arch Intern Med -- Abstract: Carotid Sinus Hypersensitivity in Asymptomatic Older Persons: Implications for Diagnosis ...
		The aim of this study was to determine the prevalence of carotid
		Carotid sinus hypersensitivity was defined as asystole of 3
		Carotid sinus hypersensitivity and syncope: cause/effect or true/true/unrelated.
	archinte.ama-assn.org /cgi/content/abstract/166/5/515 (279 words)

	Effects of caffeine on carotid sinus nerve chemosensory discharge in kittens and cats -- Bairam et al. 82 (2): 413 -- ...
		Effects of caffeine on carotid sinus nerve chemosensory discharge in kittens and cats
		Carotid chemoreceptor response to natural stimuli in the newborn kitten.
		Dual responses of carotid chemosensory afferents to dopamine in the newborn kitten.
	jap.physiology.org /cgi/content/full/82/2/413 (3242 words)

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