Makindo Medical Notes

⚠️ Always assess stroke risk before CSM — exclude carotid stenosis with Doppler ultrasound first. Perform in a monitored setting with full resuscitation backup.

📖 About

• Requires a quiet, warm room 🌡️
• Attach ECG 📈 and BP monitoring equipment
• Resuscitation equipment at hand 🛟

🛠️ Technique

• Apply gentle pressure to the right carotid sinus for ~5 seconds
• Observe for HR and BP changes
• Repeat on the left carotid
• Repeat with patient tilted to 70° (upright) ↔️

📊 Monitoring

• Positive = pause ≥3 sec (cardioinhibitory) ⚡ OR systolic BP drop ≥50 mmHg (vasodepressor)
• Mixed type shows both responses

⚠️ Cautions

• Small risk of stroke/TIA → avoid if recent event or significant carotid stenosis 🚫
• Avoid in recent MI ❤️ or significant arrhythmias
• Drugs (digoxin, diltiazem, beta-blockers) may exaggerate sensitivity 💊
• Consider repeating test off drugs if safe

🛟 Immediate Management (if syncope)

• Lay patient flat 🛏️
• Raise legs 🦵 to improve cerebral perfusion
• Give oxygen if hypoxic

📚 Case Example

👴 An 82-year-old man with recurrent unexplained falls undergoes CSM under ECG/BP monitoring. On right-sided massage, he develops a 4-second sinus pause ⚡ with presyncope. ✅ Diagnosis: Carotid sinus hypersensitivity (cardioinhibitory). 🛠️ Plan: Lifestyle advice (avoid tight collars), review medications, pacemaker considered 💓.