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Tilt testing and carotid sinus massage4, 5 and 6
Tilt testing is used to evaluate syncope, particularly if SB-207499 syncope or orthostatic hypotension is suspected. Reflex syncope describes conditions in which the cardiovascular reflexes that usually control blood pressure become intermittently inappropriate following a certain trigger (orthostatic stress, emotion, micturition, etc.), leading to vasodilatation and/or bradycardia. Orthostatic hypotension is caused by a more pervasive failure of blood pressure control that results in an inadequate increase in vascular resistance in response to standing.
Carotid sinus massage (CSM) is indicated in older patients with unexplained syncope, to diagnose carotid sinus hypersensitivity; guidelines recommend this in the over 40s although realistically it is in the over 60s where it becomes an issue. Pressure at the common carotid artery bifurcation can produce a fall in HR and BP and this reflex can be exaggerated in some people. CSM is performed on each side for 10 seconds in both the supine and erect positions with continuous HR and BP monitoring. Falls in BP or HR associated with typical symptoms define carotid sinus hypersensitivity (CSH). Carotid sinus syndrome (CSS) is diagnosed in patients with spontaneous syncope and CSH and a pacemaker is indicated for those with a significant bradycardic response. Neurological complications are rare but CSM should be avoided in patients with recent TIA or stroke or with carotid bruits, unless carotid Doppler studies have shown no significant stenosis.