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Medicine (Baltimore) 2018 Sep;97(37):e12335

Department of Cardiology.

Rationale: Carotid sinus hypersensitivity (CSH) is traditionally classified into 3 subgroups: cardioinhibitory, vasodepressor, and mixed subtypes. However, the underlying mechanism of CSH in head and neck cancer is controversial. Several pathological mechanisms of CSH have been proposed: atherosclerotic noncompliance, sternocleidomastoid proprioceptive denervation, and generalized autonomic dysfunction. Read More

Arq Bras Cardiol 2018 Jul;111(1):84-91

Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.

Background: Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. Read More

Herzschrittmacherther Elektrophysiol 2018 Jun 29;29(2):166-170. Epub 2018 May 29.

Service de Cardiologie, CHU La Timone, 13005, Marseille, France.

Adenosine is a ubiquitous substance that is released under several physiological and pathological conditions and has cardiovascular effects including cardioinhibition and vasodilation. It has been shown to be an important modulator implicated in several forms of syncope. In patients with chronic low plasma levels of adenosine, a transient release of endogenous adenosine can be sufficient to block conduction in the atrioventricular node and induce prolonged asystole; conversely, when plasma adenosine levels are chronically high, adenosine release is responsible for vasodepression. Read More

Front Pharmacol 2017 12;8:913. Epub 2017 Dec 12.

Centro de Estudos de Doenças Crónicas, NOVA Medical School - Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal.

It is known that adenosine and adenosine-5'-triphosphate (ATP) are excitatory mediators involved in carotid body (CB) hypoxic signaling. The CBs are peripheral chemoreceptors classically defined by O, CO, and pH sensors. When hypoxia activates the CB, it induces the release of neurotransmitters from chemoreceptor cells leading to an increase in the action potentials frequency at the carotid sinus nerve (CSN). Read More

Physiol Rep 2017 Oct 16;5(19). Epub 2017 Oct 16.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada

The arterial baroreflex is crucial for short-term blood pressure control - abnormal baroreflex function predisposes to syncope and falling. Hypersensitive responses to carotid baroreflex stimulation using carotid sinus massage (CSM) are common in older adults and may be associated with syncope. The pathophysiology of this hypersensitivity is unknown, but chronic denervation of the sternocleidomastoid muscles is common in elderly patients with carotid sinus hypersensitivity (CSH), and is proposed to interfere with normal integration of afferent firing from the carotid baroreceptors with proprioceptive feedback from the sternocleidomastoids, producing large responses to CSM. Read More

Postepy Kardiol Interwencyjnej 2017 25;13(2):184-185. Epub 2017 May 25.

Cardiology Unit, Policlinico Casilino, Rome, Italy.

Ned Tijdschr Geneeskd 2017 ;161:D1312

AMC, afd. Cardiologie, Amsterdam.

Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the A&E department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. Read More

Ned Tijdschr Geneeskd 2017 ;161:D826

VU medisch centrum, afd. Neurologie, Amsterdam.

Background: Carotid sinus massage is a widely used method for diagnosis and treatment of supraventricular tachycardia and carotid sinus hypersensitivity. Complications, mostly neurological, can occur but are rare. Carotid stenosis is a risk factor for complications. Read More

J Electrocardiol 2017 Jul - Aug;50(4):523-525. Epub 2017 Mar 14.

Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Swallow induced syncope is a rare clinical condition which is thought to result from an abnormal vagal reflex leading to bradycardia and cerebral hypoperfusion. It mostly occurs in patients with organic or functional disorders of the esophagus, and often requires permanent pacemaker implantation, along with treatment of the underlying esophageal pathology. In the following case, we report of a 71-year-old male with achalasia post per oral endoscopic myectomy, who presented with syncope and documented AV-block while eating solid food. Read More

Heart Rhythm 2017 08 9;14(8):e255-e269. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

J Am Coll Cardiol 2017 Aug 9;70(5):664-679. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

Circulation 2017 Aug 9;136(5):e123-e135. Epub 2017 Mar 9.

Objectives: To determine, using systematic review of the biomedical literature, whether pacing reduces risk of recurrent syncope and relevant clinical outcomes among adult patients with reflex-mediated syncope.

Methods: MEDLINE (through PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (through October 7, 2015) were searched for randomized trials and observational studies examining pacing and syncope, and the bibliographies of known systematic reviews were also examined. Studies were rejected for poor-quality study methods and for the lack of the population, intervention, comparator, or outcome(s) of interest. Read More

BMC Anesthesiol 2016 10 6;16(1):85. Epub 2016 Oct 6.

Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.

Background: We present a case of a patient with multinodular goiter disease who suffered asystole during head hyperextension for surgical positioning on the operational table.

Case Presentation: Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome. Read More

Rom J Intern Med 2016 Sep;54(3):173-178

Background: Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition. Read More

Yale J Biol Med 2016 03 24;89(1):59-71. Epub 2016 Mar 24.

Professor of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James' Hospital, Hospital 4 Top Floor, Dublin 8, Ireland.

Neurocardiovascular instability (NCVI) refers to abnormal neural control of the cardiovascular system affecting blood pressure and heart rate behavior. Autonomic dysfunction and impaired cerebral autoregulation in aging contribute to this phenomenon characterized by hypotension and bradyarrhythmia. Ultimately, this increases the risk of falls and syncope in older people. Read More

Neurol Clin 2016 Aug;34(3):525-45

Department of Neurology, Columbia University College of Physicians and Surgeons, Neurological Institute of New York, 710 West 168th Street, New York, NY 10032, USA. Electronic address:

Syncope, or the sudden loss of consciousness, is a common presenting symptom for evaluation by neurologists. It is not a unique diagnosis but rather a common manifestation of disorders with diverse mechanisms. Loss of consciousness is typically preceded by a prodrome of symptoms and sometimes there is a clear trigger. Read More

Hypertension 2016 07 9;68(1):227-35. Epub 2016 May 9.

From the Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (T.E.L.); Department of Pharmacology (R.I.) and Department of Physiology (I.T.), University of Medicine and Pharmacy, "Gr. T. Popa," Iasi, Romania; Colonial Pipeline Company, Atlanta, GA (R.C.); CVRx, Inc., Minneapolis, MN (A.W.C., D.G.); and North Memorial Medical Center, Trauma Services, Robbinsdale, MN (E.D.I.).

Carotid bodies play a critical role in protecting against hypoxemia, and their activation increases sympathetic activity, arterial pressure, and ventilation, responses opposed by acute stimulation of the baroreflex. Although chemoreceptor hypersensitivity is associated with sympathetically mediated hypertension, the mechanisms involved and their significance in the pathogenesis of hypertension remain unclear. We investigated the chronic interactions of these reflexes in dogs with sympathetically mediated, obesity-induced hypertension based on the hypothesis that hypoxemia and tonic activation of carotid chemoreceptors may be associated with obesity. Read More

Europace 2016 Jul 2;18(7):1101-7. Epub 2016 May 2.

Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Clinical Academic Office, M3.100, 3rd Floor Leech Building, Newcastle upon Tyne NE2 4HH, UK Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

Aims: Carotid sinus hypersensitivity (CSH) is arbitrarily defined as ≥3 s asystole or vasodepression of ≥50 mmHg in response to carotid sinus massage (CSM). Using this definition, 39% of older people meet the criteria for CSH. It has been suggested that current criteria are too sensitive. Read More

World J Cardiol 2016 Mar;8(3):277-82

Nicholay Teodorovich, Moshe Swissa, Kaplan Medical Center, the Hebrew University, Jerusalem 91120, Israel.

A tilt table test (TTT) is an inexpensive, noninvasive tool for the differential diagnosis of syncope and orthostatic intolerance and has good diagnostic yield. The autonomic system malfunction which underlines the reflex syncope is manifested as either hypotension or bradycardia, while an orthostatic challenge is applied. The timing of the response to the orthostatic challenge, as well as the predominant component of the response help to differentiate between various forms of neurocardiogenic syncope, orthostatic hypotension and non-cardiovascular conditions (e. Read More

J Am Med Dir Assoc 2016 Mar 9;17(3):193-9. Epub 2015 Oct 9.

Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Objective: Cardiovascular disorders are recognized as risk factors for falls in older adults. The aim of this systematic review was to identify cardiovascular disorders that are associated with falls, thus providing angles for optimization of fall-preventive care.

Design: Systematic review. Read More

Clin Ter 2015 ;166(3):e216-33

Dipartimento di Medicina Clinica e Molecolare - Azienda Ospedaliera Sant' Andrea, University of Rome, Italy.

Nowadays, syncope still generates complicated challenges for clinicians for the alarm it arises in patients and, at the same time, for the multiple causes it has determined by. In almost one third of cases, syncope is neuromediated, in young subjects in vasovagal, whereas in elderly is often determinated by carotid sinus hypersensitivity. These two kinds of syncope have two completely different diagnostic approach. Read More

PLoS One 2015 9;10(6):e0126241. Epub 2015 Jun 9.

Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.

Background: Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity.

Methods: Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Read More

Front Physiol 2014 8;5:471. Epub 2014 Dec 8.

Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil.

Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1-39. Read More

Glob Cardiol Sci Pract 2014 18;2014(2):1-8. Epub 2014 Jun 18.

Emeritus Professor of Clinical Cardiology, National Heart & Lung Institute, Imperial College, London, UK.

Carotid sinus syndrome (CSS) is a disease of the autonomic nervous system presenting with syncope, especially in older males who often have cardiovascular disease. The aetiology is unknown and epidemiological data is limited. Forty new patients/million population have been estimated to require pacing for CSS and these patients represent ∼9% of those presenting syncope to a specialist facility. Read More

Cardiol Rev 2015 May-Jun;23(3):130-4

From the *Department of Medicine and †Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA.

Carotid sinus hypersensitivity, first described less than 65 years ago, is an important and often undiagnosed cause of syncope in the elderly. Its pathophysiology is complex and certain aspects are not completely understood. The timely diagnosis and treatment of this condition can improve morbidity and prevent complications in the elderly. Read More

Pacing Clin Electrophysiol 2015 Jan 5;38(1):48-53. Epub 2014 Sep 5.

Department of Cardiology, Ha Emek Medical Center, Afula, Israel.

Introduction: Life expectancy increases progressively and nonagenarians are a growing population. We report trends in pacing and long-term outcome in nonagenarians over a 20-year period in a single center compared with those of younger patients.

Methods: We retrospectively reviewed all the patients who underwent their first pacemaker implantation from January 1, 1991 to December 31, 2010 and were followed through December 31, 2013. Read More

Rev Med Inst Mex Seguro Soc 2014 Jul-Aug;52(4):462-7

Servicio de Angiología, Hospital de Especialidades, Centro Médico Nacional La Raza, Distrito Federal, México.

Syncope is a medical emergency, which is more or less frequent. Its prevalence increases with age. It is defined as the loss of consciousness and postural tone resulting from a transient alteration of cerebral flow. Read More

Neurol Int 2014 Apr 3;6(2):5352. Epub 2014 Jun 3.

Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki , Japan.

A 46-year-old woman was admitted to our hospital with mild right-sided hemiparesis and orthostatic hypotension. Magnetic resonance angiography of the neck showed stenosis of the left distal carotid sinus surrounded by intraluminal hyperintensities on both T1-weighted and T2-weighted images, representing a periluminal hematoma secondary to carotid artery dissection. The dissection hyper-extended the carotid artery wall and stimulated baroreceptors in the carotid sinus. Read More

J Am Heart Assoc 2014 Jun 19;3(3):e000514. Epub 2014 Jun 19.

Institute for Ageing and Health, Newcastle University and Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom (S.J.K., S.W.P.).

Background: Carotid sinus hypersensitivity (CSH) is associated with syncope, unexplained falls, and drop attacks in older people but occurs asymptomatically in 35% of community-dwelling elders. We hypothesized that impaired cerebral autoregulation is associated with the conversion of asymptomatic CSH to symptomatic CSH. We therefore conducted a case-control study evaluating individuals with CSH with and without the symptoms of syncope or unexplained falls, as well as non-CSH controls, to determine whether the blood pressure and heart rate changes associated with CSH are associated with symptoms only when cerebral autoregulation is altered. Read More

N Z Med J 2014 Mar 28;127(1391):84-5. Epub 2014 Mar 28.

Mayo Clinic, 200 1st Street Southwest, Rochester, MN, USA, 55905.

Tidsskr Nor Laegeforen 2014 Apr 8;134(7):705-9. Epub 2014 Apr 8.

Institutt for klinisk medisin Universitetet i Oslo og Geriatrisk avdeling Oslo universitetssykehus.

Background: Falls are common among elderly people, leading to increased morbidity and reduced quality of life. A broad-based interdisciplinary study, for example in an outpatient clinic specialising in falls, has been recommended in light of the multiple and complex causes that tend to be involved. At present there are few outpatient clinics in Norway specialising in falls, and no data from such studies have yet been published. Read More

Avicenna J Med 2014 Jan;4(1):9-12

King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.

Ibn Sina, known in the West as Avicenna, was the most famous and influential of all the Islamic philosopher-scientists. His most important medical works are the Canon of Medicine medical encyclopedia and a treatise on cardiac drugs. His Canon of Medicine remained the standard text in both the East and West until the 16(th) century. Read More

JAMA Otolaryngol Head Neck Surg 2014 May;140(5):459-63

IMPORTANCE Carotid body tumors are rare neoplasms of neural crest origin that are both highly vascularized and locally invasive. Treatment options for these tumors often include surgery with preoperative embolization, which can pose major cardiovascular risk to patients. As demonstrated by this case report, hemodynamic instability following preoperative embolization of a carotid body tumor may indicate severe carotid sinus hypersensitivity and the need for temporary cardiac pacing. Read More

Int J Cardiol 2014 4;172(1):e143-4. Epub 2014 Jan 4.

Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran; Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Masui 2013 Oct;62(10):1230-2

Department of Anesthesiology, Okayama Red Cross Hospital, Okayama 700-0941.

We report a case of a 19-year-old male with rocuronium-induced anaphylactic shock. He was scheduled for endoscopic sinus surgery for chronic sinusitis under general anesthesia. Induction of anesthesia was done with fentanyl, propofol and sevoflurane. Read More

Aging Clin Exp Res 2013 Dec 22;25(6):651-7. Epub 2013 Oct 22.

VITALiTY (Vancouver Initiative to Add Life to Years) Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada,

Background And Aims: Vasodepressive carotid sinus hypersensitivity (V-CSH) is a common but incurable etiology for fainting in older adults with diabetes (OADM), and is diagnosed by carotid sinus massage (CSM). Aerobic exercise has been shown to be an effective therapy for other neuroautonomic etiologies of syncope (such as orthostatic hypotension), but the effectiveness of aerobic training in V-CSH remains unknown. We examined whether aerobic training could attenuate the vasodepressive response to CSM in OADM (older adults with type 2 diabetes) subjects complicated by V-CSH. Read More

Arch Orthop Trauma Surg 2013 Nov 1;133(11):1557-60. Epub 2013 Sep 1.

Orthopedics and Traumatology Department, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.

Objective: The purpose of the prospective study is to investigate the cardiovascular effects of abduction shoulder sling (ASS) in elderly patients who underwent rotator cuff surgery.

Methods: The study included 49 consecutive patients older than 50 years (mean 59.3 ± 8. Read More

PLoS One 2013 16;8(8):e72837. Epub 2013 Aug 16.

Department of Geriatric Medicine Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Carotid sinus hypersensitivity has a high prevalence in the elderly and is a possible cause of falls. In carotid sinus hypersensitivity, external triggers cause sudden reductions in blood pressure, leading to dizziness or syncope, resulting in falls. Turning of the head is considered an important example of such an external trigger in everyday life, wherein rotation of the neck is thought to manipulate the hypersensitive carotid sinus. Read More

Scand J Public Health 2013 Jul 3;41(5):442-54. Epub 2013 Apr 3.

Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.

Aims: Falls often result in soft tissue injuries, dislocations, fractures, longstanding pain and reduced quality of life. Therefore, fall preventive programmes have been developed.

Methods: In this review, we evaluate programmes that in randomized controlled trials (RCT) have been shown with fall reducing effect. Read More

Turk Kardiyol Dern Ars 2013 Jan;41(1):75-83

Department of Syncope and Electrophysiology, ND Secours/USEK University Hospital, Byblos, Lebanon.

Neurocardiogenic syncope is known to be associated with autonomic nervous system dysfunction, although the mechanism has not been entirely elucidated. In this study, we sought to highlight the pathogenic role of the autonomic nervous system in neurocardiogenic syncope and to review the associated co-morbidities known to have a dysautonomic basis. Herein we discuss migraine, orthostatic hypotension, postural orthostatic tachycardia syndrome, endothelial dysfunction, chronic fatigue syndrome, and carotid sinus hypersensitivity with a focus on the pathogenic role of the autonomic nervous system and any consecutive clinical implications. Read More

J Intern Med 2013 Apr;273(4):359-67

Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.

Objectives: The aim of the study was to investigate the resting levels of novel cardiovascular biomarkers in common types of noncardiac syncope.

Design And Setting: An observational study was conducted including 255 patients (mean age 60 years, range 15-93; 45% men) with unexplained syncopal attacks. Subjects underwent an expanded head-up tilt test including carotid sinus massage, and nitroglycerin provocation if indicated. Read More

J Intern Med 2013 Apr;273(4):345-58

Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

The aim of this review is to provide an update of the current knowledge of the physiological mechanisms underlying reflex syncope. Carotid sinus syncope will be used as the classical example of an autonomic reflex with relatively well-established afferent, central and efferent pathways. These pathways, as well as the pathophysiology of carotid sinus hypersensitivity (CSH) and the haemodynamic effects of cardiac standstill and vasodilatation will be discussed. Read More

J Am Med Dir Assoc 2013 May 14;14(5):326-30. Epub 2013 Jan 14.

New York Medical College, Valhalla, NY, USA.

Objectives: To investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department.

Participants: Participants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department.

Design: Observational retrospective study. Read More

Osteoporos Int 2013 Mar 8;24(3):747-62. Epub 2013 Jan 8.

Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205-02 Malmö, Sweden.

The proportion of elderly in the society increases and fall frequency increases with advancing age. Many falls result in fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, increased mortality, and excess in healthcare costs. Due to the magnitude of these negative effects, a variety of single- and multicomponent fall-preventive intervention programs has been initiated. Read More

Am J Alzheimers Dis Other Demen 2013 Feb 12;28(1):47-53. Epub 2012 Dec 12.

Department of Geriatric Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.

To investigate the association of the hypotensive syndromes orthostatic hypotension (OH), postprandial hypotension (PPH), and carotid sinus hypersensitivity (CSH) with cognitive impairment (mild cognitive impairment/dementia). Continuous measurements of blood pressure (Finapres) were performed during active standing, meal test, and carotid sinus massage, among 184 elderly patients presenting with falls. Mild cognitive impairment (MCI) and dementia were diagnosed following a multidisciplinary assessment. Read More

Cardiol Clin 2013 Feb;31(1):111-21

Arrhythmia Service, Section of Cardiology, St. Boniface Hospital, The University of Manitoba, Y3006, 401 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.

Carotid sinus hypersensitivity was first reported more than 200 years ago. Nevertheless, a complete understanding of this relatively common clinical finding in older patients has proven elusive. There is evidence to support an association between symptoms, particularly syncope, and a hypersensitive response to carotid sinus massage. Read More

J Gerontol A Biol Sci Med Sci 2013 May 15;68(5):581-9. Epub 2012 Oct 15.

Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, The Netherlands.

Background: Though highly prevalent, the pathophysiology of orthostatic hypotension (OH), postprandial hypotension (PPH), and carotid sinus hypersensitivity (CSH) are rarely studied together. Therefore, we conducted such a comprehensive study focusing on the common role of the cardiovascular autonomic system. We hypothesized that in geriatric patients, OH, PPH, and CSH are manifestations of cardiovascular autonomic dysfunction and investigated state-of-the-art cardiovascular autonomic function indices in a group of geriatric falls or syncope patients. Read More

ISRN Cardiol 2012 10;2012:216206. Epub 2012 Sep 10.

UO Emergency Medicine and Syncope Unit, Ospedale Santa Maria Nuova-Firenze, Piazza S. Maria Nuova, 1-50131, Florence, Italy ; Cardiology Unit, Electrophysiology and Syncope Unit, Ospedale Santa Maria Nuova-Firenze, Piazza S. Maria Nuova, 1-50131, Florence, Italy.

Syncope recurrence in pacemaker-implanted subjects for the cardio-inhibitory response to sinus carotid massage (SCM) was investigated. The study-hypothesis was that recurrences had significant vasodepressor responses that could justify the loss of consciousness. Forty-six patients were enrolled (16 patients and 30 controls), followed and revaluated after 5-7 years. Read More

Cochrane Database Syst Rev 2012 Sep 12(9):CD007146. Epub 2012 Sep 12.

Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Background: Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009.

Objectives: To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. Read More

Am J Ther 2016 Jan-Feb;23(1):e208-17

1Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY 2Division of Cardiology, Department of Medicine, Robert Packer Hospital, Sayre, PA.

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion followed by spontaneous recovery. Common causes of syncope include vasovagal syncope, situational syncope, orthostatic hypotension, carotid sinus hypersensitivity, left- and right-sided obstructive cardiac lesions, and cardiac arrhythmias. History and physical examination often provide valuable clues about the underlying etiology of syncope. Read More