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Pacing Clin Electrophysiol 2020 May 4. Epub 2020 May 4.

Dept of Cardiology, , Arrhythmology Centre and Syncope Unit, Ospedali del Tigullio, Lavagna, Italy.

Aims: The reproducibility of carotid sinus massage (CSM) is debated. Aim of this study was to assess the reproducibility according to the methodology and diagnostic criteria defined by the guidelines on syncope of the European Society of Cardiology.

Method: Among 2800 patients with syncope who underwent CSM in the years 2005-2019, 109 patients (62 males; mean age 76±10 years), had performed a second CSM after a median of 28 months. Read More

Arq Bras Cardiol 2020 02;114(2):254-255

Hospital das Clínicas Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, SP - Brazil.

Arq Bras Cardiol 2020 02;114(2):245-253

Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil2.

Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias.

Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Read More

Ann Noninvasive Electrocardiol 2020 Jan 29:e12744. Epub 2020 Jan 29.

Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA.

Background: Implantation of the subcutaneous implantable cardioverter-defibrillator (S-ICD) is spreading and has been shown to be safe and effective; however, it does not provide brady-pacing. Currently, data on the need for brady-pacing and cardiac resynchronization therapy (CRT) implantation in patients with ICD indication are limited.

Methods: The Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II enrolled post-MI patients with reduced ejection fraction (EF ≤ 35%), randomized to either an implantable cardioverter-defibrillator (ICD) or conventional medical therapy. Read More

J Geriatr Phys Ther 2019 Jul 31. Epub 2019 Jul 31.

Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.

Background/purpose: The carotid bifurcation (CB) is the location of the carotid sinus and the baroreceptors and is also a major site for atherosclerotic plaque formation. Health care providers have therefore been cautioned to avoid the CB during carotid pulse palpation (CPP) to prevent triggering the baroreflex, occluding an artery, or propagating a thrombus. Potential risks of adverse events during CPP may be greater for older adults due to age-related vascular changes and increased risk of baroreceptor hypersensitivity. Read More

Brain Pathol 2020 01 16;30(1):191-202. Epub 2019 Aug 16.

Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.

We performed a clinicopathological study to assess the burden of small vessel disease (SVD) type of pathological changes in elderly demented subjects, who had clinical evidence of autonomic dysfunction, either carotid sinus hypersensitivity or orthostatic hypotension or both or had exhibited unexpected repeated falls. Clinical and neuropathological diagnoses in 112 demented subjects comprised dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Alzheimer's disease (AD), Mixed dementia (mostly AD-DLB) and vascular dementia (VaD). Of these, 12 DLB subjects had no recorded unexpected falls in life and therefore no evidence of concomitant autonomic dysfunction. Read More

Indian Heart J 2019 Jan - Feb;71(1):1-6. Epub 2019 Jan 30.

Department of Cardiology, Government Medical College, Kozhikode, India.

Background: Carotid sinus syndrome accounts for one third of patients who presents with unexplained syncope. Prevalence of carotid sinus hypersensitivity (CSH) in Indians has not been studied till now.

Objectives: To assess the prevalence and associations of CSH in symptomatic patients above 50 years and to study its prognostic significance pertaining to sudden cardiac death, syncope, recurrent pre syncope and falls on 1 year follow up. Read More

J Nutr Health Aging 2019 ;23(4):330-337

Nathalie van der Velde, PhD, Amsterdam University Medical Center, Department of Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam 1105AZ, the Netherlands, Tel. nr: +31 20-5665991, e-mail:

Objective: Cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. Read More

Med J Aust 2019 04 4;210(6):257-257.e1. Epub 2019 Mar 4.

Calvary Public Hospital, Canberra, ACT.

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