•

Also ‘carotid bulb’

•

Lat. ‘sinus caroticus’

•

The common carotid
artery dilation just
before its
bifurcation into the
internal and
external carotid
artery

•

Contains numerous
baroreceptors



Measuring the blood pressure

(Possible thanks to stimulating
pressoreceptors present in the artery wall)



Stimulating the carotid sinus in every way,

for example:

◦

manually

◦

during head
rotation (e.g. while
shaving)

◦

by wearing a tight
collar, scarf or…
a clerical collar ;)



Blood pressure changes stimulate the
baroreceptors



The afferent impuls goes to the vagus nerve
nucleus and angiokinetic center in
brainstem



The efferent impuls runs in the vagus nerve
to the sinoatrial and atrioventicular nodes in
the heart

The reflex

The reflex

track scheme

track scheme



Stimulating the carotid sinus causes a blood
pressure increase



Receptors tell the brain about it



The brain: ‘OMG, I need to lower a heart
beating rate!’



The heart beating rate lowers



The blood pressure decreases (even though
it’s normal)



We’re fainting (only when carotid sinus
syndrome = carotid sinus hypersensitivity
occurs)



Brain hypoxia

◦

Dizziness

◦

Faintness



Death (if asystole appears)



Used to diagnose the carotid sinus syncope (faintness) –
the patient faints after the massage



Sometimes useful for differentiating
supraventricular tachycardia (SVT) from ventricular
tachycardia



Less effective than
pharmaceutical
management of SVT
though is still
the preferred first-line
of treatment



Able to steady a
racing heart (SVT)

SVT diagram



Gentle massaging the carotid artery for 5
seconds on one side of a neck whilst monitoring a
heart rhythm and blood pressure



The heart rhythm is monitored via electrodes on
a chest attached to a heart monitor, whilst
the blood pressure is being assessed* via a cuff
around an upper arm



If the test is normal on one side of the neck, it will
probably be repeated on the other side

*assessed – oszacowany



Patient upright for 5 minutes prior to massage



Initiate monitoring EKG, blood pressure, heart rate



Identify carotid sinus location at midpoint between angle of mandible,
superior border of thyroid cartilage



Start with carotid sinus on right side:

◦

Massage location firmly but gently (use same pressure that would
indent tennis ball ; do not apply so much pressure to occlude carotid)

◦

Continue massage for 5 second period

◦

Record findings (symptoms of syncope or presyncope; mark massage
period on EKG; continue EKG until heart rate returns to baseline;
record lowest systolic and diastolic blood pressure - occurs within 15
seconds of massage)



Repeat same procedure for other positions

◦

Repeat baseline monitoring values

◦

Repeat Carotid Sinus Massage of left side

◦

Repeat baseline monitoring values



Observe patient in supine position for 10 minutes

Thank you for your

attention

(if there was any)



Silbernagl S., Despopoulos A., „Ilustrowana fizjologia człowieka”, PZWL,

Warszawa 2010



http://www.bartleby.com/107/Images/large/image513.gif



http://en.wikipedia.org/wiki/Carotid_sinus



http://medical-dictionary.thefreedictionary.com/_/viewer.aspx?

path=dorland&name=sinus_caroticus.jpg



http://www.zgapa.pl/zgapedia/Zatoka_t%C4%99tnicy_szyjnej.html



http://pl.wikipedia.org/wiki/Zatoka_t%C4%99tnicy_szyjnej



http://www.cartoonstock.com/newscartoons/cartoonists/cgo/lowres/cgon466l.jpg



http://upload.wikimedia.org/wikipedia/commons/6/62/Lead_II_rhythm_generated

_sinus_bradycardia.JPG



http://demotywatory.pl/302704/Koloratka



http://www.poradnikmedyczny.pl/mod/archiwum/629_zesp

%C3%B3%C5%82_ciasnego_ko%C5%82nierzyka.html



http://www.interna.com.pl/zespolzatokiszyjnej.htm



http://www.fpnotebook.com/cv/exam/CrtdSnsMsg.htm



http://www.ruh.nhs.uk/gps/services/specialties/older_peoples_unit/documents/c

arotid_sinus_massage_leaflet.pdf