Carotid Sinus Syndrome: Historical Context, Clinical Classification, and Challenges in Management

Bhaskaran Sathyapriya¹, Jayesh S Raghavendra², Swamikannu Bhuminathan³, Kesavaram Padmavathy⁴, Adugula Chandrakala^5*, Arun Shriram, Shreevithya D

This review discusses Carotid Sinus Syndrome's historical roots, clinical classification, and challenges in managing its complex forms and triggers

Abstract

Background: Carotid Sinus Syndrome (CSS) is a disorder involving an exaggerated response to the stimulation of carotid sinus baroreceptors, often resulting in syncope, particularly in older adults. Historically linked to ancient medical practices, CSS is now recognized as a manifestation of autonomic nervous system dysregulation, with significant clinical implications. This article provides a comprehensive review of CSS, focusing on its pathophysiology, diagnostic challenges, and current treatment strategies, particularly in the context of cardiac pacing. Methods: A thorough review of historical and contemporary literature was conducted, examining the pathophysiological mechanisms of CSS, its classification, and clinical presentation. The effectiveness of various diagnostic tools, including carotid sinus massage (CSM), and treatment approaches, particularly pacing and pharmacological interventions, were analyzed. Key studies were identified and synthesized to provide a detailed understanding of CSS and its management. Results: CSS is classified into three main types: cardioinhibitory, vasodepressor, and mixed, each with distinct clinical features. The condition primarily affects older males and is often triggered by external stimuli such as tight collars or neck movements. Diagnostic challenges persist, particularly in distinguishing CSS from other causes of syncope. Carotid sinus massage remains the gold standard for diagnosis, despite its risks. Treatment strategies vary, with cardiac pacing being most effective for cardioinhibitory CSS, while management of the vasodepressor form remains difficult due to the interplay between hypotension and hypertension. Pharmacological interventions, including fludrocortisone and midodrine, are limited by side effects and potential risks in hypertensive patients. Conclusion: Carotid Sinus Syndrome, though underdiagnosed, is a significant cause of syncope in older adults. While cardiac pacing is effective in preventing recurrences, managing the vasodepressor form of CSS poses ongoing challenges. Further research into new treatment options and a deeper understanding of autonomic dysregulation are essential to improving patient outcomes in CSS management.

Keywords: Carotid Sinus Syndrome, syncope, autonomic dysregulation, carotid massage, cardiac pacing

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