Carotid sinus hypersensitivity (CSH) is a frequent but often overlooked cause of unexplained falls. There are two types of CSH: “cardioinhibitory” or “vasodepressor.” The cardioinhibitory type is characterized by bradycardia during carotid sinus massage. With the “vasodepressor” type, hypotension is seen. Only the “cardioinhibitory” type benefits from pacemaker. Among older patients presenting to an Emergency Department with “unexplained” or “recurrent” falls, 23% had cardioinhibitory CSH. The “SAFE PACE” trial showed that implantation of dual-chamber pacemaker in patients with “cardioinhibitory” CSH reduced falls by two thirds.

Patient with carotid sinus hypersensitivity often do not remember that they lost consciousness when bradyarrhythmias and syncope were induced by examiners.

Carotid sinus massage is contraindicated in the presence of:

1. carotid bruits
2. stroke or MI within 6 months
3. ventricular tachycardia
4. ventricular fibrillation Careful monitoring (EKG running, BP monitoring, nursing staff present) is recommended when performing this clinical test

• Do carotid sinus massage in a patient that is falling if there is no other good explanation

• Don’t assume that lack of a history of syncope rules out carotid sinus problems.

• Avoid carotid sinus massage in certain patients.

• Take precautions when performing carotid sinus massage.