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Carotid sinus hypersensitivity is common in older patients presenting to an accident and emergency department with unexplained falls

Lookup NU author(s): Dr Nick Steen, Professor Rose Anne Kenny


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Objective: to determine the prevalence of carotid sinus hypersensitivity and orthostatic hypotension in older patients with non-accidental falls attending an accident and emergency department. Design: a prospective case-control non-randomized study. Data were collected from semi-structured interviews, physical examination and neurocardiovascular investigations. Setting: we recruited cases and controls from an inner-city accident and emergency department. Participants: 26 consecutive patients presenting to accident and emergency with non-accidental falls and 54 controls matched for age, sex and cognitive function presenting to the same department either because of an accidental fall or a reason other than falling. Main variables measured: detailed history and clinical evaluation, including postural phasic blood pressure measurements, heart rate and blood pressure responses to supine and upright carotid sinus stimulation. Results: orthostatic blood pressure responses did not differ between groups. The heart rate and blood pressure responses to carotid sinus massage were abnormal in patients with non-accidental falls compared with controls (P=0.002). Asystolic responses were present in 12 (46%) of 26 cases and seven (13%) of 54 controls. Loss of consciousness occurred during carotid sinus massage in seven (27%) of the cases, all of whom had asystole, and in none of the controls. Conclusions: Almost half of the cognitively normal older patients attending accident and emergency with non-accidental falls have carotid sinus hypersensitivity, emphasizing that a post-fall intervention strategy should include carotid sinus studies.

Publication metadata

Author(s): Kenny RA; Steen N; Davies AJ

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2001

Volume: 30

Issue: 4

Pages: 289-293

Print publication date: 01/01/2001

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press


DOI: 10.1093/ageing/30.4.289

PubMed id: 11509305


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