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Cerebral autoregulation is impaired in cardioinhibitory carotid sinus syndrome

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


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Objectives: To compare changes in cerebral autoregulation in response to controlled, lower body negative pressure-induced hypotension in patients with carotid sinus syndrome (CSS) and case controls. Design: Prospective case controlled study. Setting: Secondary and tertiary referral falls and syncope service. Patients: 17 consecutive patients with CSS and 11 asymptomatic controls. Interventions: Hypotension insufficient to cause syncope induced by lower body negative pressure (minimum 30 mm Hg fall in systolic blood pressure (SBP)) during concomitant transcranial Doppler ultrasonography. Main outcome measures: Cerebral autoregulation (systolic, diastolic and mean middle cerebral arterial blood flow velocities and cerebrovascular resistance) with continuous end-tidal carbon dioxide and haemodynamic monitoring. Results: Cerebral autoregulatory indices differed significantly between patients with CSS and controls. Systolic, diastolic and middle cerebral arterial blood flow velocities were, respectively, 9.2 m/s (95% confidence interval (CI) 2.9 to 15.4 m/s), 4.7 m/s (95% CI 1.5 to 7.9 m/s) and 6.9 m/s (95% CI 2.5 to 11.4 m/s) slower in patients with CSS. Cerebrovascular resistance was significantly greater in patients with CSS than in controls at SBP nadir and suction release; differences were 0.9 mm Hg/m/s (95% CI 0.0 to 1.7 mm Hg/m/s) and 0.8 mm Hg/m/s (95% CI 0.0 to 1.7 mm Hg/m/s), respectively. End-tidal carbon dioxide and systemic haemodynamic variables were similar for patients and controls at baseline and during lower body negative pressure. Conclusions: Cerebral autoregulation is altered in patients with CSS. This difference may have aetiological implications in the differential presentation with falls and drop attacks rather than syncope.

Publication metadata

Author(s): Parry SW, Steen N, Baptist M, Fiaschi KA, Parry O, Kenny RA

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2006

Volume: 92

Issue: 6

Pages: 792-797

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Group


DOI: 10.1136/hrt.2004.053348

PubMed id: 16449521


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