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The maneuver of the carotid sinus massage (Msc)

  1. Gastroepato
  2. Cardiology
  3. The maneuver of the carotid sinus massage
  4. Sick sinus syndrome
  5. Arrhythmias
  6. Electrocardiogram (ECG)
  7. Criteria for reading an ecg
  8. Atrio-ventricular block (BAV)
  9. Arrhytmias post infarction

Notes by dr. Claudio Italiano

The carotid sinus massage (MSC) stimulates the parasympathetic and sympathetic fibers contained in it, inducing an increase in vagal activity through the former and a reduction of the sympathetic activity through the latter.

Parasympathetic stimulation is clinically more important and manifests immediately.

MAIN EFFECTS OF MSC

- Cardioinhibition by vagal effect on the node SA and AV, this effect is blocked by atropine.
- Vasodepression with pressure drop: this effect is blocked by adrenaline.
The test is usually performed when there are doubts to be clarified regarding a patient's malaise with momentary loss of consciousness if a bradyarrhythmia is suspected (cf. syncope)

INDICATIONS

- Diagnosis of heart rhythm disturbances not classified only with ECG (or lacking the possibility to record ECG).
- Treatment of some rhythm disorders.

CONTRAINDICATIONS

- Age over 75 years.
- Presence of arterial murmur on the carotids.
- Positive or suspected anamnesis due to disease of the node de. (SSS).
- Suspected digital intoxication.
- Junctional tachycardia.
- Positive or suspected history of hypersensitivity of the carotid sinus (MSC can be used for diagnostic purposes, but must be done with due precautions).

Diagnostic features of carotid sinus hypersensitivity syndrome

- Asistoia> 3 sec.
- PA fall of 50 mmHg
- Reproducibility of results after MSC.
A response characterized by:
- slowing of the heart rate equal to 30-50% of the initial one or
- PA fall of 30 mmHg.

FACTORS WHICH ALTERED THE SENSITIVITY OF THE CAROTID SINUS

Provoking an increase:
- atherosclerosis carotid and cerebral arteries;
- coronary atherosclerosis;
- angina crisis and acute myocardial infarction;
- hypertension;
- sinus node disease (SND);
- old age;
- acidosis;
- drugs: cholinergic, digital, a-methyldopa, beta-blockers, morphine, nitrites, calcium, salicylates, insulin;

Causing a reduction:
All conditions that predispose sinus tachycardia to sympathetic hypertonia:
- temperature;
- anemia;
- thyrotoxicosis;
- COPD;
- anxiety and hyperventilation states;
- hypocalcemia;
- hypoxia;
- drugs: sympathomimetic, alcohol, vagolytic, quinidine.


PROCEDURE

- Exclude that there are contraindications (auscultate the neck).
- Patient lying down and relaxed, head slightly rotated from the opposite side.
- Set up venous access. Keep ready 2 f. of atropine.
- Monitor ECG.
- First massage the right carotid sinus
- Use your fingertips to perform a real massage, compressing the artery between the fingers and the vertebral column. Exerting only pressure on the carotid is less effective and more dangerous.
It is possible to ascertain that the MSC does not cause temporary occlusion of the carotid artery, palpating the ipsilateral temporal artery with the other hand.
Normally the SC is located under the angle of the jaw, at the level of the upper edge of the thyroid cartilage, anterior to the sternocleidomastoid muscle.
- Massage for no more than 10 seconds and then stop for a few seconds. In case of no answer, try again on the same side, a little lower; in this way the massage
• should be performed along the entire length of the carotid. Repeat with the same technique, on the left, if necessary.
Caution Never perform the left and right MSCs at the same time.
- In case of non-response, the MSC can be performed by asking the patient to perform the Valsalva maneuver or after administration of drugs such as digital or beta-blockers. The effectiveness of the MSC does not depend on the duration of the massage. Failure is most frequently caused by an incorrect execution technique.


COMPLICATIONS

- Interference with cerebral circulation: transient and non-cerebral ischemic accidents. Important selection of patients (age, atherosclerosis, carotid breaths).
- Heart rhythm disturbances: asystole, ventricular fibrillation (in the case of digitalis intoxication).


cardiology index