CAROTID SINUS SYNDROME: CLINICAL AND METHODOLOGICAL ASPECTS OF DIAGNOSING

Сarotid sinus hypersensitivity (CSH) is defined as a drop in systolic blood pressure of at least 50 mm Hg and/or asystole for 3 or more seconds when pressing on the carotid sinus. If symptoms appear (syncope or presyncope) and clinical signs compatible with the reflex mechanism of syncope (dizziness, sensation of sudden hot flashes, nausea, darkening in the eyes, increased sweating, pallor, lethargy) are observed then we are talking about carotid sinus syndrome (CSS). CSS is a treatable cause of neurocardiogenic syncope in the elderly but is often not considered in differential diagnosis. Carotid sinus massage (CSM) as an obligatory part of the diagnostic algorithm is indicated for all patients over 40 years of age with syncope of unclear genesis and a suspected reflex mechanism. CSM is the only diagnostic tool for verifying CSH. Despite the fact that the GSM was introduced into medical practice more than 100 years ago there are large differences in the methodology of its implementation which inevitably affects the frequency of positive results and makes many physicians skeptical about the real benefit of this test and reluctant to perform it. Thus the ICS is underused in clinical practice and is performed only in 0.07-8% of patients over 40 years old with unexplained syncope. The article describes a step-by-step algorithm for performing the ICS, available for use in clinical practice and makes it possible to improve the quality of medical care for patients with syncope of the unknown genesis.