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Updated: May 21, 2025
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Pathophysiological aspects of carotid sinus massage
J Gert van Dijk1, Boriana S Gagaouzova1,2, Jelle S Y de Jong3,4
1Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
Insights
Cardioinhibition (CI) and arterial vasodepression (aVD) are distinct responses to carotid sinus massage. CI is an early, transient reaction, while aVD is a delayed response, both contributing to blood pressure decrease.
Area of Science:
- Cardiovascular Physiology
- Autonomic Nervous System Regulation
Background:
- Carotid sinus massage (CSM) is used to assess autonomic function.
- Understanding the distinct mechanisms of blood pressure (BP) decrease during CSM is crucial for diagnosing syncope.
Purpose of the Study:
- To investigate the characteristics of cardioinhibition (CI) and arterial vasodepression (aVD) following CSM.
- To determine if CI and aVD occur independently.
- To elucidate the factors influencing the termination of BP decrease during CSM.
Main Methods:
- Retrospective analysis of BP, heart rate (HR), stroke volume, and total peripheral resistance (TPR) in 244 CSMs from two Dutch syncope centers.
- Defining CI and aVD based on HR and TPR deviations from baseline.
- Utilizing the logratio method to analyze relative changes and assess the co-occurrence and dependencies of CI and aVD.
Main Results:
- CI occurred in 48% and aVD in 30% of CSMs.
- CI and aVD did not co-occur more frequently than by chance.
- CI was an earlier, faster, and shorter response compared to aVD, with a similar overall BP-lowering effect.
- Longer massage duration enhanced aVD and the overall BP decrease.
- BP decrease triggered corrective increases in HR and TPR.
Conclusions:
- CI is a phasic response to CSM onset, independent of aVD.
- aVD is a more latent response, sensitive to ongoing massage.
- BP correction mechanisms likely involve contralateral carotid sinus and aortic baroreceptors.
- The efficacy of corrective responses may influence the overall BP decrease post-CSM.
Aims:
We studied the blood pressure (BP) decrease after carotid sinus massage to study cardioinhibition (CI) and arterial vasodepression (aVD), whether CI and aVD occur independent of one another, and how the BP decrease ends.
Methods And Results:
We measured BP, heart rate (HR), stroke volume, and total peripheral resistance (TPR) retrospectively in carotid sinus massage cohorts in two Dutch syncope centres. Cardioinhibition and aVD were defined as HR and TPR decreasing below 3 SD under pre-massage baseline means. We used the logratio method to analyse changes relative to baseline and tested whether CI and aVD occurred together more often than through chance and whether the responses depended on massage duration and on corrective BP increases. Cardioinhibition occurred in 48% and aVD in 30% of 244 massages of 90 persons. Cardioinhibition and aVD did not occur together more often than randomly. Compared with aVD, CI occurred more often, earlier, faster, and shorter with a larger maximal but similar overall BP-decreasing effect. Longer massage duration yielded a larger BP decrease through stronger aVD. The BP decrease evoked corrective increases of HR and TPR.
Conclusion:
Cardioinhibition appears as a phasic response to the onset of massage, independent of aVD, which is a more latent response sensitive to ongoing massage. Blood pressure corrections probably depend on the contralateral carotid sinus and aortic baroreceptors. The BP decrease after sinus massage may in part depend on the efficacy of corrective responses.
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