Carotid node syndrome
In carotid node syndrome, stimulation of one or both hypersensitive carotid nodes located at the bifurcation of the common carotid arteries leads to short episodes of syncope. There are 4 types.
- Cardiac inhibition – due to a parasympathetic response, causes bradycardia, sinoatrial arrest, or AV block.
- Vasodepression – a sudden drop in peripheral vascular resistance leads to arterial hypotension without a decrease in heart rate and conduction.
- Mixed type – a combination of symptoms that occur with cardiac inhibition and vasodepression.
- Cerebral type – occurs exclusively infrequently, fainting
not accompanied by bradycardia or arterial hypotension. Frequency. 50% of examined patients over 65 years of age with a history of frequent episodes of dizziness or fainting. The predominant age is the elderly. The predominant gender is male. Etiology
- Stimulation of hypersensitive carotid sinus baroreceptors (causes parasympathetic or sympathetic responses)
- Tumors of the carotid body
- Inflammatory and tumor processes in the lymph nodes of the neck
- Metastases in the area of the carotid node.
- organic heart disease
- Systemic atherosclerosis
- Mechanical irritation of the carotid nodes (tight collar on clothes, shaving the neck area, head movements)
- Emotional disorders.
- Veil before the eyes
- Arterial hypotension
- No symptoms following an attack.
- In the position of the sick person lying on his back with constant ECG monitoring, a careful massage of the carotid node is performed (before performing the massage, you will need to check if the sick person has contraindications to this procedure). In carotid node syndrome, there is a delay in systole for more than 3 seconds (cardiac inhibition) and / or a drop in systolic blood pressure by more than 50 mm Hg. no decrease in heart rate (vasodepression)
- Duplex scanning of the carotid arteries.
differential diagnosis. Vagal reactions, postural hypotension, primary insufficiency of the autonomic nervous system, hypovolemia, arrhythmias, pathological sinus syndrome and other conditions accompanied by low cardiac output, cerebrovascular insufficiency, emotional disorders.
- Anticholinergic products – atropine for cardiac inhibition
- Sympathomimetic products – ephedrine
- precautionary measures. The simultaneous use of digitalis products, B-blockers and methyldopa enhances the response of the carotid sinus to its mechanical irritation. Surgery
- Carotid sinus denervation with surgery or radiotherapy for selected patients
- In patients with elements of cardiac inhibition, the insertion of a pacemaker helps prevent recurrence of symptoms.
- With atherosclerotic lesions of the carotid sinus – surgical removal of atheromatous plaques.
- Prolonged confusion after fainting
- Frequent falls lead to injuries and fractures.
Current and forecast. With atheromatous lesions of the carotid or basilar artery, the prognosis is not very favorable. Concomitant pathology
- Weak sinoatrial node syndrome
- AV block.
- Carotid syncope
- Hypersensitivity of the carotid sinus
See also Atherosclerosis
ICD. G90.0 Idiopathic peripheral autonomic neuropathy Clinically, it is very important to distinguish between carotid node hypersensitivity syndrome and sick sinoatrial node syndrome.