Carotid sinus massage
Carotid sinus massage is carried out in a quiet warm room. ECG and blood pressure monitoring equipment is attached and, after a brief period of rest, gentle pressure is applied to the right carotid sinus for five seconds with continuous monitoring of heart rate and blood pressure. If no response, or physiological responses only, are obtained, massage is performed once the heart rate and blood pressure have returned to baseline – this usually takes about 30 seconds. The left carotid sinus is then tested. Massage should then be repeated when tilted at 70 °.
Because there is a small risk of inducing neurological complications (with an incidence of 0.4% for transient symptoms and < 0.02% for permanent neurology)[/one_half] [one_half_last] carotid sinus massage should not be carried out if there is a history of recent cerebral ischaemia or if there is a carotid bruit unless investigation has demonstrated normal flow characteristics. Other contraindications include recent myocardial infarction and previous ventricular tachydysrhythmia. Some medications, including Digoxin, Diltiazem, Beta-blockers and Alpha Methyldopa, increase carotid sinus sensitivity. If carotid sinus massage elicits a positive response when a patient is taking one of these medications, the medication should, if possible, be discontinued and carotid sinus massage repeated at another time.[/one_half_last] [hr_shadow]