Carotid sinus hypersensitivity is common in older patients presenting to an accident and emergency department with unexplained falls

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Abstract

Objective

to determine the prevalence of carotid sinus hypersensitivity and orthostatic hypotension in older patients with non-accidental falls attending an accident and emergency department.

Design

a prospective case–control non-randomized study. Data were collected from semi-structured interviews, physical examination and neurocardiovascular investigations.

Setting

we recruited cases and controls from an inner-city accident and emergency department.

Participants

26 consecutive patients presenting to accident and emergency with non-accidental falls and 54 controls matched for age, sex and cognitive function presenting to the same department either because of an accidental fall or a reason other than falling.

Main variables measured

detailed history and clinical evaluation, including postural phasic blood pressure measurements, heart rate and blood pressure responses to supine and upright carotid sinus stimulation.

Results

orthostatic blood pressure responses did not differ between groups. The heart rate and blood pressure responses to carotid sinus massage were abnormal in patients with non-accidental falls compared with controls (P = 0.002). Asystolic responses were present in 12 (46%) of 26 cases and seven (13%) of 54 controls. Loss of consciousness occurred during carotid sinus massage in seven (27%) of the cases, all of whom had asystole, and in none of the controls.

Conclusions

Almost half of the cognitively normal older patients attending accident and emergency with non-accidental falls have carotid sinus hypersensitivity, emphasizing that a post-fall intervention strategy should include carotid sinus studies.

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