Abstract
Patients with established reproducible cardioinhibitory carotid sinus hypersensitivity were studied to define the dose of atropine required to abolish the heart rate slowing in response to carotid sinus massage, the heart rate response to the Valsalva manoeuvre and salivary gland flow. Bolus doses of intravenous atropine were given to a cumulative dose of 700 mcg. Cardioinhibition was abolished in all patients with a total dose of 700 mcg. The heart rate ratio during the Valsalva manoeuvre did not vary significantly. The decline in salivary gland flow was evident earliest, at a dose of 75 mcg. In clinical studies, 700 mcg of atropine will abolish the diagnostic cardioinhibitory response to carotid sinus massage in patients with the syndrome. This may not prevent syncope, as could occur in the key frequent vasodepressor form of carotid sinus hypersensitivity syndrome.
Similar content being viewed by others
References
Kenny RA, Traynor G. Carotid sinus syndrome—clinical characteristics in elderly patients.Age Ageing 1991;20: 449–454.
da Costa D, McIntosh S, Kenny RA. Benefits of fludrocortisone in the treatment of symptomatic vasodepressor carotid sinus syndrome.Br Heart J 1993;69: 308–310.
McIntosh S, da Costa D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a syncope clinic.Age Ageing 1993;22: 53–58.
Brignole M, Menozzi C, Gianfranchi L, Oddone D, Lolli G, Bertulla A. Carotid sinus massage, eyeball compression and head-up tilt in patients with syncope of uncertain origin and in healthy control subjects.Am Heart J 1991;122: 1644–1651.
Brignole M, Menozzi L, Lolli C, Oddone D, Gianfranchi L, Bertulla A. Pacing for carotid sinus syndrome and sick sinus syndrome.PACE 1990;13: 7071–7075.
Smith ML, Ellenbogen KA, Eckberg DL. Sympathoinhibition and hypotension in carotid sinus hypersensitivity.J Clin Auton Res 1992;2: 383–387.
Almquist A, Gornick C, Benson DW, Dunnigan A, Benditt DG. Carotid sinus hypersensitivity: evaluation of the vasodepressor component.Circulation 1985;71: 927–936.
McIntosh S, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly.Am J Med 1993;95: 203–208.
Morley CA, Perrins EJ, Grant P, Chan SL, McBrien DJ, Sutton R. Carotid sinus syndrome treated by pacing: analysis of persistent symptoms and role of atrioventricular sequential pacing.Br Heart J 1982;47: 411–418.
Ewing DJ. Cardiovascular reflexes and autonomic neuropathy (editorial review).Clin Sci 1978;55: 321–327.
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy.Br Med J 1982;285: 916–918.
Walter PF, Crawley IS, Dorney ER. Carotid sinus hypersensitivity syndrome.Am J Cardiol 1978; 396–403.
Tristani FE, Kamper DG, McDermott GH, Peters BJ, Smith JS. Alterations of postural and Valsalva responses in coronary heart disease.Am J Physiol 1977;233: H694-H699.
Dollery CT, Davies DS, Draffan GH, Dargie HJ, Dean CR, Reid JL, Calre RA, Murray S. Clinical pharmacology and pharmacokinetics of clonidine.Clin Pharmac Ther 1975;19: 11–17.
Hulme EC, Birdsall NJM, Burgess ASV, Mehta P. The binding of antagonists to brain muscarinic receptors.Mol Pharmacol 1978;14: 737–750.
Kenny RA, Lyon CC, Ingram AM, Bayliss J, Lightman SL, Sutton R. Enhanced vagal activity and normal arginine vasopressin response in carotid sinus syndrome: implications for a central abnormality in carotid sinus hypersensitivity.Cardiovasc Res 1987;21: 545–550.
Kenny RA, Allen J, Wallace W. Autonomic reflexes in patients with cardioinhibitory carotid sinus syndrome.J Clin Auton Res 1993;3: 101–105.
Goodman Gilman A, Rall TW, Nies AS, Taylor P.The Pharmacological Basis of Therapeutics. 8th edition. Oxford: Pergamon Press, 1990; 150–158.
McIntosh SJ, da Costa D, Lawson J, Kenny RA. Heart rate and blood pressure responses to carotid sinus massage in healthy elderly subjects.Age Ageing 1994 (in press).
Morley CA, Dehn TCB, Perrins EJ, Sutton R. Baroreflex sensitivity measured by the phenylephrine pressor tests in patients with carotid sinus and sick sinus syndrome.Cardiovasc Res 1984;18: 752–761.
Mathias CS, Armstrong E, Brasse N, Chandhuri KR, Enevoldsow P, Russell RWR. Value of non-invasive continuous blood pressure monitoring in the detection of carotid sinus hypersensitivity.Clin Auton Res 1991;1: 157–159.
Parchi P, Pierangeli B, Verlicchi A, Cortelli P. Non-invasive continuous cardiovascular monitoring in the vasodepressor form of carotid sinus hypersensitivity—confirmation of its value.Clin Auton Res 1993;3: 81–82.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kenny, R.A., McIntosh, S.J. & Wynne, H. Pattern of inhibition of parasympathetic activity in response to incremental bolus doses of atropine in carotid sinus hypersensitivity. Clinical Autonomic Research 4, 63–66 (1994). https://doi.org/10.1007/BF01828840
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01828840