Carotid pressure test

H. In 1924, E. Hering was the first to describe the changes in the heartbeat during the carotid pressure test as a reflex (Fenz 1953). In the same year Koch described the depressor vascular reflex after the carotid pressure test (Atzler 1927).

A carotid pressure test is understood to be a drop in heart rate caused by external compression on the carotid sinus up to max. 25% of the initial value, a slight extension of the PQ time (max. up to an AV block I. degree) and / or a slight RR drop (Braun 2014).

The carotid pressure test can be used both diagnostically and therapeutically (Knuth 2006).

During the carotid pressure test, stimulation of the pressosensors causes a hyperactive reflex. This causes a slowing down of the heart rate and / or the arterial blood pressure. In hypersensitive carotid sinus, stimulation by abnormal vagal function and hypersensitivity to acetylcholine causes the hypersensitive baroreceptors located in the carotid sinus to slow down the polarization of the sinus node (Gertsch 2008 / Gülker 1998).

Indication:

The carotid pressure test can be used for:

• Especially carotid sinus syndrome (Herold 2020)
• Especially Sick Sinus Syndrome (Lüderitz 1981)
• for the clarification of syncope (Seewöster 2019)
• Therapeutically for hemodynamically stable tachycardia (Class I B indication [Knuth 2006])

Absolute contraindications:

• large, irregular plaques or stenoses of > 70% of the carotid artery
• within the last 3 months
  • TIA
  • Apoplexy
  • Myocardial infarction (Diehl 2020)

Preparations:

Before the carotid sinus massage is performed, both carotides should first be auscultated. If there is a flow noise, according to empirical data, mobilizable plaques should first be excluded by means of duplex sonography (Braun 2014 / Diehl 2020).

Prerequisites for the carotid pressure test are:

• continuous 12- channel ECG recording
• continuous, non-invasive blood pressure measurement
• Provision of 1 mg of atropine as required medication

Procedure: The patient lies on a stretcher and keeps the head slightly turned. Start with the side that supplies the non-dominant hemisphere of the brain (the right side for right-handed patients).

The carotid sinus located approx. 2 - 3 transverse fingers below the angulus mandibulae is first pressed manually only slightly for 5 sec. (because of the danger of the hypersensitive sinus), then it is pressed harder in the direction of the cervical transverse processes for max. 10 sec. (Diehl 2020 / Furger 2003). If the result is negative, it is recommended to repeat the procedure in standing position (in the best case on the tilting table) (Diehl 2020).

Test evaluation:

The test is considered positive for a hypertensive carotid sinus if:

• ≥ 3 sec. Asystole

and / or

• systolic RR- drop of > 50 mmHg

If a syncope should occur, this is called carotid sinus syndrome (Diehl 2020). However, it should be taken into account that the test is positive in 25% of the over 65-year-olds. In these cases one speaks of a sensitive carotid sinus. For this reason, the test should only be evaluated in conjunction with the patient's medical history and clinic (Herold 2020 / Erdmann 2009).

1. Atzler E et al (1927) Blood circulation: Blood vessels - circulation. Part Two. Springer Publishing House 1352
2. Braun J et al (2014) Clinical Guide to Internal Medicine. Elsevier Urban and Fischer Publishers 95 - 96
3. Erdmann E (2009) Clinical Cardiology: Diseases of the heart, the circulation and the vessels near the heart. Springer publishing house 87
4. Fenz E (1953) Bibliographia Neurovegetativa 1900 - 1950 Springer Verlag Vienna 236
5. Furger P (2003) Interior quick: The facts- Turbo Thieme Verlag 80
6. Gertsch M (2008) The ECG: At a glance and in detail. Springer Medizin Verlag 400
7. Gülker H et al (1998) Guidelines for the therapy of cardiac arrhythmias. Walter de Gruyter Publisher 31 - 31
8. Herold G et al (2020) Internal medicine. Herold Publishing House 281
9. Knuth P et al (2006) Emergencies according to leading symptoms. Deutscher Ärzte Verlag 167
10. Lüderitz B (1981) Therapy of Cardiac Rhythm Disorders: Guide for Clinics and Practices Springer Verlag 118
11. Seewöster T et al (2019) Differential diagnosis of unclear syncopations. Heart (44) 759 - 768