Evaluation: The carotid artery is auscultated for bruits prior to sinus massage. If a bruit is heard over the carotid artery, then Doppler ultrasonography (US) is performed.
Contraindications to carotid sinus massage:
(1) history of myocardial infarction within the past 3 months
(2) history of transient ischemia attack or stroke within the past 3 months
(3) history of a previous serious adverse response to carotid sinus massage
(4) carotid artery stenosis on ultrasonography > 70%
If carotid artery stenosis is 50 to 70%, then carotid artery massage is only performed with the patient supine.
Additional reasons to avoid carotid sinus massage (not listed in paper):
(1) recent carotid artery surgery on that side
(2) abscess adjacent to carotid sinus
