Kerr et al identified different types of carotid hypersensitivity based on the response to carotid sinus massage. The authors are from the University of Newcastle upon Tyne and University of Cambridge in England and Trinity College in Dublin.


Carotid sinus hypersensitivity involves a profound drop in heart rate and/or systolic blood pressure following carotid sinus massage.


Carotid sinus massage is performed:

(1) The patient is left to relax for 10 minutes in the supine position.

(2) The point of maximal carotid pulsation on each side of the neck (usually at the left of the upper border of the cricoid cartilage) is identified.

(3) The point on one side is massaged for 5 seconds.

(4) The opposite side is massaged 1 minute later.

(5) The patient is then tilted upright to 70 degrees and the massage is repeated on both the left and right sides.

(6) The cycle can be repeated up to 4 times.


Contraindications to carotid massage:

(1) recent myocardial infarction (within past 3 months)

(2) recent stroke or transient ischemic attack (within past 3 months)

(3) any history of ventricular tachyarrhythmia

(4) carotid bruits

(5) persistent atrial fibrillation



(1) asystole

(2) drop in systolic blood pressure



Drop in Systolic Blood Pressure

Type of Carotid Sinus Hypersensitivity

>= 3 seconds

< 50 mm Hg



>= 50 mm Hg


>= 3 seconds

>= 50 mm Hg




• The paper did not discuss a cutoff for a drop in systolic blood pressure.


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