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

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.