Carotid endarterectomies

Carotid sinus

In human anatomy, the carotid sinus is a localized dilation of the internal carotid artery at its origin, the common carotid artery bifurcation.

Functions

It contains numerous baroreceptors, which function as a "sampling area" for many homeostatic mechanisms for maintaining blood pressure. The carotid sinus baroreceptors are innervated by the sinus nerve of Hering, which is a branch of IX (glossopharyngeal nerve). The glossopharyngeal nerve synapses in the nucleus tractus solitarius (NTS) located in the medulla of the brainstem. The NTS modulates the activity of sympathetic and parasympathetic (vagal) neurons in the medulla. These neurons then regulate the autonomic control of the heart and blood vessels. The aortic arch baroreceptors are innervated by the aortic nerve (Nerve of Cyon), which combines with X (vagus nerve) and travels to the NTS.

Disease of the carotid sinus

The carotid sinus often has atherosclerotic plaques because of disturbed hemodynamics (low wall shear stress, flow reversal/recirculation). Since these plaques, if large and unstable, predispose to ischemic strokes and transient ischemic attacks, carotid endarterectomies are frequently done for prophylaxis.

The carotid sinus can be oversensitive to manual stimulation, a condition known as carotid sinus hypersensitivity, carotid sinus syndrome or carotid sinus syncope, in which manual stimulation causes large changes in heart rate and/or blood pressure.

Carotid sinus massage

Massage of the carotid sinus, carotid sinus massage is used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia. It, like the valsalva maneuver, is a therapy for SVT. However, it is less effective than pharmaceutical management of SVT with verapamil or adenosine.

Carotid sinus reflex death

Carotid sinus reflex death is a disputed mechanism of death in which manual stimulation of the carotid sinus allegedly causes strong vagus nerve impulses leading to terminal cardiac arrest. Carotid sinus reflex death has been pointed out as a possible cause of death in cases of strangulation and hanging, but such deductions remain controversial. Studies have however suggested that the carotid sinus reflex can be a contributing factor in other mechanisms of death by reducing blood pressure and heart rate, especially in the elderly or in people suffering from carotid sinus hypersensitivity. A carotid massage can also possibly dislodge a thrombus, or some plaque. This could lead to any number of life threatening effects, including, but not limited to pulmonary embolism, heart attack, and stroke. All of these are potentially lethal.

See also

References

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