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Carotid sinus syndrome causing recurrent falls — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyCarotid sinus syndrome causing recurrent fallsSCE Acute Medicine

A 77-year-old man presents after three unexplained falls without prodrome. One episode occurred while shaving and another when turning his head to reverse the car. ECG shows sinus rhythm with first-degree AV block; lying and standing blood pressure are unchanged. Neurological examination is normal. What is the most appropriate investigation?

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Correct answer: D — Carotid sinus massage with continuous ECG and blood pressure monitoring in an appropriate setting

Syncope triggered by neck movement or shaving in an older man suggests carotid sinus syndrome, and monitored carotid sinus massage is the diagnostic test when safe. Carotid Doppler assesses stenosis, not reflex syncope. CT head and EEG have low yield without focal neurology or seizure features.

Reference: NICE CG109 transient loss of consciousness