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Carotid sinus syndrome — SCE Geriatric Medicine MCQ

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HardFallsCarotid sinus syndromeSCE Geriatric Medicine

An 81-year-old man is reviewed after recurrent syncope while shaving and turning his head. He has hypertension and previous TIA. ECG shows sinus rhythm with first-degree AV block; lying-standing BP is stable. Carotid sinus massage in a monitored setting produces 5 seconds of asystole with reproduction of symptoms. What is the most likely diagnosis?

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Correct answer: B — Cardioinhibitory carotid sinus syndrome

Reproduction of symptoms with a significant cardioinhibitory pause during carotid sinus massage supports carotid sinus syndrome. Orthostatic hypotension is less likely because postural BP is stable and symptoms are triggered by neck movement. BPPV causes vertigo rather than syncope, and seizure would not be provoked in this manner. Falls assessment should include cardiovascular causes when episodes are unexplained or injurious.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/neurological-conditions/dementia