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Carotid sinus

January 14, 2023

In human anatomy, the carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage. The carotid sinus extends from the bifurcation to the "true" internal carotid artery.[1] The carotid sinus is sensitive to pressure changes in the arterial blood at this level. It is the major baroreception site in humans and most mammals.

Carotid sinus
Arteries of the neck. The carotid sinus is at the origin of the internal carotid artery.
Details
Arterycarotid artery
Nervebranch of glossopharyngeal nerve to carotid sinus
Identifiers
Latinsinus caroticus
MeSHD002346
TA98A12.2.04.008
A12.2.06.003
TA24367
FMA50094
Anatomical terminology
[edit on Wikidata]

Structure

The carotid sinus is the reflex area of the carotid artery, consisting of baroreceptors which monitor blood pressure.

Function

The carotid sinus 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 carotid sinus nerve, which is a branch of the glossopharyngeal nerve (CN IX).[2][3] The neurons which innervate the carotid sinus centrally project to the solitary nucleus in the medulla of the brainstem. The solitary nucleus indirectly modulates the activity of sympathetic and parasympathetic neurons in the medulla and pons through the hypothalamus. 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, Ludwig nerve), which combines with CN X (vagus nerve) and travels to the NTS.

Clinical significance

It is a sensitive site of the body because stimulation can drive large-scale reflex effects throughout the body. This can be used therapeutically in treatment of resistant hypertension[4] by baroreflex activation. Physical assault at this point, producing massive baroreflex activation can cause dramatic falls in blood pressure and cerebral ischemia.

Disease

The carotid sinus often has atherosclerotic plaques because of disturbed hemodynamics (low wall shear stress, flow reversal/recirculation).[5] 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. This classically presents as a patient who has "fainted" (actually a presyncope) on several occasions while shaving, or in some other way coming into contact with their carotid sinus.

Carotid sinus syndrome is a temporary loss of consciousness that sometimes accompanies convulsive seizures because of the intensity of the carotid sinus reflex when pressure builds in one or both carotid sinuses.[6]

Treatment of resistant hypertension

Stimulation of baroreceptors at the carotid sinus can be used to treat resistant hypertension via activation of the baroreflex. A pacemaker-like device can be implanted to electrically stimulate the receptors chronically, which is found to lower blood pressure by 15–25 mmHg.[4]

Massage

See also: vagal maneuver and Czermak–Hering test

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. Like the valsalva maneuver, it is a treatment for acute SVT.[7] It is less effective than pharmaceutical management of SVT with verapamil or adenosine,[8] but it is still the preferred first line of treatment in a hemodynamically stable patient.[9]

Carotid sinus reflex death

Carotid sinus reflex death is a potential etiology of sudden death in which manual stimulation of the carotid sinus allegedly causes strong glossopharyngeal nerve (Vagus nerve is for aortic arch baroreceptors) impulses leading to terminal cardiac arrest. Carotid sinus reflex death has been pointed out as a possible cause of death in cases of strangulation, hanging and autoerotic strangulation, but such deductions remain controversial. Medical literature examining the use of carotid sinus massage involving brief gentle pressure of the carotid sinus in therapeutic settings as a diagnostic and therapeutic examination tool have reported few potentially fatal complications.[10][11][12][13][14] A carotid massage can also possibly dislodge a thrombus, or some plaque. This could lead to any number of life-threatening effects, including stroke.

In martial arts and self defense

Stimulation of the carotid sinus via a slap or a strike, to induce (usually temporary, but sometimes lethal) loss of consciousness is a self-defense technique, and is often taught in martial arts such as karate.[15]

See also

References

  1. ^ S., Pellerito, John; F., Polak, Joseph (2012). Introduction to vascular ultrasonography. Saunders/Elsevier. ISBN 9781437714173. OCLC 797855544.
  2. ^ Câmara, Richard; Griessenauer, Christoph J. (2015-01-01), Tubbs, R. Shane; Rizk, Elias; Shoja, Mohammadali M.; Loukas, Marios (eds.), "Chapter 27 - Anatomy of the Vagus Nerve", Nerves and Nerve Injuries, San Diego: Academic Press, pp. 385–397, doi:10.1016/b978-0-12-410390-0.00028-7, ISBN 978-0-12-410390-0, retrieved 2020-11-20
  3. ^ Hermanowicz, Neal (2007-01-01), Goetz, Christopher G. (ed.), "Chapter 13 - Cranial Nerves IX (Glossopharyngeal) and X (Vagus)", Textbook of Clinical Neurology (Third Edition), Philadelphia: W.B. Saunders, pp. 217–229, doi:10.1016/b978-141603618-0.10013-x, ISBN 978-1-4160-3618-0, retrieved 2020-11-20
  4. ^ a b Scheffers, IJ; Kroon, AA; Schmidli, J; Jordan, J; Tordoir, JJ; Mohaupt, MG; Luft, FC; Haller, H; Menne, J; Engeli, S; Ceral, J; Eckert, S; Erglis, A; Narkiewicz, K; Philipp, T; de Leeuw, PW (5 October 2010). "Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study". Journal of the American College of Cardiology. 56 (15): 1254–8. doi:10.1016/j.jacc.2010.03.089. PMID 20883933.
  5. ^ Glagov, S; Zarins, C; Giddens, DP; Ku, DN (Oct 1988). "Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. biod degradable". Arch Pathol Lab Med. 112 (10): 1018–31. PMID 3052352.
  6. ^ Wallbach, M; Koziolek, MJ (9 November 2017). "Baroreceptors in the carotid and hypertension-systematic review and meta-analysis of the effects of baroreflex activation therapy on blood pressure". Nephrology, Dialysis, Transplantation. 33 (9): 1485–1493. doi:10.1093/ndt/gfx279. PMID 29136223.
  7. ^ Lim, SH; Anantharaman, V; Teo, WS; Goh, PP; Tan, AT (Jan 1998). "Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage". Ann Emerg Med. 31 (1): 30–5. doi:10.1016/S0196-0644(98)70277-X. PMID 9437338.
  8. ^ Ballo, P; Bernabo, D; Faraguti, SA (Aug 2004). "Heart rate is a predictor of success in the treatment of adults with symptomatic paroxysmal supraventricular tachycardia". Eur Heart J. 25 (15): 1310–7. doi:10.1016/j.ehj.2004.05.011. PMID 15288158.
  9. ^ American Heart Association. Tachycardia algorithm. Advanced Cardiac Life Support Provider Manual (2007).
  10. ^ Greenwood, Richard J.; Dupler, Donald A. (1962-08-18). "Death Following Carotid Sinus Pressure". JAMA. 181 (7): 605–609. doi:10.1001/jama.1962.03050330035007. ISSN 0098-7484.
  11. ^ Deepak, Sasalu Marulasiddappa; Jenkins, Nicholas P.; Davidson, Neil C.; Bennett, David H.; Mushahwar, Shukri S. (2005-11-01). "Ventricular fibrillation induced by carotid sinus massage without preceding bradycardia". EP Europace. 7 (6): 638–640. doi:10.1016/j.eupc.2005.06.006. ISSN 1099-5129.
  12. ^ Darrell L. Ross, Ted Chan Sudden Deaths in Custody
  13. ^ Passig, K. Carotid sinus reflex death - a theory and its history. URL last accessed February 28, 2006.
  14. ^ Mankikar, G. D.; Clark, A. N. (May 1975). "Cardiac effects of carotid sinus massage in old age". Age and Ageing. 4 (2): 86–94. doi:10.1093/ageing/4.2.86. ISSN 0002-0729. PMID 1146669.
  15. ^ "Carotid Sinus strike/slap as an effective self defense technique". Full Potential Martial Arts. Retrieved 30 May 2015.

Additional Images

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    Carotid sinus

External links

  • lesson5 at The Anatomy Lesson by Wesley Norman (Georgetown University) (livingneck)

January 14, 2023
carotid, sinus, human, anatomy, carotid, sinus, dilated, area, base, internal, carotid, artery, just, superior, bifurcation, internal, carotid, external, carotid, level, superior, border, thyroid, cartilage, carotid, sinus, extends, from, bifurcation, true, in. In human anatomy the carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage The carotid sinus extends from the bifurcation to the true internal carotid artery 1 The carotid sinus is sensitive to pressure changes in the arterial blood at this level It is the major baroreception site in humans and most mammals Carotid sinusArteries of the neck The carotid sinus is at the origin of the internal carotid artery DetailsArterycarotid arteryNervebranch of glossopharyngeal nerve to carotid sinusIdentifiersLatinsinus caroticusMeSHD002346TA98A12 2 04 008 A12 2 06 003TA24367FMA50094Anatomical terminology edit on Wikidata Contents 1 Structure 2 Function 3 Clinical significance 3 1 Disease 3 2 Treatment of resistant hypertension 3 3 Massage 3 4 Carotid sinus reflex death 4 In martial arts and self defense 5 See also 6 References 7 Additional Images 8 External linksStructure EditThe carotid sinus is the reflex area of the carotid artery consisting of baroreceptors which monitor blood pressure Function EditThis section needs additional citations for verification Please help improve this article by adding citations to reliable sources Unsourced material may be challenged and removed Find sources Carotid sinus news newspapers books scholar JSTOR November 2020 Learn how and when to remove this template message The carotid sinus 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 carotid sinus nerve which is a branch of the glossopharyngeal nerve CN IX 2 3 The neurons which innervate the carotid sinus centrally project to the solitary nucleus in the medulla of the brainstem The solitary nucleus indirectly modulates the activity of sympathetic and parasympathetic neurons in the medulla and pons through the hypothalamus 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 Ludwig nerve which combines with CN X vagus nerve and travels to the NTS Clinical significance EditIt is a sensitive site of the body because stimulation can drive large scale reflex effects throughout the body This can be used therapeutically in treatment of resistant hypertension 4 by baroreflex activation Physical assault at this point producing massive baroreflex activation can cause dramatic falls in blood pressure and cerebral ischemia Disease Edit The carotid sinus often has atherosclerotic plaques because of disturbed hemodynamics low wall shear stress flow reversal recirculation 5 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 This classically presents as a patient who has fainted actually a presyncope on several occasions while shaving or in some other way coming into contact with their carotid sinus Carotid sinus syndrome is a temporary loss of consciousness that sometimes accompanies convulsive seizures because of the intensity of the carotid sinus reflex when pressure builds in one or both carotid sinuses 6 Treatment of resistant hypertension Edit Stimulation of baroreceptors at the carotid sinus can be used to treat resistant hypertension via activation of the baroreflex A pacemaker like device can be implanted to electrically stimulate the receptors chronically which is found to lower blood pressure by 15 25 mmHg 4 Massage Edit See also vagal maneuver and Czermak Hering test 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 Like the valsalva maneuver it is a treatment for acute SVT 7 It is less effective than pharmaceutical management of SVT with verapamil or adenosine 8 but it is still the preferred first line of treatment in a hemodynamically stable patient 9 Carotid sinus reflex death Edit Carotid sinus reflex death is a potential etiology of sudden death in which manual stimulation of the carotid sinus allegedly causes strong glossopharyngeal nerve Vagus nerve is for aortic arch baroreceptors impulses leading to terminal cardiac arrest Carotid sinus reflex death has been pointed out as a possible cause of death in cases of strangulation hanging and autoerotic strangulation but such deductions remain controversial Medical literature examining the use of carotid sinus massage involving brief gentle pressure of the carotid sinus in therapeutic settings as a diagnostic and therapeutic examination tool have reported few potentially fatal complications 10 11 12 13 14 A carotid massage can also possibly dislodge a thrombus or some plaque This could lead to any number of life threatening effects including stroke In martial arts and self defense EditStimulation of the carotid sinus via a slap or a strike to induce usually temporary but sometimes lethal loss of consciousness is a self defense technique and is often taught in martial arts such as karate 15 See also EditBaroreflex Carotid bodyReferences Edit S Pellerito John F Polak Joseph 2012 Introduction to vascular ultrasonography Saunders Elsevier ISBN 9781437714173 OCLC 797855544 Camara Richard Griessenauer Christoph J 2015 01 01 Tubbs R Shane Rizk Elias Shoja Mohammadali M Loukas Marios eds Chapter 27 Anatomy of the Vagus Nerve Nerves and Nerve Injuries San Diego Academic Press pp 385 397 doi 10 1016 b978 0 12 410390 0 00028 7 ISBN 978 0 12 410390 0 retrieved 2020 11 20 Hermanowicz Neal 2007 01 01 Goetz Christopher G ed Chapter 13 Cranial Nerves IX Glossopharyngeal and X Vagus Textbook of Clinical Neurology Third Edition Philadelphia W B Saunders pp 217 229 doi 10 1016 b978 141603618 0 10013 x ISBN 978 1 4160 3618 0 retrieved 2020 11 20 a b Scheffers IJ Kroon AA Schmidli J Jordan J Tordoir JJ Mohaupt MG Luft FC Haller H Menne J Engeli S Ceral J Eckert S Erglis A Narkiewicz K Philipp T de Leeuw PW 5 October 2010 Novel baroreflex activation therapy in resistant hypertension results of a European multi center feasibility study Journal of the American College of Cardiology 56 15 1254 8 doi 10 1016 j jacc 2010 03 089 PMID 20883933 Glagov S Zarins C Giddens DP Ku DN Oct 1988 Hemodynamics and atherosclerosis Insights and perspectives gained from studies of human arteries biod degradable Arch Pathol Lab Med 112 10 1018 31 PMID 3052352 Wallbach M Koziolek MJ 9 November 2017 Baroreceptors in the carotid and hypertension systematic review and meta analysis of the effects of baroreflex activation therapy on blood pressure Nephrology Dialysis Transplantation 33 9 1485 1493 doi 10 1093 ndt gfx279 PMID 29136223 Lim SH Anantharaman V Teo WS Goh PP Tan AT Jan 1998 Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage Ann Emerg Med 31 1 30 5 doi 10 1016 S0196 0644 98 70277 X PMID 9437338 Ballo P Bernabo D Faraguti SA Aug 2004 Heart rate is a predictor of success in the treatment of adults with symptomatic paroxysmal supraventricular tachycardia Eur Heart J 25 15 1310 7 doi 10 1016 j ehj 2004 05 011 PMID 15288158 American Heart Association Tachycardia algorithm Advanced Cardiac Life Support Provider Manual 2007 Greenwood Richard J Dupler Donald A 1962 08 18 Death Following Carotid Sinus Pressure JAMA 181 7 605 609 doi 10 1001 jama 1962 03050330035007 ISSN 0098 7484 Deepak Sasalu Marulasiddappa Jenkins Nicholas P Davidson Neil C Bennett David H Mushahwar Shukri S 2005 11 01 Ventricular fibrillation induced by carotid sinus massage without preceding bradycardia EP Europace 7 6 638 640 doi 10 1016 j eupc 2005 06 006 ISSN 1099 5129 Darrell L Ross Ted Chan Sudden Deaths in Custody Passig K Carotid sinus reflex death a theory and its history URL last accessed February 28 2006 Mankikar G D Clark A N May 1975 Cardiac effects of carotid sinus massage in old age Age and Ageing 4 2 86 94 doi 10 1093 ageing 4 2 86 ISSN 0002 0729 PMID 1146669 Carotid Sinus strike slap as an effective self defense technique Full Potential Martial Arts Retrieved 30 May 2015 Additional Images Edit Carotid sinusExternal links Editlesson5 at The Anatomy Lesson by Wesley Norman Georgetown University livingneck Retrieved from https en wikipedia org w index php title Carotid sinus amp oldid 1095768417, wikipedia, wiki, book, books, library,

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