Carotid sinus massage in carotid sinus syndrome.

CASE REPORT A 71-year-old man was admitted to the cardiac unit having had a syncopal episode whilst eating lunch. During the meal he felt nauseated, dizzy and faint and then lost consciousness. After rapid spontaneous recovery he complained of further nausea and vomited until hospital admission. There were no epileptiform movements during the syncope. For the previous year he had had almost daily presyncopal episodes associated with prolonged standing, head turning or looking upwards, but in many episodes no precipitating features were identified. Ischaemic heart disease with infrequent exertional angina had been diagnosed 15 years previously but he was not on prophylactic anti-anginal medication. A diagnosis of alcoholic cirrhosis had been made nine years previously, and he had remained off alcohol since then, with normal liver function tests at subsequent outpatient review. On examination in the cardiac unit 60 minutes after the syncope he was fit, alert and well orientated. The heart rate was 84 per minute in sinus rhythm. Blood