Carotid sinus

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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. 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.

Video Carotid sinus

Structure

The carotid sinus is the reflex area of the carotid artery, consisting of various nerve receptors for baroregulation (pressure regulation of the body in sync to external conditions).

Maps Carotid sinus

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 sinus nerve of Hering, which is a branch of cranial nerve IX (glossopharyngeal nerve). The glossopharyngeal nerve synapses in the nucleus tractus solitarii (NTS) located in the medulla oblongata of the brainstem. The NTS indirectly modulates the activity of sympathetic and parasympathetic (vagal) 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), which combines with CN X (vagus nerve) and travels to the NTS.

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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 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). 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.

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.

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. Like the valsalva maneuver, it is a therapy for SVT. It is less effective than pharmaceutical management of SVT with verapamil or adenosine though is still the preferred first line of treatment in a hemodynamically stable patient

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. Studies have also 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 stroke.

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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 an effective self-defense technique, and is often taught in martial arts such as karate and Krav Maga.

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See also

• Carotid body
• Baroreflex

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References

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Additional Images

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External links

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

Source of article : Wikipedia