Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Carotid Artery Hypersensitivity

Forum: The Heart Forum
Topic: Echocardiography

I am a 32 yo male with a hx of unexplained syncope. Past trips to the doctor have never revealed
any significant cause for my syncope. A brief hx is as follows. For approximately 15 years, I
have experienced short episides of syncope about every 2 years. All episodes have occurred
while I have been standing with the exception of my last incident which occurred while sitting. I
am always aware I am about to pass out as I become lightheaded and start to lose focus
beforehand. Episodes usually las t about 30 - 75 sec, whereupon I awake extremely diapheretic
but otherwise unremarkable. I am aware of my surroundings, have no Sz activity, no loss of
bladder control, etc.. CAT scan, echocardiogram, bloods, bg, EKG all are unremarkable. My
father has a hx of unexplained syncope also. He has been diagnosed as being allergic to scallops
which result in syncope, but other episodes have gone unexplained.
After my last syncope episode, I became concerned because I was sitting at the time, not standing
as in every past incident. After some discussion with others I have come upon a common thread
with all my syncope episodes. In EVERY case I have had something constricting around my
neck....suit, tux, tie, etc.. When I was sitting this past weekend, I was at a barbershop and had a
cape and toweling snugged around my neck. Thus, I believe I have symptoms of carotid artery
hypersensitivity. I am currently seeing my doctor to try to find a cause for my syncope and my
questions are as follows:
1. Does this sound like a reasonable diagnosis for my syncope?
2. Is there any tests that can be performed to confirm if this is the cause of my syncope?
3. Are there any other tests I should undergo to rule in/rule out other causes for my syncope?
4. How common is carotid artery hypersensitivity?
5. Can I assume this problem may be controlled by not wearing constricting clothing around my
neck?
6. Would there be any concerns in my job duties as a firefighter (15 years with no syncope at
work)?

Thanks for your time and I look forward to your input.

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Dear Dan

1. It is reasonable to consider the diagnosis.
2. Monitoring your heart rhythm while carotid sinus massage is performed would make the diagnosis (with resuscitation equipment handy).
3. I would have performed a tilt-table test and possibly an EP (electrophysiological study).
4. Quite rare.
5. If you had carotid hypersensitivity, you could avoid episodes by staying away from tight neck clothing. However, head turning provokes syncope in some patients with this disorder, and it is hard to avoid that.
6. Yes. I would not have allowed you back on the job without conducting the above testing.

I hope this has been useful. Feel free to write back with further questions. Good luck.

Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15.

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