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Carotid Sinus Hypersensitivity Medication

  • Author: Mevan N Wijetunga, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Dec 18, 2014
 
 

Medication Summary

Although a variety of pharmacological agents has been used empirically to treat recurrent, symptomatic CSH, no single agent has been unequivocally proven to provide long-term effectiveness in large-scale, randomized controlled trials. Some observers have successfully used the serotonin reuptake inhibitors sertraline and fluoxetine in patients who were unresponsive to dual-chamber pacing.

A randomized, controlled pilot study showed that treatment with midodrine, an alpha-1 agonist, could significantly decrease the rate of symptoms and the degree of hypotension in the vasodepressor form of CSH. Treatment with midodrine was also associated with an elevation of a mean 24-hour ambulatory blood pressure level.[24] Midodrine induces arterial and venous capacitance constriction and has minimal cerebral and cardiac effects. It is indicated for the treatment of symptomatic orthostatic hypotension.

Fludrocortisone is another agent that can be used in this setting.

The US Food and Drug Administration has not yet approved these agents for the management of CSH.

 
 
Contributor Information and Disclosures
Author

Mevan N Wijetunga, MD, FACC, FHRS Cardiac Electrophysiologist, CentraCare Heart & Vascular Center

Mevan N Wijetunga, MD, FACC, FHRS is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Irwin J Schatz, MD † Former Professor, Department of Internal Medicine, University of Hawaii, John A Burns School of Medicine

Irwin J Schatz, MD is a member of the following medical societies: Alpha Omega Alpha, American Autonomic Society, American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven J Compton, MD, FACC, FACP, FHRS Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Physicians, American Heart Association, American Medical Association, Heart Rhythm Society, Alaska State Medical Association, American College of Cardiology

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

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