In human anatomy, the carotid sinus (or carotid bulb) is a dilated area at the base of

the internal carotid just superior to the bifurcation of the common carotid at the level of the
superior border of thyroid cartilage. The carotid sinus is sensitive to pressure changes in the
arterial blood at this level.

Contents
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1 Structure
2 Function
3 Clinical significance
o 3.1 Disease
o 3.2 Carotid sinus massage
o 3.3 Carotid sinus reflex death
4 See also
5 References
6 Additional Images
7 External links

Structure[edit]
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2014)

Function[edit]
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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 themedulla 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.

Clinical significance[edit]
Disease[edit]
The carotid sinus often has atherosclerotic plaques because of
disturbed hemodynamics (low wall shear stress, flow reversal/recirculation).[1] 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" 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.

Carotid sinus massage[edit]

See also: 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 therapy for SVT.[2] It is less effective than
pharmaceutical management of SVT with verapamil or adenosine[3]though is still the preferred
first line of treatment in a hemodynamically stable patient[4]

Carotid sinus reflex death[edit]

Carotid sinus reflex death is a potential etiology[5] 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 ofstrangulation, hanging and Autoerotic
Strangulation, but such deductions remain controversial. Studies[citation needed] 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.[6]