Carotid Massage

Carotid Massage

Simplify version:
1.First auscultate over the carotids for any bruit, which is produced by atheromatous plaque, which may dislodge and causes stroke if massage if given.
2.If no bruit, give massage over the carotid area so that the carotid body gets compressed over vertebral body.Give the massage for 5 sec and ask pt to do valsalva maneuver at the same time and stop both suddenly at the same time.Give massage on the other sides for 2-3 times.

Carotid Massage

Proper Explanation:

Carotid sinus massage involves rubbing the large part of the arterial wall at the point where the common carotid artery, located in the neck, divides into its two main branches(dilated area superior to the bifurcation of the common carotid at the level of the superior border of thyroid cartilage).

Carotid sinus massage will slow the heart rate during episodes of atrial flutter, fibrillation, and some tachycardias. It has been known to stop the arrhythmia completely. If the procedure is being done to help diagnose angina pectoris, massaging the carotid sinus may make the discomfort go away.

The patient will be asked to lie down, with the neck fully extended and the head turned away from the side being massaged. While watching an electrocardiogram monitor, the doctor will gently touch the carotid sinus. If there is no change in the heart rate on the monitor, the pressure is applied more firmly with a gentle rotating motion. After massaging one side of the neck, the massage will be repeated on the other side. Both sides of the neck are never massaged at the same time.
Doctor must be sure there is no evidence of blockage in the carotid artery before performing the procedure. Massage in a blocked area might cause a clot to break loose and cause a stroke.


Absolute contraindications to carotid sinus massage include myocardial infarction, transient ischemic attack or stroke within the preceding three months. A history of ventricular fibrillation or tachycardia, or a previous adverse reaction to carotid sinus massage are also absolute contraindications. A relative contraindication is the presence of carotid bruits, which should be evaluated by Doppler ultrasonography before proceeding with massage. If the ultrasound shows stenosis or atheroma, the patient should understand the risks and benefits of the procedure.

Carotid sinus massage should be discontinued immediately if the ECG shows asystole for more than three seconds. If asystole is prolonged, a chest blow should be administered. If neurologic complications occur, the procedure should be stopped, aspirin should be given if not contraindicated, and the patient should be closely observed. Symptoms of pre-syncope or syncope should be recorded and compared with the original symptoms for which the patient is being evaluated. The procedure is then repeated on the left side with the patient in the supine position, and then on both sides with the patient in the erect position. The diagnostic rate increases when the carotid sinus massage is repeated in the upright position. The baseline values should return before the next step of the procedure is begun. After the procedure, the patient should be observed in the supine position for at least 10 minutes before discharge.



Valsalva Maneuver

The Valsalva  manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to clear the ears and sinuses by equalize pressure between them when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or air travel.

By Lakdhes.