Observations On Unilateral Compression And Palpation Of The Carotid Bifurcation

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    Carotid bifurcation compression tests in a patient 64 years of age, with thrombosed right middle cerebral artery. Mild manipulation of carotid bifurcation resulted in a drop in pulse rate from 72 to 48, with asystole lasting about 6 sec. After the manipulation was stopped the pulse rate reached 72 in 19 sec. Following the injection of 1/100 gr. of atropine intravenously, the pulse rate was 102 in 8 minutes and another manipulation of the right carotid bifurcation resulted in a drop in the cardiac rate (68) but not as severe as the pre-atropine drop. The pulse rate increased to 96 in 5 sec. Severe compression of the left carotid area resulted in a syncope in this patient. Mild manipulation resulted in changes in the pulse rate unassociated with syncope.

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    Left carotid bifurcation compression and manipulation in the patient in Fig. 1 resulted in a small drop in the pulse rate but the effects were much less when atropine was injected. Occlusive compression of the left carotid bifurcation resulted in syncope in 20 sec.

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    A 46-year-old female, with an aneurysm of the right middle cerebral artery, was thought to be a candidate for right common carotid artery ligation. Palpation-compression revealed the presence of a severe irritable carotid sinus with asystole and syncope occurring in about 10 sec. This patient became unconscious on mild manipulation of the right side of the neck, not only around the bifurcation but lower down. Note the marked lowering of the heart rate following the beginning of the compression. Note that during a period of 20 sec. there were only three pulsations of the heart. During her syncopal attack she also had several vomiting spells suggesting a vagal stimulation. After complete atropinization and the use of local anesthesia and local infiltration with novocain hydrochloride, her right common carotid artery was ligated.

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    Showing the record of compression in neighborhood of right carotid bifurcation 5 days after ligation of right carotid artery and denervation of the carotid sinus. The cardiac rate remained 108 throughout; no dizziness or syncope was caused by the manipulations. The lower portion of the record of the same patient 9 months postoperatively shows some return of the sinus effect with a drop in the cardiac rate from 72 to 36 on right carotid compression and manipulations. There is, however, a rapid escape even before the compression is stopped, with recovery of the pulse rate to about 66. The bradycardia in this case may be the result of regeneration of some of the sinus fibers.

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    Continuous blood-pressure record in a patient with thrombosis of the left internal carotid artery. Compression of the right carotid, shown in the upper row, resulted in bradycardia, a drop in blood pressure and syncope at the end of 15 sec. The cardiac rate dropped from 75 to 39. Intravenous injection of 1/150 gr. of atropine increased the pulse rate from 75 to 115 in 60 sec. Occlusion-compression of the right carotid 3 min. after the injection of atropine resulted in a syncope at the end of 18 sec. but with no associated bradycardia. The patient's pulse rate had stabilized at 84 per min. The blood pressure dropped 35 mm. during the compression.

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    A 26-year-old patient was treated by ligation of the right common carotid artery for an arteriovenous malformation of the right parietal area. Compression of the left carotid artery bifurcation resulted in a syncopal effect at the end of about 13 sec. with severe changes in the electroencephalogram bilaterally. The electrocardiographic record shows a cardiac rate of 120 throughout.

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