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From: Near-Syncope After Exercise JAMA. 2004;292(10):1221-1226. doi:10.1001/jama.292.10.1221 Figure Legend: The carotid sinus is a small dilatation of the internal carotid arteryimmediately above the bifurcation of the common carotid artery that containsspecialized sensory nerve endings sensitive to pressure or stretch. To performcarotid sinus massage, firm but gentle pressure is applied to the area atthe midpoint between the angle of the mandible and the superior border ofthe thyroid cartilage along the anterior margin of the sternocleidomastoidmuscle. Date of download: 5/2/2017 Copyright © 2004 American Medical Association. All rights reserved. From: Near-Syncope After Exercise JAMA. 2004;292(10):1221-1226. doi:10.1001/jama.292.10.1221 Figure Legend: A, A pure cardioinhibitory response produces a reflex slowing ofthe heart and may produce sinus arrest or asystole. A fall in systolic bloodpressure typically occurs deriving from and proportional to the extent andduration of the decrease in heart rate. During carotid sinus massage, a positivecardioinhibitory response is defined as a ventricular pause of more than 3seconds. If the slowing of the heart is prevented (for example with a pacemaker),individuals exhibiting a pure cardioinhibitory response will not experiencea decline in blood pressure. B, A pure vasodepressor response produces hypotensionwithout bradycardia due chiefly to inhibition of Copyright © 2004 American Medical Date of download: 5/2/2017 sympathetic vasoconstriction.A pure vasodepressor response results in a decline in systolic blood pressurethat is of longer duration Association. All rights reserved. than that observed in a pure cardioinhibitory response.During carotid sinus massage, a positive vasodepressor response is