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Head and neck cancers rarely manifest as Carotid Sinus Syndrome (CSS). CSS is a rare complex of symptoms found in 1% of all patients who experience syncope, the pathophysiology of which is yet to be fully understood. Common trigger mechanisms for CSS include neck movement, shaving, constricting neck wear, coughing, sneezing and straining to lift heavy objects. The left carotid sinus mainly causes AV block while the right carotid sinus mainly causes sinus bradycardia. The incidence of AV block in CSS is very low (4.9 to 16.7%) as reported in many case series. In case of head and neck cancers, treatment is by surgical removal of the cancer, chemotherapy or radiation. We present an interesting case where a patient with head and neck cancer developed bradycardia and second degree heart block due to compression of the carotid sinus on neck movement. Whenever the patient turned his neck to the right, telemetry showed prolongation of the PR interval and 2:1 conduction across the AV node (Wenckebach) which resolved on moving his neck back to the midline. In conclusion, unexplained abrupt episodes of bradycardia and intermittent heart block should alert the physician of the possibility of carotid sinus compression by a neck mass in patients with head and neck cancer.

Carotid Sinus Syndrome as a Manifestation of Head and Neck Cancer - Case Report and Literature Review