A Close Shave

How shaving can trigger a cardiovascular response.

By Marven Ewen, MD
Medical Director

The day started out fairly quiet in the ER. Pretty good for early Sunday morning. All the usual Saturday night characters had been discharged or admitted. That is when the local EMS service rolled up with an elderly male patient.

 

His story was he passed out in his bathroom and his wife called 911. Upon arrival to the scene, he had regained consciousness but was brought to the ER to be checked.

 

He denied injury or pain of any kind and felt like he was in his usual state of health. When I asked him if he had experienced episodes of fainting or lightheadedness in the past, he reported that yes he had, but only when using his electric razor. He had felt light-headed when shaving on many occasions, but this time actually had a syncopal spell. He denied any history of TIAs, strokes or heart problems.

 

Now if you remember your anatomy and physiology, you may recall that the baroreceptors are located in the common carotid arteries, at about the level of the bifurcation of the internal and external carotids at the upper neck just below the angle of the jaw. These receptors help regulate your heart rate by decreasing the rate when the blood pressure increases.

 

Some patients, especially elderly male patients, develop a sensitivity of the carotid baroreceptors. When stimulated, they can cause the heart to stop for several seconds with an associated drop in blood pressure. If the blood pressure drops far enough, brain perfusion is transiently impaired and the patient loses consciousness.

 

So when my patient was shaving, he was applying pressure to the baroreceptors in the upper neck with his electric razor, causing his heart to briefly stop and the rate to slow.

 

His lightheadedness and cardiac pause was easily reproduced with a brief carotid massage while being monitored in the ER. Because the patient’s carotid sinus sensitivity was causing him episodic symptoms of lightheadedness and syncope, he was referred to cardiology for pacemaker placement. 

 

He was also advised not to drive or operate machinery until he had a pacemaker, because even turning the head or looking up can trigger this response in a susceptible patient.

More from The Allied Times

Clean Hands

Clean Hands In a time of necessary infection prevention, this is how doctors wash their hands.By Marven Ewen, MDMedical DirectorCurrently, the COVID-19 pandemic is a reminder of the importance of infection control. Handwashing is the most important part of preventing the spread of infection. The CDC recommends 20 seconds of handwashing with soap and water…

Huntington's Disease

Huntington’s DiseaseThe genetic brain disease that has no cure.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewHuntington’s disease is an autosomal dominant genetic disease causing a breakdown of nerve cells in the brain, resulting in decline of a person’s physical and mental abilities. Most commonly, Huntington’s disease emerges during adulthood when someone is in their 30s or 40s. When…

Calcaneal Fracture

Calcaneal FractureOne of the bones you really don’t want to break.By Marven Ewen, MDMedical DirectorI was seeing a middle-aged tradesman. He told me how he misjudged the last couple of steps of the ladder and ended up dropping onto his right foot with his knee in a fully extended position. He was wearing stiff boots…

Hemophilia

HemophiliaThe disorder that causes unstoppable bleeding.By Jenny Ewen, BA, NREMTEditor-In-ChiefA Little Bit of HistoryIn 1837-1901, Queen Victoria of England ruled and was believed to have passed on the traits of hemophilia B to three of her nine children. Her daughters then passed it on to their children, one of whom married Tsar Nicholas of Russia,…

Bell's Palsy

Bell’s PalsyA look at a case of Bell’s Palsy.By Marven Ewen, MDMedical DirectorThe patient was 34-years-old and well into her third pregnancy. She came to the ER concerned that she was having a stroke. Her pregnancy and general health had been unremarkable until she awoke this morning. Something didn’t seem right about the right side…

Celiac Disease

Celiac DiseaseThe most serious reason to request “gluten-free” food.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewThere has been a trend towards gluten-free food options over the last decade, but while some people avoid gluten simply for a healthier diet or weight loss, others have to avoid it to the degree that even a crumb of regular bread from…

Are you ready to start saving lives?