Ischemic Stroke Occurring After Supraventricular Dysrhythmia Conversion With Carotid Massage: A Case Report

BACKGROUND: Supraventricular tachycardia (SVT) is commonly managed with vagal maneuvers, including carotid sinus massage, as first-line therapy. If unsuccessful, pharmacological treatment with adenosine is recommended. However, concerns regarding the safety and efficacy of carotid sinus massage have been raised after previous case reports have described ischemic stroke following its use. CASE REPORT: A 67-year-old woman presented with acute chest pain, dizziness, and palpitations. She had a heart rate of 234 bpm prehospital but was hemodynamically stable on arrival. SVT was suspected; initial vagal maneuvers and carotid sinus massage failed, and adenosine administration eventually restored sinus rhythm. Within 30 min after, she developed right-sided hemiparesis and transcortical motor aphasia. Computed tomography excluded hemorrhage, and thrombolysis was given for presumed ischemic stroke. Magnetic resonance imaging confirmed left Middle Cerebral Artery territory infarction; no significant carotid or atherosclerotic disease was found. The patient was discharged from the hospital 2 days later, with only minor residual deficits from the stroke. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ischemic stroke following carotid sinus massage has been rarely reported, particularly when performed therapeutically by healthcare professionals. We report a stroke occurring shortly after cardioversion for SVT under controlled hospital conditions. Although the timing suggests a possible causal link, both plaque-related embolization and conversion-related thromboembolism remain plausible mechanisms. This case highlights a potential stroke risk associated with SVT management and underscores the need for further investigation.