sick sinus syndrome


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Sick Sinus Syndrome

 

Definition

Sick sinus syndrome is a disorder of the sinus node of the heart, which regulates heartbeat. With sick sinus syndrome, the sinus node fails to signal properly, resulting in changes in the heart rate.

Description

The sinus node in the heart functions as the heart's pacemaker, or beat regulator. In sick sinus syndrome, patients normally will experience bradycardia, or slowed heart rate. Also, it is not uncommon to see fluctuations between slow and rapid heart rate (tachycardia). This makes the diagnosis and treatment of sick sinus syndrome more complicated than most other cardiac arrhythmias (irregular heart beats). A sick sinus node may be responsible for starting beats too slowly, pausing too long between initiation of heartbeats, or not producing heartbeats at all.

Causes and symptoms

Sick sinus syndrome may be brought on by the use of certain drugs, but is most common in elderly patients. Cardiac amyloidosis, a condition in which amyloid, a kind of protein, builds up in heart tissue, may affect the sinus node. Other conditions, such as sarcoidosis (round bumps in the tissue surrounding the heart and other organs), Chagas' disease (resulting from the bite of a bloodsucking insect) or certain cardiac myopathies can cause fiber-like tissue to grow around the normal sinus node, causing the node to malfunction.
A patient may not show any symptoms of sick sinus syndrome. In general, however, the common symptoms are those associated with slow heart rate, such as light-headedness, or dizziness, fatigue and fainting. Patients may also experience confusion, heart palpitations, angina or heart failure.

Diagnosis

A slow pulse, especially one that is irregular, may be the first indication of sick sinus syndrome. Electrocardiography (ECGs) is a commonly used method of detecting sick sinus syndrome. ECG monitoring for 24 hours is most useful, since with this syndrome, heart rate may alternate between slow and fast, and the determination of this fact can help differentiate sick sinus syndrome from other arrhythmias.

Treatment

If drugs are causing the problem, their withdrawal may effectively eliminate the disorder. However, the treatment of sick sinus syndrome is normally delayed until a patient shows symptoms. Once treatment is indicated, most patients will receive a pacemaker. This is a permanent treatment involving implantation of a small device under the skin below the collarbone. Small electrodes run from the device to the heart; they deliver and regulate the electrical signals that cause the heart to beat. Patients with sick sinus syndrome should generally receive dual chamber pacing systems to prevent atrial fibrillation (involuntary contraction of the muscles of the atria). Some drugs are used to treat sick sinus syndrome, but digitalis should be used with caution. Often the use of drugs to regulate the heartbeat should be implemented only after the pacemaker has been placed, since these drugs may further worsen the slow heart rate.

Key terms

Arrhythmia — Irregular heart beat.
Atria — Plural for atrium. The atria are the upper chambers of the heart.
Bradycardia — A heart rate slower than normal.
Electrocardiograph (ECG) — A test of a patient's heartbeat that involves placing leads, or detectors, on the patient's chest to record electrical impulses in the heart. This test will produce a strip, or picture record of the heart's electrical functioning.
Myopathy — Weakness of muscle.
Pacemaker — A device implanted under the skin, below the collarbone, to regulate heartbeat. Leads from the device to the heart stimulate the electrical functions of the heart. Pacemakers are often used to control bradycardia and are usually smaller than a silver dollar.

Alternative treatment

The reduction or elimination of certain foods and substances, such as alcohol or caffeine, may be advised to control heart rate. Stress reduction may also assist with changes in rate. Homeopathic treatment can work on a deep healing level, while acupuncture and botanical medicine can offer supportive treatment for symptoms.

Prognosis

Patients with sick sinus syndrome face relatively normal lives if the disorder is controlled by a pacemaker. However, in some patients, the pacemaker does not adequately control the fluctuations in heart rate. Left untreated, or in severe cases, the heart could stop beating.

Prevention

Elimination of a drug therapy which aggravates sick sinus syndrome is the first line of treatment for some patients. Other causes of the syndrome are not preventable. However, proper treatment of those underlying conditions which affect the tissues of the heart may intervene to prevent sick sinus syndrome from becoming a significant problem.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

sick

 [sik]
not in good health; ill; afflicted with disease.
sick sinus syndrome a complex cardiac arrhythmia usually associated with syncope and manifested as severe sinus bradycardia alone, sinus bradycardia alternating with tachycardia (see bradycardia-tachycardia syndrome), or sinus bradycardia with atrioventricular block. It is a combination of sinoatrial node dysfunction and failure of an escape pacemaker.

sick si·nus syn·drome

[MIM*182190]
symptoms ranging from dizziness to unconsciousness due to chaotic or absent atrial activity often with bradycardia alternating with tachycardia, recurring ectopic beats including escape beats, runs of supraventricular and ventricular arrhythmias, sinus arrest, and sinoatrial block.

sick si·nus syn·drome

[MIM*182190]
symptoms ranging from dizziness to unconsciousness due to chaotic or absent atrial activity often with bradycardia alternating with tachycardia, recurring ectopic beats including escape beats, runs of supraventricular and ventricular arrhythmias, sinus arrest, and sinoatrial block.

sick sinus syndrome (SSS)

Etymology: AS, seoc + L, sinus, hollow
a complex of arrhythmias associated with sinus node dysfunction. The condition may result from a variety of cardiac diseases, ranging from cardiomyopathies to inflammatory myocardial disease. It is most commonly related to either intermittent sinoatrial (SA) block or inadequate SA conduction. SSS is characterized by severe sinus bradycardia, either alone, alternating with tachycardia, or accompanied by atrioventricular block. The most common symptoms are lethargy, weakness, light-headedness, dizziness, and syncope. The severity of symptoms is related to the duration of the asystolic period. Elderly patients with episodes of near-syncope associated with a history of palpitations are most likely to be symptomatic. Accurate diagnosis requires electrocardiography. At present the only treatment is the implantation of a permanent pacemaker.

sick sinus syndrome

Bradycardia-tachycardia syndrome, sinus node dysfunction Cardiology A diffuse cardiac conduction system defect characterized by a pathologically slow or erratic rate of sinus depolarization due to impaired automaticity; SSS accounts for up to 50% of pacemaker implantations Intrinsic causes Scarring, degeneration, damage to conduction system–eg, aging, MI; ischemia; infiltrative disease–eg, amyloidosis, hemochromatosis, sarcoidosis; collagen vascular disease–SLE, RA, scleroderma; myotonic muscular dystrophy; heart surgery–valve replacement, transplantation; infections-Chagas' disease, endocarditis Extrinsic causes–autonomic syndromes–eg, carotid hypersensitivity, neurocardiac syncope, vagal stimulation; drugs–CCBs, beta-blockers, digoxin, clonidine, sympatholytics, antiarrhythmics; hypothyroidism; hypothermia; neurologic defects; ↑/↓ K+ Clinical Common in elderly; if severe, associated with vertigo, palpitations, exercise intolerance, syncope, cerebral dysfunction, persistent sinus bradycardia–30–60/min PLUS SVT, hence the trivial name, 'brady-tachy' syndrome Treatment Verapamil, diltiazem, pacemaker Prognosis Mortality at 1, 3, and 10 yr is 5%, 9%, 25% respectively; unaffected by pacemakers

sick si·nus syn·drome

(sik sīnŭs sindrōm)
Symptoms ranging from dizziness to unconsciousness due to chaotic or absent atrial activity often with bradycardia alternating with tachycardia, recurring ectopic beats including escape beats, runs of supraventricular and ventricular arrhythmias, sinus arrest, and sinuatrial block.

sick sinus syndrome

Abnormal functioning of the natural pacemaker, the SINOATRIAL NODE of the heart. This causes episodes of slowing or speeding or even short periods of heart stoppage. An artificial pacemaker may be fitted.

sick

not in good health; ill; afflicted with disease.

sick sinus syndrome
a complex cardiac arrhythmia manifested as severe sinus bradycardia alone, sinus bradycardia alternating with tachycardia, or sinus bradycardia with atrioventricular block.
References in periodicals archive ?
The authors of the study, the Mode Selection in Sinus Node Dysfunction Trial (MOST), write: "For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life expectancy at a cost that is generally considered acceptable".
Jude Medical in the introduction of a pacemaker that represents a quantum leap in the care of patients with sick sinus syndrome.
Sperzel implanted the Identity(TM) XL DR pacemaker in a 77-year-old male with sick sinus syndrome and paroxysmal atrial fibrillation (AF).
This was an exceptional case of an elderly male with severe COPD (chronic obstructive pulmonary disease) and sick sinus syndrome with syncope.
It has been shown that over 43 percent of patients implanted with a pacemaker for sick sinus syndrome or AV block (common pacing indications) will develop some sort of atrial arrhythmia within the first year of implant.
Verapamil Hydrochlororide ER is an extended release calcium channel blocker for the treatment of severe left ventricular dysfunction, hypertension, cardiogenic shock and sick sinus syndrome.
Tse implanted the lead with the Integrity AFx(TM) AutoCapture(TM) Pacing System in a standard-pacemaker indicated 74-year-old female patient with sick sinus syndrome.
Nor should Coreg be used in patients with bronchial asthma or related bronchospastic conditions, certain cardiovascular conditions including flaws in the electrical conduction of the heart, sick sinus syndrome, cardiogenic shock, or severe bradycardia.