What Causes Sick Sinus Syndrome
Sick sinus syndrome has several causes. Sometimes, providers dont know the cause.
Known causes of sick sinus syndrome include:
- Injury or breakdown of your hearts electrical route or SA node due to aging.
- Injury to your SA node .
- Some medicines for high blood pressure or arrhythmia.
- Your genetics .
- Metabolic problems.
Other heart conditions can cause sick sinus syndrome, including heart failure and atrial tachyarrhythmias.
Other health problems can cause sick sinus syndrome, such as sarcoidosis, collagen vascular disease, inflammation, muscular dystrophy or cancer that has spread.
What are the risk factors for sick sinus syndrome?
Youre more likely to get sick sinus syndrome if you:
Iv Management With Co
Patients with concomitant sinus node dysfunction and significant aortic valve stenosis who receive pacemakers should have their pacemakers programmed carefully to avoid elevated heart rates via the rate response mode to avoid heart failure, angina, syncope, or severe ventricular arrhythmias related to hemodynamic causes .
Patients with coronary artery disease who require beta-blocker therapy may have had their drug discontinued when SND was diagnosed. If this was the case and a pacemaker is implanted, the drug should be reinstituted. This is almost always possible to do.
If a patient is on a class 1C antiarrhythmic drug and develops coronary artery disease, the drug should be discontinued. If the patient is on a type 1C drug or dronedarone and develops atrial fibrillation that is deemed to be chronic, or congestive heart failure, it should be discontinued. Patients on amiodarone should have liver and thyroid function tests, a chest radiograph, pulmonary function tests with diffusion capacity, and eye examinations as per established guidelines.
Preventing Sick Sinus Syndrome
The most common cause of sick sinus syndrome is natural aging. This type of SSS usually does not require any treatment and does not have any noticeable symptoms. Sick sinus syndrome is related to another illness in other cases.â
It is best to be concerned with living a heart-healthy life generally rather than try to prevent SSS specifically. Some things you can do to help keep your heart healthy include:â
- Quit or donât start smoking.
- Manage high cholesterol and high blood pressure.
- Eat food that is low in cholesterol, sugar, and fat.
- Regularly exercise.
- Keep your BMI at a healthy number.
- Visit your doctor regularly.
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What Medications Or Treatments Are Used For Sick Sinus Syndrome
Your provider may want to do one or more of these treatments:
- Permanent pacemaker for slow heart rate .
- Medicine for a fast heart rate .
- Catheter ablation for a fast heart rate .
What are the complications of the treatment?
Any medical procedure has the possibility of complications. Those related to a pacemaker include:
- A lead can get out of place.
- You could get an infection.
If you have a catheter ablation, theres a risk of:
- Injury to your heart or blood vessels.
Ii Diagnostic Confirmation: Are You Sure Your Patient Has Sick Sinus Syndrome
The diagnosis is made electrocardiographically. SND may manifest with atrial bradyarrhythmias, tachyarrhythmias, or a combination of the two.
It is commonly accepted that ambulatory sinus pauses of greater than 3 seconds in duration are rare and may indicate SND. Sinus pauses may be due to either sinus arrest or sinus exit block.
Other rhythms associated with or indicative of SND are severe sinus bradycardia, paroxysmal atrial tachyarrhythmias , and chronic atrial fibrillation with slow ventricular rates in the absence of AV nodal blocking pharmacologic therapy).
Chronotropic incompetence is another manifestation of SND. It is the inability to increase heart rate with exercise.
There exist varying quantitative criteria for defining chronotropic incompetence. One is the inability to achieve a maximal exercise heart rate of 100 bpm. Another is the inability to achieve 80% of the predicted maximal heart rate when adjusted for age.
SND may first manifest after initiation of antiarrhythmic drugs. Sometimes the SND is solely due to the drug but other times may unmask or exacerbate intrinsic SND.
If the first manifestation of the SND is with pharmacologic therapy that may be discontinued or there exists an alternative drug, cessation of the drug and observation with prolonged monitoring may be appropriate to differentiate between intrinsic and extrinsic SND.
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B History Part : Prevalence:
The prevalence of SND is not known because so many patients are asymptomatic. In addition, the criteria for defining a heart rate or pause as abnormally slow are more dependent on the association of symptoms than an arbitrary number.
SND is usually diagnosed in the seventh and eighth decades of life, with an average age of 65 in a few studies. There are rare familial cases of SND that may manifest in younger patients, some of which may be associated with long QâT syndrome.
What Are The Symptoms Of Sick Sinus Syndrome
is usually asymptomatic at first. However, as the condition progresses over time, individuals may develop symptoms. Such symptoms may include exercise intolerance, fatigue, , headaches, nausea, palpitations, chest pain, and . In addition, individuals with SSS may experience StokesAdams attacks, which are fainting episodes that specifically occur due to arrhythmias. Finally, possible complications of include , transient , and .
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What Laboratory Studies Should Be Ordered To Help Establish The Diagnosis How Should The Results Be Interpreted
Laboratory studies indicated in patients presenting with symptoms and suspected of possibly having SND should include a complete blood count, electrolytes, renal function tests, liver function tests, and serum thyroid studies. These tests are performed to diagnose secondary causes of SND or causes of the presenting symptoms, rather than making a diagnosis of intrinsic SND.
What Are The Long
Overall, the outlook for children and youth with sick sinus syndrome is good. Often the problem causes only mild symptoms. If needed, pacemakers have proven to be effective in treating the symptoms with few changes in lifestyle needed.
References
Kugler JD: Sinus node dysfunction. In Gillette PC, Garson A Jr. : Pediatric Arrhythmias: Electrophysiology and Pacing. Philadelphia: WB Saunders Company 1990:250-300.
Kugler JD, Yabek SM: Sick sinus syndrome: Clinical features and non-invasive evaluation. In Yabek SM, Gillette PC, Kugler JD : The Sinus Node in Pediatrics. New York: Churchill Livingstone 1984:48-66.
Yabek SM, Jarmakani JM: Sinus node dysfunction in children, adolescents, and young adults. Pediatrics 1978 61:593-598.
Reviewed September, 2012
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Symptoms Of Sick Sinus Syndrome
Sick sinus syndrome is one of the hardest heart problems to diagnose because it overlaps with so many other possible problems. It can cause three different types of arrhythmias: sinus bradycardia , tachycardias and bradycardia-tachycardias . Sinus bradycardia is the most common problem caused by sick sinus syndrome.
Symptoms typically include fatigue, decreased exercise tolerance, palpitations, dizziness, or shortness of breath. These symptoms can be intermittent, and the heartbeat may be strong and regular when the patient is examined, which is another reason it can be challenging to diagnose.
Diagnosis of sick sinus syndrome can be difficult in one office visit or a single electrocardiogram . Your doctor may use longer-term monitoring methods like a Holter monitor to track your heart rhythm for a couple of days to monitor any changes.
Class Efficacy And Safety
All CCBs are considered among first-line antihypertensive agents and appear to be equally efficacious and safe.397,456 In contrast to other vasodilators, CCBs attenuate the reflex increase of neurohormonal activity that accompanies a reduction in BP and in the long term, they inhibit or do not change the sympathetic activity.457,458 The longer-acting agents produce sustained BP reductions of 16 to 28mm Hg systolic and 14 to 17mm Hg diastolic, with no appreciable development of tolerance. The CCBs are effective in young, middle-aged, and older patients with white coat hypertension and mild, moderate, or severe hypertension.459462 Their efficacy may be determined by genetic polymorphisms.463 CCBs are equally efficacious in men and women, in patients with a high or low plasma renin activity regardless of dietary salt intake, and in African American, white, and Hispanic patients.464 Effects of CCBs are diminished in smokers.465 CCBs are effective and safe in patients with hypertension and coronary artery disease,466 as well as in patients with ESKD.467 CCBs also reduce adverse cardiovascular events and slow the progression of atherosclerosis in normotensive patients with coronary artery disease.468
The use of CCBs is contraindicated in patients with HFrEF . These drugs should not be used as first-line antihypertensive agents in patients with heart failure, a history of MI, or unstable angina.455
Megan C. Leary, … Louis R. Caplan, in, 2014
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Types Of Sick Sinus Syndrome
Sick sinus syndrome can include different types of heart rhythm problems including arrhythmias.â
Sinus bradycardia. The average heart beats 60 to 100 times per minute. Someone with sinus bradycardiaâs heart beats less than 60 times per minute. People like endurance athletes can have a heart rate lower than 60 that doesn’t cause them any problems. But for most people that heart rate may be too low to pump oxygen-rich blood to the rest of the body.
Risk factors for bradycardia include coronary heart disease, diabetes, high blood pressure, heart valve disease, or cardiomyopathy.
Tachycardia. Tachycardia is when your heart beats faster than 100 beats per minute. A fast heart rate can happen normally during exercise or when your body is under stress or has a fever. But it may lead to serious cardiac events such as heart failure stroke, cardiac arrest, or even death if it happens at other times and is not treated.
Bradycardia-tachycardia. This is when you have alternating fast and slow heartbeats.
What Is The Treatment For Sick Sinus Syndrome
The treatment of depends on the underlying cause and symptoms, and both artificial pacemakers and medications are used in the course of treatment.
Artificial pacemaker
For symptomatic individuals, the treatment of choice is usually an artificial pacemaker, which is a small electronic device implanted near the during a minor surgical procedure, with pacer leads that extend to the heart. The pacemaker is programmed to pace the heart as needed to keep it beating. Most individuals with benefit from dual chamber pacemakers, in which one lead paces the atria and one lead paces the ventricles. Indications for an artificial pacemaker include chronotropic incompetence, , symptomatic bradycardia, and asymptomatic severe bradycardia . Potential complications from the implantation of an artificial pacemaker can include bruising, swelling, or infection in the surgical area.
Medications
Individuals with symptoms or hemodynamic compromise may be prescribed medications like , while those who are at greater risk of having a may get blood-thinning medications like .
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What Can I Expect If I Have Sick Sinus Syndrome
Sick sinus syndrome usually keeps getting worse slowly over many years, but some people never end up with other health issues connected to sick sinus syndrome. A pacemaker can help your symptoms and give you a better quality of life, but it may not extend your life expectancy.
How long does sick sinus syndrome last?
Sick sinus syndrome is a long-term problem that slowly gets worse over a number of years.
What is the outlook for sick sinus syndrome?
Getting a pacemaker gives you a great outlook. There is only a low risk of sudden cardiac death with sick sinus syndrome.
Sick Sinus Syndrome Diagnosis
Symptoms of sick sinus syndrome are nonspecific and can be caused by many conditions, as well as by minor issues like dehydration, a viral illness or too much caffeine. To determine if someone has sick sinus syndrome, we use advanced technology to determine if the heart is beating abnormally.
Electrocardiogram : This test measures the electrical activity of the heart and can help determine if the heart rate is fast, slow or interrupted by pauses. The hearts electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.
Event monitor: This portable EKG device records the heart rate when a button is pressed. It can be worn for weeks, or until symptoms occur.
Holter monitor: This portable EKG device continuously records the hearts rhythms and is worn for 24 to 48 hours during normal activity.
Implantable loop recorder: This small device, implanted just under the skin of the chest, is automatically triggered by an irregular heart rhythm, but can also be triggered manually. It is used for continuous, long-term monitoring of the heart’s electrical activity and may be worn from months to years.
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Questions To Ask Your Doctor
- What is the likely cause of my symptoms?
- What is the best treatment option for me?
- Will I need a pacemaker? What does that procedure involve?
- How will my life change after I have a pacemaker?
- Will I be able to return to my normal levels of activity?
- Is it safe for me to exercise? What kind of exercise should I do?
- Does sick sinus syndrome put me at risk for any other health problems?
How Is Sick Sinus Syndrome Treated
You may have sick sinus syndrome without symptoms and not need treatment. However, if you do have symptoms and need treatment, there are options, such as:
- Medicine change. Your healthcare provider may change your medicines if you are taking any known to cause sick sinus syndrome.
- Blood thinners. Because there is an increased risk for blood clots forming in your heart and causing a stroke, you may need to take a blood thinner as a preventive step.
- Pacemaker. The most common treatment for people with symptoms that do not have an identifiable reversible causes is a pacemaker implant. This is a small, battery-powered device that takes the place of your SA node and regulates your heart rate. A doctor places a pacemaker under the skin of your chest during a minor surgical procedure. Wires are placed within the heart that can monitor the heart rate and stimulate the heartbeat when needed.
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Sick Sinus Syndrome Treatment
Most people who have sick sinus syndrome will need to have an artificial pacemaker put into their body. A pacemaker is a small electronic device thats put under the skin on your chest. It helps your heart keep a regular beat, especially when your heart beats too slowly.
If you have a pacemaker and your heart rate is too fast, your doctor may prescribe medicine to control it. In addition, your doctor may want to change some of your other medicines because some medicines can make sick sinus syndrome worse.
Pearls And Other Issues
Sick sinus syndrome or sinus node dysfunction is primarily a disease of the elderly population. It results from the degeneration of the SA node affecting its ability to generate or transmit impulses to the atrial tissue. Sinus node dysfunction has several characteristic rhythm disturbances manifesting in symptoms of organ hypo-perfusion. The main treatment of sick sinus syndrome is permanent pacemaker it is usually done after secondary causes are ruled out. The risk of sudden cardiac death with sinus node dysfunction is low.
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Living With Sick Sinus Syndrome
The aging of your SA node causes most cases of sick sinus syndrome, and theres no way to prevent that. But you can help prevent complications by learning as much as you can about the disease and working closely with your cardiologist to find the best treatment.
You can also make healthy lifestyle changes:
- Work with your healthcare provider to keep conditions like high cholesterol and high blood pressure under control.
- Eat a heart-healthy diet.
- Tell your healthcare provider if you have any symptoms.
How Is This Problem Diagnosed
Symptoms: Possible symptoms include low energy levels, low exercise tolerance, lightheadedness, chest pain with exercise, and fainting.
Physical findings: The pulse is slow and often irregular. The physical findings otherwise reflect any underlying heart disease.
Medical tests: One of the first tests usually done is an electrocardiogram. This is a safe and painless test that involves putting some stickers across the chest. The stickers are connected to a machine that records the hearts electrical activity. Other useful tests include a Holter monitor, echocardiogram, and/or an exercise test. If further information is needed, a special type of heart catheterization called an electrophysiologic study may be done.
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E Common Pitfalls And Side
The most common pitfall in patients being evaluated for SND is treating bradycardia during sleep, asymptomatic sinus bradycardia unassociated with atrial tachyarrhythmias not requiring antiarrhythmic drug therapy, bradycardia associated with high vagal tone, or vagally mediated events with pacemaker therapy. The correlation of symptoms with arrhythmias is a cornerstone of evaluation in the vast majority of patients.
Side effects of antiarrhythmic drug therapy may include worsening of sinus node dysfunction or conduction below the sinus node, ventricular arrhythmias in patients with structural heart disease or noncardiac side effects and toxicities related to the specific drug.
Pacemaker therapy may be complicated by heart failure with ventricular pacing . Pacemaker function needs to be checked as per established guidelines.
How Can I Reduce My Risk Of Sick Sinus Syndrome
Although you cant control risk factors like your genetics or your age, there are some things you can do to reduce your risk of sick sinus syndrome:
- Take care of your heart to prevent heart disease.
- Check with your doctor to see if the medicines you take put you at risk.
- Keep your follow-up appointments for other health conditions that could put you at risk.
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A Appropriate Prophylaxis And Other Measures To Prevent Readmission
Patients experiencing presyncope, syncope, chest pain, and/or shortness of breath should be instructed to alert their physician, as these symptoms may represent worsening arrhythmia status, the development of concomitant coronary artery disease, or congestive heart failure, or adverse effects from medication or pacemaker programmed parameters.