Sick sinus syndrome

Description

Sick sinus syndrome is a type of heart rhythm disorder. It affects the heart's natural pacemaker (sinoatrial node), which controls the beat of the heart. The sick sinus syndrome causes slow heart beats, the breaks (long periods of time between heart beats) or irregular heart beats (arrhythmias).

Sick sinus syndrome is a relatively uncommon. The risk of developing it increases with age. Many people with sick sinus syndrome, finally, the need for an implanted device called a pacemaker to keep the heart in a regular rhythm.

The sick sinus syndrome may also be called sinus node dysfunction or disease of the sinus node.

Symptoms

The majority of people with sick sinus syndrome have few or no symptoms. The symptoms may be mild, or come and go, which makes them difficult to recognize at first.

The signs and symptoms of sick sinus syndrome may include:

  • A sensation of rapid, fluttering heartbeat (palpitations)
  • Chest pain or discomfort
  • The confusion
  • Dizziness or lightheadedness
  • Fainting or near fainting
  • Fatigue
  • Shortness of breath
  • Slow pulse (bradycardia)

When to see a doctor

Talk with your health care provider if you have any of the signs or symptoms of sick sinus syndrome. Many medical conditions that can cause these problems. It is important to obtain a timely and accurate diagnosis.

If you have new or unexplained chest pain or think they are having a heart attack, call for emergency medical help immediately.

Causes

To understand the cause of sick sinus syndrome, it can be useful to know how the heart normally beats.

The heart consists of four chambers: two upper (atria) and two lower (ventricles). The rhythm of the heart is normally controlled by the sinus node, an area of specialized cells in the right upper heart chamber (right atrium).

This natural pacemaker produces electrical signals that trigger each beat of the heart. From the sinus node, the electrical signals that travel through the atria to the ventricles, causing them to contract and pump blood to the lungs and the body.

Normally, the sinus node produces a steady pace of electrical impulses. The rhythm changes, depending on the activity, emotions, and other factors.

In sick sinus syndrome, the electrical signals are in the form of irregular rhythm. The heartbeat may be too fast, too slow, interrupted by long pauses, or an alternating combination of these rhythm problems. Sick sinus syndrome is a relatively uncommon, but the risk of developing it increases with age.

Causes of disease of the sinus node syndrome may include:

  • Age-related wear and tear of the tissues of the heart
  • Damage to the sinus node or the scar from the heart surgery
  • Heart disease
  • Inflammatory diseases that affect the heart
  • Medicines to treat high blood pressure, including calcium channel blockers and beta-blockers
  • Medicines to treat irregular heartbeats (arrhythmias)
  • Some medications for Alzheimer's disease
  • Neuromuscular diseases such as muscular dystrophy
  • Obstructive sleep apnea
  • Rare genetic changes

Characteristics of the sick sinus syndrome include:

  • Sinus bradycardia. The sinus node produces a slow heartbeat.
  • Sinus arrest. The signals from the sinus node, pause, causing skipped beats.
  • Sinoatrial exit block. Signals from the upper chambers of the heart is slowed or blocked, causing breaks or skipped beats.
  • Chronotropic incompetence. The heart rate is within the regular range of rest, but does not increase as much as I should with the physical activity.
  • Tachycardia-bradycardia syndrome. The heart rate alternates between unusually slow and fast rhythms, often with a long pause between the beats of the heart.

Risk factors

Sick sinus syndrome can occur at any age. It is more common in people aged 70 years or more. Common cardiovascular risk factors, could increase the risk of sick sinus syndrome. The risk factors for heart disease include:

  • High blood pressure
  • High cholesterol
  • The excess of body weight
  • Lack of exercise

Complications

The complications of sick sinus syndrome include:

  • Atrial fibrillation, a type of irregular heart rhythm (arrhythmia)
  • Heart failure
  • Stroke
  • Cardiac arrest

Sick sinus syndrome

Diagnosis

To diagnose the sick sinus syndrome, a doctor will perform a physical examination and ask about your symptoms and medical history.

Symptoms of sick sinus syndrome — such as dizziness, shortness of breath and fainting — these can only occur when the heart beats irregularly. You may not have symptoms at the time of the appointment.

To determine if the symptoms are related to problems in the sinoatrial node and the function of the heart, a health care provider may use the following tests:

  • Electrocardiogram (ECG or EKG). This simple test that measures the electrical activity of the heart. Sensors (electrodes) are attached to the chest and legs. Connect the cables from the sensors to a computer, which displays or prints the results. An electrocardiogram (ECG) can tell how fast or slow the heart is beating. A health care provider may search for patterns of signal to determine if the sick sinus syndrome is present.
  • Holter Monitor. This portable device can be used for a day or more during the daily activities. Automatically records the heart's activity for 24 to 72 hours. A person wearing a monitor, you can also keep a diary of symptoms.
  • Event recorder. This portable device is designed to be worn for up to 30 days or until you have an irregular heartbeat or symptoms. Normally you press a button when symptoms occur.
  • Other monitors. Some personal devices, such as smart watches, offer electrocardiogram monitoring. Ask your health care provider if this is an option for you.
  • Implantable loop recorder. This small device that is implanted under the skin of the chest. It is used for the continuous long-term monitoring of the electrical activity of the heart, especially for people who have infrequent symptoms.

Electrophysiological (EP) testing

This test, also called an EP study, rarely is used to detect the sick sinus syndrome. You can, however, be carried out to verify the function of the sinus node and to evaluate other electrical properties of the heart.

During an electrophysiological (EP) study, thin, flexible wires with the tips of the electrodes are threaded through the blood vessels to different areas within the heart. Once in place, the electrodes can map the spread of electrical signals through the heart.

Treatment

The objectives of sick sinus of treatment are to reduce or eliminate symptoms and management of other contributors of the conditions of health.

The treatment of sick sinus syndrome may include:

  • Regular check-ups
  • Drugs
  • Catheter procedures
  • The surgery to implant a device to maintain a regular heartbeat (pacemaker)

If you have no symptoms, the doctor may recommend regular medical checkups to monitor your condition. The majority of people with symptoms of the need to have a procedure to implant a device to maintain a regular heartbeat (pacemaker).

Drugs

Some medications, including those used to treat high blood pressure or heart disease, may interfere with the function of the sinoatrial node. Your health care provider will likely review the medications you take and can adjust to them, or to prescribe different.

Medicines may be needed to prevent or delay heart beats fast.

Of the blood (anticoagulants) such as warfarin (Jantoven), dabigatran (Pradaxa), or others, may be prescribed if the sick sinus syndrome is associated with atrial fibrillation or other irregular heart rhythms linked to a stroke.

Surgeries or other procedures

The majority of people with sick sinus syndrome, finally, the permanent need of a device to control the rhythm of the heart (the pacemaker). A pacemaker is a small battery-powered device that is implanted under the skin near the collarbone during a minor surgical procedure. The pacemaker that stimulates (steps) to the heart you need to keep it beating regularly.

If the sick sinus syndrome symptoms are mild or infrequent, the decision to use a pacemaker will depend on the results of the electrocardiograms (Ecg), your general state of health and the risk of serious problems.

The type of pacemaker you need depends on the type of irregular heart rhythm you have. Types of pacemakers include:

  • A chamber pacemaker. This type usually carries the electrical signals to the right lower heart chamber (ventricle) of the heart.
  • Dual-chamber pacemaker. This type of proof of the right lower heart chamber (ventricle) and the right upper heart chamber (atrium) separately. The majority of people with sick sinus syndrome benefit of dual-chamber pacemakers.
  • Biventricular Pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people who have heart failure and arrhythmias. This type of pacemaker that stimulates both the heart's lower chambers (the right and left ventricles) to make the heart beat more efficiently.

If your heart rate is still irregular after receiving a pacemaker, you may need medications or a catheter-based procedure called a cardiac ablation to correct or control. Cardiac ablation uses heat or cold energy to create small scars on the heart to block the signals guilty and restore a regular heartbeat. It is most often makes use of thin, flexible tubes called catheters are inserted through the veins or arteries. Less commonly, the ablation is performed during cardiac surgery. A type of cardiac ablation called the atrioventricular (AV) node ablation is often used for the rapid control of heart rhythms in people with pacemakers.

Self-care

It is important to take measures to reduce the risk of heart disease. Try these heart-healthy strategies:

  • Eat a healthy diet. Choose generous portions of non-starchy vegetables, fruits, and whole grains and modest portions of fish, lean meats, poultry, and dairy products.
  • Exercise and maintain a healthy weight. Being overweight increases your risk of developing heart disease. Unless your doctor tells you otherwise, try to do at least 30 minutes of moderate physical activity every day. Ask your doctor about what your goal weight should be.
  • Keep blood pressure and cholesterol under control. Make lifestyle changes and take medications as prescribed to treat high blood pressure or high cholesterol.
  • Do not smoke. If you smoke and can't stop smoking on your own, talk with your health care provider about ways or programs to help break the habit of smoking.
  • If you drink, do so in moderation. For some conditions it is recommended to completely avoid alcohol. Ask your health care provider for advice specific to your condition. If you can't control your consumption of alcohol, talk with your doctor about a program to stop drinking and driving other behaviors related to alcohol consumption.
  • Do not use illegal drugs. Talk with your doctor about a program if you need help to quit smoking.
  • Control stress. Do more exercise, the practice of mindfulness and connecting with others in support groups are some of the ways to reduce stress.
  • Go to your appointments of medical control. Have regular physical exams and report any signs or symptoms to their health care provider.

Preparing for your appointment

Call your health care provider if you have symptoms of sick sinus syndrome. You may be referred to a doctor trained in the diagnosis and treatment of diseases of the heart (cardiologist).

Be prepared to answer questions about your medical history and symptoms. Write down your answers to help you remember details.

Questions to your provider may ask about symptoms include:

  • Do your symptoms include feeling dizzy or lightheaded?
  • Have you ever fainted?
  • Do you have a rapid, fluttering or pounding of the heart?
  • Do you feel pressure, heaviness, tightness or pain in the chest?
  • Exercise or activity worsen your symptoms?
  • Is there something to improve your symptoms?
  • How often have you had the symptoms?
  • How long have the symptoms lasted?

Other questions may include the following:

  • Have you been diagnosed with high blood pressure, high cholesterol, diabetes or a heart condition?
  • What medications do you take and what dose? Who is the doctor?
  • Why were prescription drugs?
  • Have you been taking the medication as prescribed?
  • Have recently stopped, starting or changing medications?
  • What over-the-counter medications, herbal remedies or supplements you take?

Write down any questions that you have for your provider. You might bring a friend or family member to write down the information for the appointment.

What you can do in the meantime

If the exercise worsens the symptoms, avoid exercise until you see your provider.

Symptoms and treatment of Sick sinus syndrome