Sick sinus syndrome (patient information)

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Sick sinus syndrome
Overview
What are the symptoms?
What are the causes?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Sick sinus syndrome?
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Sick sinus syndrome is a collection of heart rhythm disorders that include:

• Sinus bradycardia -- slow heart rates from the natural pacemaker of the heart
• Sinus pauses or arrest -- when the natural pacemaker of the heart stops working for periods of time

People with these disorders may also have other abnormal heart rhythms, such as:

• Atrial tachycardia -- fast heart rate that starts in the upper chambers of the heart (atria)
• Bradycardia-tachycardia -- alternating slow and fast heart rhythms

What are the symptoms of Sick sinus syndrome?

Usually, no symptoms occur. Symptoms that do occur are may mimic those of other disorders.

Symptoms may include:

• Chest pain or angina
• Confusion or other changes in mental status
• Fainting or near-fainting
• Fatigue
• Dizziness or light-headedness
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath, possibly only with activity

What causes Sick sinus syndrome?

Sick sinus syndrome usually occurs in people older than 50. The cause is often scar-like damage to the heart's conduction system. In children, a common cause of sick sinus syndrome is heart surgery, especially on the upper chambers. Coronary artery disease, high blood pressure, and aortic and mitral valve diseases may occur with sick sinus syndrome, although these diseases may have nothing to do with the syndrome. Sick sinus syndrome is uncommon.

Diagnosis

Medical history

• Sick sinus syndrome may cause symptoms ofheart failure to occur or get worse.
• Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia.

Physical exam

• The heart rate may be very slow at any time.
• Blood pressure may be normal or low.

Testing

• An ECG may show abnormal heart rhythms related to this syndrome.
• Holter monitoring is an effective tool for diagnosing sick sinus syndrome. It may pick up extremely slow heart rate and long pauses, along with episodes of atrial tachycardias. Other forms of long-term electrical monitoring may also be useful.
• An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and it may not be able to confirm the diagnosis.
• Exercise testing has not been proven very effective as a screening tool.

When to seek urgent medical care?

Call for an appointment with health care provider if spells of light-headedness, episodes of fainting, palpitations, or other symptoms are experienced.

Treatment options

• No treatment is needed, if patient do not have any symptoms.

• Your doctor will review the medicines you take to make sure they are not making your condition worse.

• Do not stop taking any medication unless your doctor tells you to do so.

• You may need a permanent implanted pacemaker if your symptoms are related to bradycardia (slow heart rate).

• A fast heart rate (tachycardia) may be treated with medications. Sometimes a procedure called radiofrequency ablation is used to cure tachycardia.

Patients diagnosed with sick sinus syndrome should avoid using the following medications:

• Adenosine
• Verapamil
• Esmolol
• Fingolimod
• Propafenone
  If you have been diagnosed with sick sinus syndrome, consult your physician before starting or stopping any of these medications.

Where to find medical care for Sick sinus syndrome?

Directions to Hospitals Treating Sick sinus syndrome

What to expect (Outlook/Prognosis)?

• The syndrome is progressive, which means it usually gets worse over time.

• The long-term outlook is excellent for people who have a permanent pacemaker implanted.

Possible complications

• Angina
• Decreased exercised capacity
• Fainting (syncope)
• Falls or injury caused by fainting
• Heart failure
• Poor heart pumping