Sick sinus syndrome electrocardiogram: Difference between revisions
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{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Sick sinus syndrome is a collection of heart rhythm disorders that include [[sinus bradycardia]], sinus pauses and [[sinus arrest]]. Sick sinus syndrome can evolve towards causing [[atrial fibrillation]], [[atrial flutter]], ectopic [[atrial tachycardia]], sinus node reentrant tachycardia, and | Sick sinus syndrome is a collection of heart rhythm disorders that include [[sinus bradycardia]], sinus pauses and [[sinus arrest]]. Sick sinus syndrome can evolve towards causing [[atrial fibrillation]], [[atrial flutter]], ectopic [[atrial tachycardia]], sinus node reentrant tachycardia, and tachycardia-bradycardia. | ||
==Electrocardiogram== | ==Electrocardiogram== | ||
Ambulatory monitoring of the [[electrocardiogram]] (EKG) may be necessary because arrhythmias are transient. The EKG may show any of the following:<ref name="RubensteinSchulman1972">{{cite journal|last1=Rubenstein|first1=Joel J.|last2=Schulman|first2=Charles L.|last3=Yurchak|first3=Peter M.|last4=Desanctis|first4=Roman W.|title=Clinical Spectrum of the Sick Sinus Syndrome|journal=Circulation|volume=46|issue=1|year=1972|pages=5–13|issn=0009-7322|doi=10.1161/01.CIR.46.1.5}}</ref><ref name="ParkCho2004">{{cite journal|last1=Park|first1=Hyung Wook|last2=Cho|first2=Jeong Gwan|last3=Yum|first3=Ju Hyup|last4=Hong|first4=Young Joon|last5=Lim|first5=Ji Hyun|last6=Kim|first6=Han Gyun|last7=Kim|first7=Ju Han|last8=Kim|first8=Weon|last9=Ahn|first9=Young Keun|last10=Jeong|first10=Myung Ho|last11=Park|first11=Jong Chun|last12=Kang|first12=Jung Chaee|title=Clinical Characteristics of Hypervagotonic Sinus Node Dysfunction|journal=The Korean Journal of Internal Medicine|volume=19|issue=3|year=2004|pages=155–159|issn=1226-3303|doi=10.3904/kjim.2004.19.3.155}}</ref> | Ambulatory monitoring of the [[electrocardiogram]] (EKG) may be necessary because arrhythmias are transient. The EKG may show any of the following:<ref name="RubensteinSchulman1972">{{cite journal|last1=Rubenstein|first1=Joel J.|last2=Schulman|first2=Charles L.|last3=Yurchak|first3=Peter M.|last4=Desanctis|first4=Roman W.|title=Clinical Spectrum of the Sick Sinus Syndrome|journal=Circulation|volume=46|issue=1|year=1972|pages=5–13|issn=0009-7322|doi=10.1161/01.CIR.46.1.5}}</ref><ref name="ParkCho2004">{{cite journal|last1=Park|first1=Hyung Wook|last2=Cho|first2=Jeong Gwan|last3=Yum|first3=Ju Hyup|last4=Hong|first4=Young Joon|last5=Lim|first5=Ji Hyun|last6=Kim|first6=Han Gyun|last7=Kim|first7=Ju Han|last8=Kim|first8=Weon|last9=Ahn|first9=Young Keun|last10=Jeong|first10=Myung Ho|last11=Park|first11=Jong Chun|last12=Kang|first12=Jung Chaee|title=Clinical Characteristics of Hypervagotonic Sinus Node Dysfunction|journal=The Korean Journal of Internal Medicine|volume=19|issue=3|year=2004|pages=155–159|issn=1226-3303|doi=10.3904/kjim.2004.19.3.155}}</ref> | ||
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* Ectopic atrial tachycardia | * Ectopic atrial tachycardia | ||
* Sinus node reentrant tachycardia | * Sinus node reentrant tachycardia | ||
* | * Tachycardia-bradycardia | ||
Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. | |||
Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. Cardio-inhibitory and vasodepressor forms of sick sinus syndrome may be revealed by [[tilt table test]]ing. | |||
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Shown below is an EKG demonstrating sick sinus syndrome. [[Atrial fibrillation]] is present (an irregularly irregular rhythm) which stops abruptly due to [[sinus arrest]]. | Shown below is an EKG demonstrating sick sinus syndrome. [[Atrial fibrillation]] is present (an irregularly irregular rhythm) which stops abruptly due to [[sinus arrest]]. | ||
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;For more EKG examples of sick sinus syndrome click [[Sick sinus syndrome EKG examples|here]]. | ;For more EKG examples of sick sinus syndrome click [[Sick sinus syndrome EKG examples|here]]. | ||
==Guideline== | |||
=== 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay <ref name="KusumotoSchoenfeld2019">{{cite journal|last1=Kusumoto|first1=Fred M.|last2=Schoenfeld|first2=Mark H.|last3=Barrett|first3=Coletta|last4=Edgerton|first4=James R.|last5=Ellenbogen|first5=Kenneth A.|last6=Gold|first6=Michael R.|last7=Goldschlager|first7=Nora F.|last8=Hamilton|first8=Robert M.|last9=Joglar|first9=José A.|last10=Kim|first10=Robert J.|last11=Lee|first11=Richard|last12=Marine|first12=Joseph E.|last13=McLeod|first13=Christopher J.|last14=Oken|first14=Keith R.|last15=Patton|first15=Kristen K.|last16=Pellegrini|first16=Cara N.|last17=Selzman|first17=Kimberly A.|last18=Thompson|first18=Annemarie|last19=Varosy|first19=Paul D.|title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay|journal=Journal of the American College of Cardiology|volume=74|issue=7|year=2019|pages=e51–e156|issn=07351097|doi=10.1016/j.jacc.2018.10.044}}</ref> === | |||
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| align="center" style="background: #4479BA; color: #FFFFFF |'''''Term''''' | |||
| style="background: #4479BA; color: #FFFFFF |'''''Definition''''' | |||
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| rowspan="7" |'''Sinus Node Dysfunction''' | |||
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* '''[[Sinus bradycardia]]''': Sinus rate <50 bpm | |||
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*'''Ectopic atrial bradycardia''': [[Atrial]] [[depolarization]] attributable to an [[atrial]] [[pacemaker]] other than the [[sinus node]] with a rate <50 bpm | |||
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*'''Sinoatrial exit block''': Evidence that blocked conduction between the sinus node and adjacent [[Atrium (heart)|atrial]] tissue is present. Multiple [[electrocardiographic]] manifestations including “group beating” of atrial depolarization and sinus pauses. | |||
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*'''[[Sinus pause]]''': Sinus node depolarizes >3 s after the last [[atrial]] [[depolarization]] | |||
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*'''Tachycardia-bradycardia (“tachy-brady”) syndrome''': [[Sinus bradycardia]], ectopic atrial bradycardia, or [[sinus pause]] alternating with periods of abnormal [[atrial]] tachycardia, [[atrial flutter]], or AF. The [[tachycardia]] may be associated with suppression of sinus node automaticity and a sinus pause of variable duration when the tachycardia terminates. | |||
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*'''Chronotropic incompetence''': Broadly defined as the inability of the heart to increase its rate commensurate with increased activity or demand, in many studies translates to failure to attain 80% of expected [[heart rate]] reserve during exercise. | |||
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*'''Isorhythmic dissociation''': [[Atrial]] [[depolarization]] (from either the sinus node or ectopic atrial site) is slower than [[ventricular]] [[depolarization]] (from an [[Atrioventricular node|atrioventricular nodal]], [[His bundle]], or [[ventricular]] site). | |||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 23:04, 15 April 2020
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Sick sinus syndrome electrocardiogram On the Web |
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Risk calculators and risk factors for Sick sinus syndrome electrocardiogram |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Sick sinus syndrome is a collection of heart rhythm disorders that include sinus bradycardia, sinus pauses and sinus arrest. Sick sinus syndrome can evolve towards causing atrial fibrillation, atrial flutter, ectopic atrial tachycardia, sinus node reentrant tachycardia, and tachycardia-bradycardia.
Electrocardiogram
Ambulatory monitoring of the electrocardiogram (EKG) may be necessary because arrhythmias are transient. The EKG may show any of the following:[1][2]
- Inappropriate sinus bradycardia
- Sinus arrest
- Sinoatrial block
- Atrial fibrillation with slow ventricular response
- A prolonged asystolic period after a period of tachycardias
- Atrial flutter
- Ectopic atrial tachycardia
- Sinus node reentrant tachycardia
- Tachycardia-bradycardia
Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. Cardio-inhibitory and vasodepressor forms of sick sinus syndrome may be revealed by tilt table testing.
Shown below is an EKG demonstrating sick sinus syndrome. Atrial fibrillation is present (an irregularly irregular rhythm) which stops abruptly due to sinus arrest.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
Shown below is an EKG showing the termination of a supraventricular tachycardia at about 130/min. which terminates and leaves a pause and then sinus bradycardia. This is a from of "tachy/brady" syndrome where a tachycardia is followed by a bradycardia.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
- For more EKG examples of sick sinus syndrome click here.
Guideline
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay [3]
| Term | Definition |
| Sinus Node Dysfunction |
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References
- ↑ Rubenstein, Joel J.; Schulman, Charles L.; Yurchak, Peter M.; Desanctis, Roman W. (1972). "Clinical Spectrum of the Sick Sinus Syndrome". Circulation. 46 (1): 5–13. doi:10.1161/01.CIR.46.1.5. ISSN 0009-7322.
- ↑ Park, Hyung Wook; Cho, Jeong Gwan; Yum, Ju Hyup; Hong, Young Joon; Lim, Ji Hyun; Kim, Han Gyun; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Jeong, Myung Ho; Park, Jong Chun; Kang, Jung Chaee (2004). "Clinical Characteristics of Hypervagotonic Sinus Node Dysfunction". The Korean Journal of Internal Medicine. 19 (3): 155–159. doi:10.3904/kjim.2004.19.3.155. ISSN 1226-3303.
- ↑ Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay". Journal of the American College of Cardiology. 74 (7): e51–e156. doi:10.1016/j.jacc.2018.10.044. ISSN 0735-1097.