Sick sinus syndrome is a collection of heart rhythm disorders with the sinus node, such as:
1. The heartbeat rate is too slow, called sinus bradycardia
2. The heartbeat pauses or stops, called sinus pauses or sinus arrest
3. Episodes of a fast heart rate
4. Slow heart rhythms that alternate with fast heart rhythms, called bradycardia-tachycardia or "tachy-brady syndrome"
The ECG indicates sinus node dysfunction with an atrial rate that is not suitable for normal functions.
Sick sinus syndrome is normally produced by idiopathic fibrosis of the sinus node.
Sick sinus syndrome most often happens in people older than 50.
It is often caused by scar-like injury to electrical pathways in the heart muscle tissue.
In children, heart surgery on the upper chambers is a frequent cause of sick sinus syndrome.
Coronary heart disease, high blood pressure, and aortic and mitral valve diseases may happen with sick sinus syndrome.
Sinus bradycardia happens more often than the other forms of the disorder.
Tachycardias (rapid heart rates) starting in the upper heart may be part of the syndrome:
1. Atrial fibrillation,
2. Atrial flutter,
3. Atrial tachycardia.
Periods of fast heart rates is often followed by very slow heart rates
Some medicines can worsen abnormal heart rhythms.
These are digitalis, calcium channel blockers, beta-blockers, and anti-arrhythmics.
1. An intrinsic disease of the sinus node:
a. Idiopathic degeneration of the sinus node
b. Collagen vascular disease: amyloidosis, hemochromatosis,sarcoidosis.
c. Familial sinoatrial node disorders
d. Friedreich's ataxia, muscular dystrophy.
e. Cardiomyopathies: ischemia, myocardial infarction, myocarditis, pericarditis, rheumatic heart disease
f. Surgical injury.
2. Extrinsic causes:
a. Hyper-kalemia, hypoxia, hypothermia, hypothyroidism, hyperthyroidism.
b. Drugs - e.g., digoxin
d. Sleep apnea
Most of the time, no symptoms are present.
Symptoms that do happen may imitate those of other disorders.
1. Chest pain or angina
3. Fainting or near-fainting
7. Shortness of breath
Sick sinus syndrome is diagnosed when the symptoms happen only during episodes of arrhythmia.
An ECG may show abnormal heart rhythms linked to this syndrome.
a. Atrial brady-arrhythmias
c. Ventricular (escape) tachy-arrhythmia.
d. Alternating bradycardias and tachycardias
An intra-cardiac electrophysiology study (EPS) is a very specific test for this disorder.
The patient may not require treatment if he or she does not have any symptoms.
The patient may require a permanent implanted pacemaker if the symptoms are linked to bradycardia (slow heart rate).
Atrial or dual-chamber pacemakers normally provide successful relief of symptoms and reduce the incidence of atrial fibrillation, thromboembolic events, heart failure and mortality, when compared with ventricular pacemakers
Beta-blockers, quinidine and digoxin may be given together with a pacemaker for tachy-arrhythmias.
Anticoagulation will be required for patients with atrial fibrillation
A fast heart rate (tachycardia) may be treated with medicine.
Occasionally, an intervention called radiofrequency ablation is done to cure tachycardia.
In some cases, medicines given to control periods of fast heart rate are combined with the use of a pacemaker, which protects against periods of slow heart rate.
TABLE OF CONTENT
Chapter 1 Sick Sinus Syndrome
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Atrial Flutter
Chapter 8 Wolff Parkinson White Syndrome
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About the Author
Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"