Sick Sinus Syndrome
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Contents |
Etiology
- fibrosis, inflammation or degenerative changes involving the sinoatrial (sinus) node & atria
Epidemiology
- occurs most often in the elderly with underlying heart disease or previous cardiac surgery
- can occur in the fetus, infant, or child without heart disease or other contributing factors, in which case it is considered a congenital disorder
Genetics
- autosomal recessive
- associated with mutations in SCN5A gene (type 1)
- associated with defects in HCN4 (type 2)
Clinical-manifestations
- dizziness
- weakness
- palpitations
- syncope or near syncope
Diagnostic-procedures
-
- sinus bradycardia, sinus arrest, &/or sinoatrial block
- episodes of atrial tachycardia (including atrial fibrillation) coexisting with sinus bradycardia ('tachy-brady syndrome') are also common
Management
- pharmacologic agents to control supraventricular tachycardia
- consider pacemaker for symptomatic bradycardia or sinus arrest/pause
- pacemaker implantation may be necessary in order to safely administer medications to control the ventricular response to atrial fibrillation
- minimal pacing of right ventricle may diminishe incidence of atrial fibrillation [4]
More General Terms
Additional Terms
Internet Database
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 272
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- Sweeney MO et al, for the Search AV Extension and Managed Ventricular Pacing for Promoting Atrioventricular Conduction (SAVE PACe) Trial Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med 2007, 357:1000 PMID: [1]
