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Sick sinus syndrome
From WikEM
Contents
Background
- Collection of bradyarrhythmias with or without tachycardia[1]
- 50% have alternating bradycardia and tachycardia
Causes
- Intrinsic:
- degenerative fibrosis
- infiltrative disease process
- ion channel dysfunction
- SA node remodeling
- Extrinsic:
- pharmacologic
- metabolic/electrolyte disturbance
- autonomic, OSA
Clinical Features
- Clinical manifestations related to end-organ hypoperfusion
- Syncope/pre-syncope (50%)
Differential Diagnosis
Symptomatic bradycardia
- Ischemia/Infarction
- Inferior MI (involving RCA)
- Neurocardiogenic/reflex-mediated
- Increased ICP
- Vasovagal reflex
- Hypersensitive carotid sinus syndrome
- Intra-abdominal hemorrhage (i.e. ruptured ectopic)
- Metabolic/endocrine/environmental
- Hyperkalemia
- Hypothermia (Osborn waves on ECG)
- Hypothyroidism
- Hypoglycemia (neonates)
- Toxicologic
- Infectious/Postinfectious
- Sick Sinus Syndrome
Evaluation
- ECG identification, inpatient telemetry, outpatient Holter monitoring, event monitoring, loop monitoring
- ECG frequently negative for findings early in disease course
Management
- remove extrinsic factors and/or pacemakers
- Pacemakers do not reduce mortality, only decrease symptoms
Disposition
- Admit
Complications
- (50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter
- (50%) AV block
See Also
External Links
References
- ↑ Semelka, M et Al. Sick Sinus Syndrome: A Review. Am Fam Physician. 2013 May 15;87(10):691-696. http://www.aafp.org/afp/2013/0515/p691.html
