Sick Sinus syndrome

Presented by nisa 10.10.11

What Is Sick Sinus Syndrome?

Sick sinus syndrome (SSS) is abnormalities in

sinus node impulse formation and propagation. When the sinus node malfunctions several different abnormalities may result:
Sinus bradycardia Sinus pause or sinus arrest bradycardia-tachycardia syndrome

sinoatrial exit block

chronotropic incompetence

Sinus Bradycardia

Persistent slow rate from the SA node. The

parameters from this waveform include:

Rate = 55 bpm PR interval = 180 ms (0.18 seconds)

Stuart Allen 06

Sinus Arrest

2.8-second arrest

Failure of sinus node discharge resulting in the absence

of atrial depolarisation and periods of ventricular asystole

Rate = 75 bpm

PR interval = 180 ms (0.18 seconds)

2.8 second arrest
Stuart Allen 06

Brady-Tachy Syndrome

Intermittent episodes of slow and fast rates

from the SA node or atria

Rate during bradycardia = 43 bpm Rate during tachycardia = 130 bpm

Stuart Allen 06

SA Exit Block

2.1-second pause

Transient blockage of impulses from the SA

node
Rate = 52 bpm PR interval = 180 ms (0.18 seconds) 2.1-second pause
Stuart Allen 06

Chronotropic Incompetence (CI)

Heart Rate Max Slow Unstable Rest Time Start Activity
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Quick

Normal CI

Stop Activity

Who Is at Risk to Develop SSS?

Persons over the age of 65. Persons who myocardial infarction & who may have sustained damage to the sinus node. Persons taking medications for high blood pressure and other cardiac conditions. Persons with hyperkalemia and other electrolyte disorders.

Persons with hypothyroidism. Persons with sleep apnea.

Children who have undergone corrective surgery (especially in the upper chambers) for a congenital heart defect. Persons who have had diphtheria, muscular dystrophy, or amyloidosis.These are rare causes of SSS.

What Are the Symptoms of SSS?

Palpitations Disturbed sleep

Fainting

Chest pain (angina)

Confusion

Fatigue and weakness

How Is SSS Treated?

Medical Care The only effective medical care in patients with SND is to correct extrinsic causes. Surgical Care Pacemaker therapy is the only effective surgical care for patients with chronic symptomatic SND. Because the incidence of sudden death in patients with SND is extremely low and pacemaker therapy does not appear to affect survival, the major goal of pacemaker therapy in patients with SND is to relieve symptoms.

Indications for Pacemaker Implantation

Class I Indications Sinus node dysfunction with documented symptomatic sinus bradycardia Symptomatic chronotropic incompetence Class II Indications Class IIa: Symptomatic patients with sinus node dysfunction and with no clear association between symptoms and bradycardia Class IIb: Chronic heart rate < 30 bpm in minimally symptomatic patients while awake Class III Indications Asymptomatic sinus node dysfunction

JACC Vol. 31, no. 5 April 1998, 1175-1209