Sick sinus syndrome: Difference between revisions

Jump to navigation Jump to search
Line 107: Line 107:
==External links==
==External links==
*[http://www.nlm.nih.gov/medlineplus/ency/article/000161.htm NIH website]
*[http://www.nlm.nih.gov/medlineplus/ency/article/000161.htm NIH website]
*[http://www.emedicine.com/med/topic2132.htm eMedicine Page]


==References==
==References==

Revision as of 16:20, 12 February 2012

Sick sinus syndrome
Sick sinus syndrome
ICD-10 I49.5
ICD-9 427.81
OMIM 163800
DiseasesDB 12066
MedlinePlus 000161
eMedicine med/ 

WikiDoc Resources for Sick sinus syndrome

Articles

Most recent articles on Sick sinus syndrome

Most cited articles on Sick sinus syndrome

Review articles on Sick sinus syndrome

Articles on Sick sinus syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Sick sinus syndrome

Images of Sick sinus syndrome

Photos of Sick sinus syndrome

Podcasts & MP3s on Sick sinus syndrome

Videos on Sick sinus syndrome

Evidence Based Medicine

Cochrane Collaboration on Sick sinus syndrome

Bandolier on Sick sinus syndrome

TRIP on Sick sinus syndrome

Clinical Trials

Ongoing Trials on Sick sinus syndrome at Clinical Trials.gov

Trial results on Sick sinus syndrome

Clinical Trials on Sick sinus syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Sick sinus syndrome

NICE Guidance on Sick sinus syndrome

NHS PRODIGY Guidance

FDA on Sick sinus syndrome

CDC on Sick sinus syndrome

Books

Books on Sick sinus syndrome

News

Sick sinus syndrome in the news

Be alerted to news on Sick sinus syndrome

News trends on Sick sinus syndrome

Commentary

Blogs on Sick sinus syndrome

Definitions

Definitions of Sick sinus syndrome

Patient Resources / Community

Patient resources on Sick sinus syndrome

Discussion groups on Sick sinus syndrome

Patient Handouts on Sick sinus syndrome

Directions to Hospitals Treating Sick sinus syndrome

Risk calculators and risk factors for Sick sinus syndrome

Healthcare Provider Resources

Symptoms of Sick sinus syndrome

Causes & Risk Factors for Sick sinus syndrome

Diagnostic studies for Sick sinus syndrome

Treatment of Sick sinus syndrome

Continuing Medical Education (CME)

CME Programs on Sick sinus syndrome

International

Sick sinus syndrome en Espanol

Sick sinus syndrome en Francais

Business

Sick sinus syndrome in the Marketplace

Patents on Sick sinus syndrome

Experimental / Informatics

List of terms related to Sick sinus syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Key words and synonyms: Bradycardia-tachycardia syndrome, tachycardia-bradycardia syndrome, tachy-brady syndrome, sinus node dysfunction, SND, SSS. Sinus arrest, sinus bradycardia, are forms or variants of sick sinus syndrome.

Overview

Sick sinus syndrome, also called Sinus node dysfunction, is a group of abnormal heart rhythms (arrhythmias) caused by a malfunction of the sinus node, the heart's "natural" pacemaker.

Subclassification of variants of sinus node dysfunction

  1. Bradycardia-tachycardia syndrome is a variant of sick sinus syndrome where atrial tachyarrhythmias such as atrial flutter and fibrillation alternate with prolonged periods of asystole.
  2. Chronotropic incompetence
  3. Sinus bradycardia
  4. Sinus arrest
  5. Sinus node exit block
  6. Sinus pause

Common Causes

Sick sinus syndrome can result in many abnormal heart rhythms (arrhythmias), including sinus arrest, sinus node exit block, sinus bradycardia, and other types of bradycardia (slow heart rate).

Sick sinus syndrome may also be associated with tachycardias (fast heart rate) such as paroxysmal supraventricular tachycardia (PSVT) and atrial fibrillation. Tachycardias that occur with sick sinus syndrome are characterized by a long pause after the tachycardia.

Abnormal rhythms are often caused or worsened by medications such as digitalis, calcium channel blockers, beta-blockers, sympatholytic medications, and anti-arrhythmics. Disorders that cause scarring, degeneration, or damage to the conduction system can cause sick sinus syndrome, including sarcoidosis, amyloidosis, Chagas' disease, and cardiomyopathies.

Sick sinus syndrome is more common in elderly adults, where the cause is often a non-specific, scar-like degeneration of the cardiac conduction system. Cardiac surgery, especially to the atria, is a common cause of sick sinus syndrome in children.

Coronary artery disease, high blood pressure, and aortic and mitral valve diseases may be associated with sick sinus syndrome, although this association may only be incidental.

Symptoms

Even though many types of sick sinus syndrome produce no symptoms, patients may present with:

Diagnosis

Ambulatory monitoring of the electrocardiogram (ECG) may be necessary because arrhythmias are transient. The ECG may show any of the following

Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. Cardioinhibitory and vasodepressor forms of sick sinus syndrome may be revealed by tilt table testing.



Treatment

Bradyarrhythmias are well controlled with pacemakers, while tachyarrhythmias respond well to medical therapy. However, because both bradyarrhythmias and tachyarrhythmias may be present, drugs to control tachyarrhythmia may exacerbate bradyarrhythmia. Therefore, a pacemaker is implanted before drug therapy is begun for the tachyarrhythmia.

ACC / AHA Guidelines- Recommendations for Permanent Pacing in Sinus Node Dysfunction (DO NOT EDIT) [1]

Class I

1. Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C)

2. Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence: C)

3. Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C)

Class IIa

1. Permanent pacemaker implantation is reasonable for SND with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C)

2. Permanent pacemaker implantation is reasonable for syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C)

Class IIb

1. Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. (Level of Evidence: C)

Class III

1. Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. (Level of Evidence: C)

2. Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence: C)

3. Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C)

Sources

  • The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities [1]

External links

References

  • Adan V, Crown LA (2003). "Diagnosis and treatment of sick sinus syndrome". Am Fam Physician. 67 (8): 1725–32. PMID 12725451.
  1. 1.0 1.1 Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207

Template:SIB

de:Sick-Sinus-Syndrom sv:Taky-brady-syndrom


Template:WikiDoc Sources