Sinoatrial block: Difference between revisions
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The sinoatrial (SA) node represents the original pacemaker of the heart. It's formed of cells, sometimes called P cells, in a compact region at the junction of the high right atrium and the superior vena cava. The surrounding cells or Perinodal cells, sometimes called (T) cells, transmit the electrical impulse from the SA node to the right atrium. Each of these cell types has distinct expression profiles of ion channels and gap junctions. SA nodal dysfunction typically results from either abnormalities in signal generation by the P cells or abnormalities in conduction across the T cells. Sinoatrial nodal dysfunction includes pauses, arrest, exit block and ultimately sick sinus syndrome. Here we will discuss sinoatrial block. | The sinoatrial (SA) node represents the original pacemaker of the heart. It's formed of cells, sometimes called P cells, in a compact region at the junction of the high right atrium and the superior vena cava. The surrounding cells or Perinodal cells, sometimes called (T) cells, transmit the electrical impulse from the SA node to the right atrium. Each of these cell types has distinct expression profiles of ion channels and gap junctions. SA nodal dysfunction typically results from either abnormalities in signal generation by the P cells or abnormalities in conduction across the T cells. Sinoatrial nodal dysfunction includes pauses, arrest, exit block and ultimately sick sinus syndrome. Here we will discuss sinoatrial block. | ||
==Classification== | |||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Revision as of 20:54, 29 August 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]
Synonyms and keywords:; SA nodal exit block; exit block; Sino atrial exit block; Sinoatrial nodal block
Overview
The sinoatrial (SA) node represents the original pacemaker of the heart. It's formed of cells, sometimes called P cells, in a compact region at the junction of the high right atrium and the superior vena cava. The surrounding cells or Perinodal cells, sometimes called (T) cells, transmit the electrical impulse from the SA node to the right atrium. Each of these cell types has distinct expression profiles of ion channels and gap junctions. SA nodal dysfunction typically results from either abnormalities in signal generation by the P cells or abnormalities in conduction across the T cells. Sinoatrial nodal dysfunction includes pauses, arrest, exit block and ultimately sick sinus syndrome. Here we will discuss sinoatrial block.
Classification
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Acute coronary syndrome
- Acute renal failure
- Diabetic ketoacidosis
- Lateral medullary syndrome
- Myocardial rupture
- NSTEMI
- Organophosphate poisoning
- Parathion poisoning
- Poisonous spider bites
- Septic shock
- Severe brain injury
- STEMI
Common Causes
- Acetylcholine
- Acute coronary syndrome
- Amiodarone
- Beta blockers
- Calcium channel blockers
- Digoxin
- Dilated cardiomyopathy
- Hyperkalemia
- Hypermagnesemia
- Hypertrophic cardiomyopathy
- Myocarditis
- Pericarditis
- Sick sinus syndrome
- Sinus node fibrosis
- STEMI
Causes by Organ System
Causes in Alphabetical Order
Differentiating Sinoatrial block from other Diseases
Other types of SA nodal dysfunction are discussed in detail in other chapters on wikidoc. Follow the hyperlinks for details and those include:
Diagnosis
Treatment
Sinoatrial block principles of treatment are the same as sinus pause or sick sinus syndrome. Usually no treatment is indicated if the patient is asymptomatic. Stopping the offending drug is generally reasonable. When symptoms occur and become intolerable or life-threatening, then a permanent pacemaker would be indicated.
References
- ↑ Bailey PL (1990). "Sinus arrest induced by trivial nasal stimulation during alfentanil-nitrous oxide anaesthesia". Br J Anaesth. 65 (5): 718–20. PMID 2248851.
- ↑ 2.0 2.1 2.2 Mills TA, Kawji MM, Cataldo VD, Pappas ND, O'Meallie LP, Breaux DM; et al. (2004). "Profound sinus bradycardia due to diltiazem, verapamil, and/or beta-adrenergic blocking drugs". J La State Med Soc. 156 (6): 327–31. PMID 15688675.
- ↑ 3.0 3.1 Lines D, Shipton EA (1991). "Severe bradycardia and sinus arrest after administration of vecuronium, fentanyl and halothane. A case report". S Afr Med J. 80 (4): 200–1. PMID 1678901.
- ↑ Bonvini RF, Hendiri T, Anwar A (2006). "Sinus arrest and moderate hyperkalemia". Annales De Cardiologie Et D'angéiologie. 55 (3): 161–3. PMID 16792034. Unknown parameter
|month=ignored (help) - ↑ Koay S, Dewan B (2013). "An unexpected Holter monitor result: multiple sinus arrests in a patient with lateral medullary syndrome". BMJ Case Rep. 2013. doi:10.1136/bcr-2012-007783. PMID 23386489.