Sick sinus syndrome - Revision history

ClaireLewis at 16:12, 26 September 2019

2019-09-26T16:12:19Z

← Older revision		Revision as of 16:12, 26 September 2019
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	*Intrinsic:		*Intrinsic:
	**Degenerative fibrosis		**Degenerative fibrosis
	**Infiltrative disease process		**Infiltrative disease process (e.g. [[amyloidosis]])
	**Ion channel dysfunction		**Ion channel dysfunction
	**SA node remodeling		**SA node remodeling
			**[[Myocardial ischemia]]
	*Extrinsic:		*Extrinsic:
	**Pharmacologic		**Pharmacologic
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	*[[Atropine]] for bradycardia, progress to catecholamine or pacing		*[[Atropine]] for bradycardia, progress to catecholamine or pacing
	*consider [[aminophylline]], which inhibits suppressive effects of adenosine on the SA node in: <ref> Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156 </ref>		*consider [[aminophylline]], which inhibits suppressive effects of adenosine on the SA node in: <ref> Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156 </ref>
	**Acute inferior MI with 2nd or 3rd degree AV block; 250mv IV bolus		**Acute inferior [[MI]] with 2nd or 3rd degree AV block; 250mv IV bolus
	**Heart transplant: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes		**Heart transplant: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes
	**Spinal cord injury: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes		**Spinal cord injury: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes
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	==Complications==		==Complications==
	*(50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter		*(50%) Tachy-brady syndrome with [[atrial fibrillation]] or [[atrial flutter]]
	*(50%) AV block		*(50%) [[AV block]]

	==See Also==		==See Also==

ClaireLewis at 18:51, 21 August 2019

2019-08-21T18:51:04Z

← Older revision		Revision as of 18:51, 21 August 2019
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	*Also known as sinus dysfunction, sinoatrial node disease, and tachycardia-bradycardia syndrome (a specific variant)		*Also known as sinus dysfunction, sinoatrial node disease, and tachycardia-bradycardia syndrome (a specific variant)
	*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>		*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>
	*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia		*May present as [[bradycardia]], [[tachycardia]], or alternating bradycardia and tachycardia
	**50% have alternating bradycardia and tachycardia (i.e. tachycardia-bradycardia syndrome)		**50% have alternating bradycardia and tachycardia (i.e. tachycardia-bradycardia syndrome)

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	==Clinical Features==		==Clinical Features==
	*Syncope or ~~pre-syncope~~ (50%)		*[[Syncope]] or presyncope (50%)
	*Palpitations		*[[Palpitations]]
	*Fatigue		*[[Fatigue]]
	*Generalized weakness		*Generalized [[weakness]]
	*Dyspnea		*[[Dyspnea]]
	*Angina		*[[Angina]]
	*Disturbed sleep		*Disturbed sleep
	*Confusion		*[[Confusion]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Management==		==Management==
	*~~remove~~ extrinsic factors and/or pacemakers		*Remove extrinsic factors and/or pacemakers
	**Pacemakers do not reduce mortality, only decrease symptoms		**Pacemakers do not reduce mortality, only decrease symptoms
	*~~consider~~ reversible causes ~~and~~ treat hyperkalemia or hypokalemia		*Consider reversible causes e.g. treat [[hyperkalemia]] or [[hypokalemia]]
	*~~atropine~~ for bradycardia, progress to catecholamine or pacing		*[[Atropine]] for bradycardia, progress to catecholamine or pacing
	*consider aminophylline which ~~inhibit~~ suppressive effects of adenosine on the SA node in: <ref> Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156 </ref>		*consider [[aminophylline]], which inhibits suppressive effects of adenosine on the SA node in: <ref> Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156 </ref>
	**Acute inferior MI with 2nd or 3rd degree AV block; 250mv IV bolus		**Acute inferior MI with 2nd or 3rd degree AV block; 250mv IV bolus
	**Heart transplant: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes		**Heart transplant: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes

Gregtong: /* Management */

2019-08-21T01:18:41Z

Management

← Older revision		Revision as of 01:18, 21 August 2019
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	*remove extrinsic factors and/or pacemakers		*remove extrinsic factors and/or pacemakers
	**Pacemakers do not reduce mortality, only decrease symptoms		**Pacemakers do not reduce mortality, only decrease symptoms
			*consider reversible causes and treat hyperkalemia or hypokalemia
			*atropine for bradycardia, progress to catecholamine or pacing
			*consider aminophylline which inhibit suppressive effects of adenosine on the SA node in: <ref> Kusumoto FM, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Aug 20;74(7):e51-e156 </ref>
			**Acute inferior MI with 2nd or 3rd degree AV block; 250mv IV bolus
			**Heart transplant: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes
			**Spinal cord injury: 6mg/kg in 100-200mL of IV fluid over 20-30 minutes

	==Disposition==		==Disposition==

Rossdonaldson1: /* Differential Diagnosis */

2019-04-06T12:30:36Z

Differential Diagnosis

← Older revision		Revision as of 12:30, 6 April 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{~~achycardia~~ (narrow) DDX}}		{{Tachycardia (narrow) DDX}}
	{{Symptomatic bradycardia}}		{{Symptomatic bradycardia}}

Rossdonaldson1: /* Differential Diagnosis */

2019-04-06T12:30:25Z

Differential Diagnosis

← Older revision		Revision as of 12:30, 6 April 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{achycardia (narrow) DDX}}
	{{Symptomatic bradycardia}}		{{Symptomatic bradycardia}}

Rossdonaldson1: /* Background */

2019-03-28T04:26:48Z

Background

← Older revision		Revision as of 04:26, 28 March 2019
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	==Background==		==Background==
	*Also known as ~~"Tachy~~-~~Brady Syndrome"~~		*Also known as sinus dysfunction, sinoatrial node disease, and tachycardia-bradycardia syndrome (a specific variant)
	*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>		*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>
	*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia		*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia
	**50% have alternating bradycardia and tachycardia		**50% have alternating bradycardia and tachycardia (i.e. tachycardia-bradycardia syndrome)

	===Causes===		===Causes===
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	*Extrinsic:		*Extrinsic:
	**Pharmacologic		**Pharmacologic
	**Metabolic/electrolyte disturbance		**Metabolic/[[electrolyte disturbance]]
	**Autonomic dysfunction		**Autonomic dysfunction
	**Obstructive sleep apnea		**[[Obstructive sleep apnea]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2019-03-28T04:07:16Z

Background

← Older revision		Revision as of 04:07, 28 March 2019
Line 1:		Line 1:
	==Background==		==Background==
			*Also known as "Tachy-Brady Syndrome"
	*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>		*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>
	*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia		*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia

Rossdonaldson1: /* Complications */

2019-03-06T04:17:43Z

Complications

← Older revision		Revision as of 04:17, 6 March 2019
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	*Admit		*Admit

	===Complications===		==Complications==
	*(50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter		*(50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter
	*(50%) AV block		*(50%) AV block

SLuckettG: /* Clinical Features */

2019-03-05T22:39:02Z

Clinical Features

← Older revision		Revision as of 22:39, 5 March 2019
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	==Clinical Features==		==Clinical Features==
	*Clinical manifestations related to end-organ hypoperfusion		*Syncope or pre-syncope (50%)
	**Syncope/pre-syncope (50%)		*Palpitations
			*Fatigue
			*Generalized weakness
			*Dyspnea
			*Angina
			*Disturbed sleep
			*Confusion

	==Differential Diagnosis==		==Differential Diagnosis==

SLuckettG: /* Background */

2019-03-05T22:37:23Z

Background

← Older revision		Revision as of 22:37, 5 March 2019
Line 1:		Line 1:
	==Background==		==Background==
	*Collection of ~~bradyarrhythmias with~~ or ~~without tachycardia~~<ref>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</ref>		*Collection of signs or symptoms that indicate sinus node dysfunction<ref>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</ref>
	*50% have alternating bradycardia and tachycardia		*May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia
			**50% have alternating bradycardia and tachycardia

	===Causes===		===Causes===
	*Intrinsic:		*Intrinsic:
	**~~degenerative~~ fibrosis		**Degenerative fibrosis
	**~~infiltrative~~ disease process		**Infiltrative disease process
	**~~ion~~ channel dysfunction		**Ion channel dysfunction
	**SA node remodeling		**SA node remodeling
	*Extrinsic:		*Extrinsic:
	**~~pharmacologic~~		**Pharmacologic
	**~~metabolic~~/electrolyte disturbance		**Metabolic/electrolyte disturbance
	**~~autonomic, OSA~~		**Autonomic dysfunction
			**Obstructive sleep apnea

	==Clinical Features==		==Clinical Features==