Sick sinus syndrome: Difference between revisions

(Created page with "==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. h...")
 
No edit summary
 
(20 intermediate revisions by 6 users not shown)
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>
*Also known as sinus dysfunction, sinoatrial node disease, and tachycardia-bradycardia syndrome (a specific variant)
##50% have alternating bradycardia and tachycardia
*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
**50% have alternating bradycardia and tachycardia (i.e. tachycardia-bradycardia syndrome)
 
===Causes===
*Intrinsic:
**Degenerative fibrosis
**Infiltrative disease process (e.g. [[amyloidosis]])
**Ion channel dysfunction
**SA node remodeling
**[[Myocardial ischemia]]
*Extrinsic:
**Pharmacologic
**Metabolic/[[electrolyte disturbance]]
**Autonomic dysfunction
**[[Obstructive sleep apnea]]


==Clinical Features==
==Clinical Features==
##Clinical manifestations related to end-organ hypoperfusion
*[[Syncope]] or presyncope (50%)
###Syncope/pre-syncope (50%)
*[[Palpitations]]
##Dx - ECG identification, inpatient telemetry, outpatient Holter monitoring, event monitoring, loop monitoring
*[[Fatigue]]
###ECG frequently negative for findings early in disease course
*Generalized [[weakness]]
*[[Dyspnea]]
*[[Angina]]
*Disturbed sleep
*[[Confusion]]


==Differential Diagnosis==
==Differential Diagnosis==
===Causes===
{{Tachycardia (narrow) DDX}}
#Intrinsic:
{{Symptomatic bradycardia}}
##degenerative fibrosis
##infiltrative disease process
##ion channel dysfunction
##SA node remodeling
#Extrinsic:
##pharmacologic
##metabolic/electrolyte disturbance
##autonomic, OSA


==Workup==
==Evaluation==
*[[ECG]] identification, inpatient telemetry, outpatient Holter monitoring, event monitoring, loop monitoring
**[[ECG]] frequently negative for findings early in disease course


==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 e.g. treat [[hyperkalemia]] or [[hypokalemia]]
*[[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>
**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==
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]]


==See Also==
==See Also==
Line 39: Line 58:
==External Links==
==External Links==


==Sources==
==References==
<references/>
<references/>
[[Category:Cardiology]]

Latest revision as of 16:12, 26 September 2019

Background

  • 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[1]
  • May present as bradycardia, tachycardia, or alternating bradycardia and tachycardia
    • 50% have alternating bradycardia and tachycardia (i.e. tachycardia-bradycardia syndrome)

Causes

Clinical Features

Differential Diagnosis

Narrow-complex tachycardia

Symptomatic bradycardia

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
  • Consider reversible causes e.g. treat hyperkalemia or hypokalemia
  • Atropine for bradycardia, progress to catecholamine or pacing
  • consider aminophylline, which inhibits suppressive effects of adenosine on the SA node in: [2]
    • 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

  • Admit

Complications

See Also

External Links

References

  1. ↑ 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
  2. ↑ 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
Retrieved from "https://www.wikem.org/w/index.php?title=Sick_sinus_syndrome&oldid=230199"