Sick sinus syndrome

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

  • Syncope or pre-syncope (50%)
  • Palpitations
  • Fatigue
  • Generalized weakness
  • Dyspnea
  • Angina
  • Disturbed sleep
  • Confusion

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

Disposition

  • Admit

Complications

  • (50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter
  • (50%) AV block

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