Sick sinus syndrome

(Redirected from Tachy-Brady 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

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

Authors:

Ross Donaldson