Sick sinus syndrome: Difference between revisions
(Text replacement - "*ECG" to "*ECG") |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Collection of | *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 | ||
** | **Infiltrative disease process | ||
** | **Ion channel dysfunction | ||
**SA node remodeling | **SA node remodeling | ||
*Extrinsic: | *Extrinsic: | ||
** | **Pharmacologic | ||
** | **Metabolic/electrolyte disturbance | ||
** | **Autonomic dysfunction | ||
**Obstructive sleep apnea | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 22:37, 5 March 2019
Background
- 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
Causes
- Intrinsic:
- Degenerative fibrosis
- Infiltrative disease process
- Ion channel dysfunction
- SA node remodeling
- Extrinsic:
- Pharmacologic
- Metabolic/electrolyte disturbance
- Autonomic dysfunction
- Obstructive sleep apnea
Clinical Features
- Clinical manifestations related to end-organ hypoperfusion
- Syncope/pre-syncope (50%)
Differential Diagnosis
Symptomatic bradycardia
- Cardiac
- Inferior MI (involving RCA)
- Sick sinus syndrome
- Neurocardiogenic/reflex-mediated
- Increased ICP
- Vasovagal reflex
- Hypersensitive carotid sinus syndrome
- Intra-abdominal hemorrhage (i.e. ruptured ectopic)
- Metabolic/endocrine/environmental
- Hyperkalemia
- Hypothermia (Osborn waves on ECG)
- Hypothyroidism
- Hypoglycemia (neonates)
- Toxicologic
- Infectious/Postinfectious
- Other
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
- ↑ 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