Materiały źródłowe

• #1 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] This activity describes the pathophysiology, evaluation, and management of sick sinus syndrome and highlights the role of the interprofessional team in its management. […] The first step in evaluating sinus node dysfunction is to exclude reversible causes such as electrolyte abnormalities, metabolic abnormalities, or uncontrolled sleep apnea, and removal of possible offending medications (e.g., beta-blockers, calcium channel blockers). […] Given the episodic nature of the disease, diagnosis on 12 lead ECG is unusual and prolonged monitoring to detect and document bradycardic episodes is often indicated.

• #2 Sick sinus syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554

  Sick sinus syndrome is a type of heart rhythm disorder. It affects the heart’s natural pacemaker (sinus node), which controls the heartbeat. Sick sinus syndrome causes slow heartbeats, pauses (long periods between heartbeats) or irregular heartbeats (arrhythmias). […] Talk to your health care provider if you have any signs or symptoms of sick sinus syndrome. Many medical conditions can cause these problems. It’s important to get a timely and accurate diagnosis. […] In sick sinus syndrome, the electrical signals are irregularly paced. The heartbeat can be too fast, too slow, interrupted by long pauses or an alternating combination of these rhythm issues. […] Features of sick sinus syndrome include: Sinus bradycardia. The sinus node produces a slow heartbeat. Sinus arrest. Signals from the sinus node pause, causing skipped beats. Sinoatrial exit block. Signals to the upper heart chambers are slowed or blocked, causing pauses or skipped beats. Chronotropic incompetence. The heart rate is within regular range at rest but doesn’t increase as much as it should with physical activity. Tachycardia-bradycardia syndrome. The heart rate alternates between unusually slow and fast rhythms, often with a long pause between heartbeats. […] Associated Procedures: Electrocardiogram (ECG or EKG).

• #3 Sick Sinus Syndrome: Causes, Symptoms, and Treatment

  https://patient.info/doctor/sick-sinus-syndrome

  Sick sinus syndrome is a collection of conditions in which the ECG indicates sinus node dysfunction. […] Sick sinus syndrome is usually caused by idiopathic fibrosis of the sinus node. […] Sick sinus syndrome is most common in the elderly, but can occur in all ages. […] The average age of a person with sick sinus syndrome is 68 years and it develops in 1 in 600 patients with cardiac disease aged over 65 years. […] Blood tests include renal function, electrolytes, TFTs and drug levels (eg, digoxin). […] ECG: arrhythmias associated with sick sinus syndrome include: Atrial bradyarrhythmias: sinus bradycardia, sinus arrest (with or without junctional escape), sinoatrial exit block (Mobitz type I or Mobitz type II block), ectopic atrial bradycardia, atrial fibrillation with slow ventricular response greater than three-second pause following carotid massage, long pause following cardioversion of atrial tachyarrhythmias.

• #4 Sick sinus syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/sick-sinus-syndrome/

  Sick sinus syndrome (also known as sinus node dysfunction) is a group of related heart conditions that can affect how the heart beats. „Sick sinus” refers to the sino-atrial (SA) node, which is an area of specialized cells in the heart that functions as a natural pacemaker. The SA node generates electrical impulses that start each heartbeat. These signals travel from the SA node to the rest of the heart, signaling the heart (cardiac) muscle to contract and pump blood. In people with sick sinus syndrome, the SA node does not function normally. In some cases, it does not produce the right signals to trigger a regular heartbeat. In others, abnormalities disrupt the electrical impulses and prevent them from reaching the rest of the heart. […] Sick sinus syndrome occurs most commonly in older adults, although it can be diagnosed in people of any age. The condition increases the risk of several life-threatening problems involving the heart and blood vessels. These include a heart rhythm abnormality called atrial fibrillation, heart failure, cardiac arrest, and stroke.

• #5 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html

  Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function. […] Diagnosis may be challenging, and is ultimately made by electrocardiographic identification of the arrhythmia in conjunction with the presence of symptoms. […] The diagnosis of sick sinus syndrome requires correlating symptoms of end-organ hypoperfusion with the presence of bradyarrhythmia observed on cardiac monitoring. […] Sick sinus syndrome is diagnosed by correlating symptoms of end-organ hypoperfusion with the occurrence of bradycardia, with or without accompanying tachycardia. […] When 12-lead electrocardiography does not yield a diagnosis, prolonged cardiac monitoring should be considered. […] Although rhythm monitoring is the diagnostic standard, electrophysiologic studies are sometimes useful in the evaluation of sick sinus syndrome.

• #6 Diagnosis and Treatment of Sick Sinus Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.html

  Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. […] Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. […] The diagnosis of sick sinus syndrome may be difficult because of the slow and erratic course of the syndrome. […] The most common method of diagnosis is Holter monitoring. […] If two 24-hour periods of Holter monitoring fail to reveal the dysrhythmias of sick sinus syndrome, but the symptoms are severe and intermittent, it is likely that the sinus node dysfunction is severe but intermittent. […] The diagnosis requires not only documentation of sinus node dysfunction but also correlation with the associated symptoms of sick sinus syndrome.

• #7 Sick sinus syndrome – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/sick-sinus-syndrome/

  Sick sinus syndrome can occur at any age, but it’s most common in people in their 70s or older. […] Your doctor will perform a physical exam and ask questions about your symptoms and medical history. […] Symptoms of sick sinus syndrome — such as dizziness, shortness of breath and fainting — only occur when the heart is beating abnormally. You may not have symptoms at the time of your doctor’s appointment. […] To determine if your symptoms are related to problems with the sinus node and heart function, your doctor may use the following tests: […] Electrocardiogram (ECG). During this test, sensors (electrodes) are attached to your chest and legs to create a record of the electrical signals traveling through your heart. The test might show patterns that indicate sick sinus syndrome, including a fast heart rate, slow heart rate or long pause in the heartbeat after a fast heart rate.

• #8 Sinus node dysfunction: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/sick-sinus-syndrome-clinical-manifestations-diagnosis-and-evaluation?

  Sinus node dysfunction (SND) is characterized by age-related fibrosis of the sinoatrial (SA) nodal tissue and surrounding atrial myocardium. SND causes symptoms such as fatigue, dyspnea on exertion, lightheadedness, presyncope, and syncope. […] The clinical manifestations and diagnosis of SND will be reviewed here. […] While various definitions of sinus node dysfunction (SND) exist, we define SND as abnormal sinus node function that causes symptoms (eg, fatigue, dyspnea on exertion, lightheadedness, presyncope, syncope) and does not have a reversible cause (eg, acute myocardial infarction, sinoatrial [SA] nodal-blocking medications). […] Abnormal sinus node function refers to the presence of one or more of the following: Sinus bradycardia with rate <50 bpm while awake.

• #9 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] This activity describes the pathophysiology, evaluation, and management of sick sinus syndrome and highlights the role of the interprofessional team in its management. […] The first step in evaluating sinus node dysfunction is to exclude reversible causes such as electrolyte abnormalities, metabolic abnormalities, or uncontrolled sleep apnea, and removal of possible offending medications (e.g., beta-blockers, calcium channel blockers). […] Given the episodic nature of the disease, diagnosis on 12 lead ECG is unusual and prolonged monitoring to detect and document bradycardic episodes is often indicated.

• #10 Sinus Node Dysfunction Differential Diagnoses

  https://emedicine.medscape.com/article/158064-differential

  Following a comprehensive history and physical examination, a resting 12-lead ECG, review of previous medical records and ECG tracings, and exercise stress testing are the keys to making a diagnosis of SND and establishing a symptom-rhythm correlation. […] In patients with medication use (eg, beta blockers, calcium channel blockers, digoxin, antiarrhythmics, and acetylcholine esterase inhibitors) suspected to result in symptomatic bradycardia, the patient should remain on an ECG monitor while the medications are withdrawn. If symptoms and ECG abnormalities persist following the withdrawal of the medications (ie, after 3-5 half-lives), then SND/sick sinus syndrome (SSS) may be diagnosed. […] If the diagnosis of SND cannot be definitively diagnosed following a thorough history and physical examination, an initial 12-lead ECG, and/or an ambulatory ECG monitoring [Holter] for 1 to 14 days, perform an event monitor for up to 4 weeks to identify symptomatic episodes of arrhythmias and to monitor average heart rates over extended periods of surveillance.

• #11 Sinus Node Dysfunction (Sick Sinus Syndrome) • LITFL • ECG Library

  https://litfl.com/sinus-node-dysfunction-sick-sinus-syndrome/

  A disease characterized by abnormal sinus node functioning with resultant bradycardia and cardiac insufficiency. […] ECG abnormalities can be variable and intermittent. Multiple ECG abnormalities can be seen in sinus node dysfunction including: […] Sinus node dysfunction with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. […] Symptomatic chronotropic incompetence. […] Sinus node dysfunction occurring spontaneously or as a result of necessary drug therapy, with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. […] Sinus node dysfunction in asymptomatic patients, including those in whom substantial sinus bradycardia (heart rate less than 40 bpm) is a consequence of long-term drug treatment. […] Sinus node dysfunction with symptomatic bradycardia due to nonessential drug therapy.

• #12 Sinus node dysfunction – Wikipedia

  https://en.wikipedia.org/wiki/Sinus_node_dysfunction

  Sinus node dysfunction (SND), also known as sick sinus syndrome (SSS), is a group of abnormal heart rhythms (arrhythmias) usually caused by a malfunction of the sinus node, the heart’s primary pacemaker. […] Diagnosing sinus node dysfunction requires clinical symptoms as well as ECG abnormalities. If ECG findings cannot be identified, prolonged cardiac monitoring should be pursued either with a Holter monitor in an outpatient setting or telemetry while inpatient, due to the transient nature of abnormal ECG findings. […] The primary 12-lead electrocardiogram (ECG) finding in sinus node dysfunction is inappropriate sinus bradycardia. Sinus node dysfunction can also present with sudden sinus arrest with or without junctional escape, sinoatrial block, prolonged asystolic period followed by tachycardias, or tachycardia-bradycardia syndrome presenting as various atrial arrhythmias such as atrial fibrillation, flutter, tachycardia, or paroxysmal supraventricular tachycardia.

• #13 Sick sinus syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/sick-sinus-syndrome

  Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia. However, the link is often hard to prove. […] An electrocardiogram (ECG) may show abnormal heart rhythms related to this syndrome. […] Holter or longer term rhythm monitors are effective tools for diagnosing sick sinus syndrome. They may pick up very slow heart rates and long pauses, along with episodes of atrial tachycardias. […] An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and may not confirm the diagnosis.

• #14 Diagnosis and Treatment of Sick Sinus Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.html

  Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. […] Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. […] The diagnosis of sick sinus syndrome may be difficult because of the slow and erratic course of the syndrome. […] The most common method of diagnosis is Holter monitoring. […] If two 24-hour periods of Holter monitoring fail to reveal the dysrhythmias of sick sinus syndrome, but the symptoms are severe and intermittent, it is likely that the sinus node dysfunction is severe but intermittent. […] The diagnosis requires not only documentation of sinus node dysfunction but also correlation with the associated symptoms of sick sinus syndrome.

• #15 Diagnosis and Treatment of Sick Sinus Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.html

  Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. […] Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. […] The diagnosis of sick sinus syndrome may be difficult because of the slow and erratic course of the syndrome. […] The most common method of diagnosis is Holter monitoring. […] If two 24-hour periods of Holter monitoring fail to reveal the dysrhythmias of sick sinus syndrome, but the symptoms are severe and intermittent, it is likely that the sinus node dysfunction is severe but intermittent. […] The diagnosis requires not only documentation of sinus node dysfunction but also correlation with the associated symptoms of sick sinus syndrome.

• #16 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=232

  How is sick sinus syndrome diagnosed? Your healthcare provider may think you have SSS based on your symptoms, but they are common in many other diseases. To diagnose your condition, your healthcare provider will do an electrocardiogram (ECG). This is a machine that records your heart’s rate and rhythm. If you don’t have symptoms at the time of your ECG, it may look normal. […] Other possible tests include: An ECG while you walk on a treadmill (stress test). A Holter monitor. This is a recorder you wear for over 24 hours that takes an ECG. Some Holter monitors can be worn for several weeks. […] An event recorder. This is a recorder you wear over several days to weeks that samples your heart rate. An implantable loop recorder. This is a small heart recorder put underneath the skin over the heart. It records the heart rhythm for up to 3 years. Electrophysiologic testing. This is a hospital test that involves threading catheters into your heart through a vein in your groin, and electrically stimulating parts of your heart. Echocardiogram or ultrasound (sonogram) of your heart. This is done to check for structural heart problems.

• #17 Sick Sinus Syndrome – What You Need to Know

  https://www.drugs.com/cg/sick-sinus-syndrome.html

  How is sick sinus syndrome diagnosed? […] Your healthcare provider will ask about your symptoms and when they started. He or she will ask what triggers your symptoms and if they get worse with exercise. Tell him or her if you have a heart condition or take any medicines. You may also need any of the following: […] An ECG records the electrical activity of your heart. It may be used to check for problems with the way electrical signals travel through your heart. […] A cardiac event monitor is used to track your heart rate and rhythm. This device is also called a Holter monitor or mobile telemetry. You may need to wear it for several days at home. […] A cardiac loop recorder is a device implanted in your chest or armpit, just under the skin. The device will record any heart rhythm problems automatically. You may also receive a handheld controller. You will press a button on the controller when you have symptoms, such as dizziness or lightheadedness. The device will record any rhythm problem happening at that moment.

• #18 Sick sinus syndrome | Altru Health System

  https://www.altru.org/health-library/conditions/sick-sinus-syndrome

  Holter monitor. This portable ECG device can be worn for a day or more during daily activities. It automatically records the heart’s activity for 24 to 72 hours. A person wearing a monitor might also keep a diary of symptoms. […] Event recorder. This portable ECG device is intended to be worn for up to 30 days or until you have an irregular heartbeat or symptoms. You typically press a button when symptoms occur. […] Other monitors. Some personal devices, such as smart watches, offer electrocardiogram monitoring. Ask your health care provider if this is an option for you. […] Implantable loop recorder. This small ECG device is implanted just under the skin of the chest. It’s used for continuous, long-term monitoring of the heart’s electrical activity, particularly for people who have infrequent symptoms. […] This test, also called an EP study, is rarely used to screen for sick sinus syndrome. However, it may be done to check the function of the sinus node and to evaluate other electrical properties of the heart.

• #19 Sick Sinus Syndrome: Symptoms & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/sick-sinus-syndrome

  Like holter monitoring, common consumer technologies such as watch, ring, phone technologies can now document heart rate and rhythm accurately to help a clinician make a diagnosis. […] This diagnostic test measures how well your heart functions during physical activity. The test typically involves walking on a treadmill or pedaling on a stationary bike while hooked to a monitor. The activity will gradually intensify to increase your heart rate and put stress on the cardiovascular system.

• #20 Sick Sinus Syndrome

  https://mobile.fpnotebook.com/CV/EKG/SckSnsSyndrm.htm

  Sick Sinus Syndrome requires correlation of Bradycardia and sinus pauses with symptoms. […] Asymptomatic Bradycardia alone is insufficient to make the diagnosis of Sick Sinus Syndrome. […] Consider other causes of Sinus Bradycardia. […] Consider Obstructive Sleep Apnea. […] Correlate symptom diary with ambulatory monitoring. […] External Patch Recorder (e.g. Zio monitor) or Holter Monitor. […] Continuous monitoring (Preferred) for 7-14 days. […] Consider repeating if non-diagnostic initially. […] Event Monitor. […] Consider for non-diagnostic Holter Monitor or less frequent symptoms. […] Other EKG testing to consider. […] Electrophysiology (less commonly indicated). […] Exercise Stress Test (if Exercise related). […] Chronotropic incompetence. […] Inadequate Heart Rate response to Exercise (maximum Heart Rate 80% of predicted).

• #21 Sick Sinus Syndrome

  https://mobile.fpnotebook.com/CV/EKG/SckSnsSyndrm.htm

  Sick Sinus Syndrome requires correlation of Bradycardia and sinus pauses with symptoms. […] Asymptomatic Bradycardia alone is insufficient to make the diagnosis of Sick Sinus Syndrome. […] Consider other causes of Sinus Bradycardia. […] Consider Obstructive Sleep Apnea. […] Correlate symptom diary with ambulatory monitoring. […] External Patch Recorder (e.g. Zio monitor) or Holter Monitor. […] Continuous monitoring (Preferred) for 7-14 days. […] Consider repeating if non-diagnostic initially. […] Event Monitor. […] Consider for non-diagnostic Holter Monitor or less frequent symptoms. […] Other EKG testing to consider. […] Electrophysiology (less commonly indicated). […] Exercise Stress Test (if Exercise related). […] Chronotropic incompetence. […] Inadequate Heart Rate response to Exercise (maximum Heart Rate 80% of predicted).

• #22 Sinus Node Dysfunction Workup: Approach Considerations, Electrocardiography, Ambulatory ECG (Holter) Monitoring and Event Recording

  https://emedicine.medscape.com/article/158064-workup

  For patients in whom sinus node dysfunction (SND) is clinically suspected but not confirmed by electrocardiography (ECG) and/or exercise stress test findings, a number of different modalities may be helpful. […] The introduction of the implantable loop monitor has also enhanced the diagnostic yield of the clinical evaluation if symptoms are intermittent, extending over weeks to months. […] No specific imaging studies are required in the initial workup of SND. However, an echocardiogram should be considered because it can document the presence of underlying valvular or ischemic heart disease and may suggest the diagnosis of amyloid when diffuse conduction system findings are present. […] Exercise stress testing helps in identifying abnormal sinus node function. A subnormal increase in heart rate after exercise (ie, chronotropic incompetence) can help identify individuals with SND who may benefit from a pacemaker implantation.

• #23 Sick Sinus Syndrome

  https://mobile.fpnotebook.com/CV/EKG/SckSnsSyndrm.htm

  Common for Sick Sinus Syndrome patients to fail to reach a Maximal Heart Rate over 120 bpm. […] Atrial Bradyarrhythmia (inappropriately). […] Sinus Bradycardia (50 bpm). […] Sinus pauses 3 sec. […] Sinus Arrest. […] May present as Junctional Rhythm or junctional escape beats. […] Sinoatrial Exit Block. […] May be associated with Tachycardia-Bradycardia Syndrome and Supraventricular Tachycardia. […] Second Degree Heart Block (Mobitz Type I or II). […] Atrial Fibrillation with slow ventricular response. […] Tachycardia-Bradycardia Syndrome (present in 50% of Sick Sinus Syndrome cases). […] Alternating Tachycardia-Bradycardia. […] Typically associated with Atrial Fibrillation or Atrial Flutter and higher risk of Cerebrovascular Accident.

• #24 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html

  Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function. […] Diagnosis may be challenging, and is ultimately made by electrocardiographic identification of the arrhythmia in conjunction with the presence of symptoms. […] The diagnosis of sick sinus syndrome requires correlating symptoms of end-organ hypoperfusion with the presence of bradyarrhythmia observed on cardiac monitoring. […] Sick sinus syndrome is diagnosed by correlating symptoms of end-organ hypoperfusion with the occurrence of bradycardia, with or without accompanying tachycardia. […] When 12-lead electrocardiography does not yield a diagnosis, prolonged cardiac monitoring should be considered. […] Although rhythm monitoring is the diagnostic standard, electrophysiologic studies are sometimes useful in the evaluation of sick sinus syndrome.

• #25 Sinus Node Dysfunction Workup: Approach Considerations, Electrocardiography, Ambulatory ECG (Holter) Monitoring and Event Recording

  https://emedicine.medscape.com/article/158064-workup

  The diagnosis of sinus node dysfunction (SND) in patients with suggestive symptoms is often made on the basis of surface electrocardiographic (ECG) features. […] The specificity of a direct observation of spontaneous (ie, not provoked by an electrophysiologic [EP] study) SND is 100%, and an EP study is not required. […] A 24-hour Holter study also has the advantage of revealing whether SND produces symptoms such as dizziness, presyncope, or syncope; these cannot be determined during an EP study, because the patient is heavily sedated. […] Invasive electrophysiologic (EP) studies are rarely used for the evaluation of sinus node dysfunction (SND) because of their limited sensitivity in eliciting bradyarrhythmias as well as due to the widespread availability of diagnostic options for long-term monitoring.

• #26 Sinus Node Dysfunction Workup: Approach Considerations, Electrocardiography, Ambulatory ECG (Holter) Monitoring and Event Recording

  https://emedicine.medscape.com/article/158064-workup

  Classic EP criteria for SND include the presence of 1 or more of the following: Corrected SN recovery time (CSNRT) greater than 275 milliseconds (ms), SA conduction time greater than 200 ms, SA node arrest, SA exit block, SN reentry tachycardia. […] EP studies can document SND when studying SN automaticity by directly recording electrical activity.

• #27 Mayo Clinic Health Library – Sick sinus syndrome | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20377538

  Electrophysiologic (EP) testing. This test, also called an EP study, is rarely used to screen for sick sinus syndrome. However, it may be done to check the function of the sinus node and to evaluate other electrical properties of the heart. […] During an EP study, thin, flexible wires tipped with electrodes are threaded through blood vessels to different areas within the heart. Once in place, the electrodes can map the spread of electrical signals through the heart.

• #28 Sick Sinus Syndrome: Causes, Symptoms, and Treatment

  https://patient.info/doctor/sick-sinus-syndrome

  Sick sinus syndrome is a collection of conditions in which the ECG indicates sinus node dysfunction. […] Sick sinus syndrome is usually caused by idiopathic fibrosis of the sinus node. […] Sick sinus syndrome is most common in the elderly, but can occur in all ages. […] The average age of a person with sick sinus syndrome is 68 years and it develops in 1 in 600 patients with cardiac disease aged over 65 years. […] Blood tests include renal function, electrolytes, TFTs and drug levels (eg, digoxin). […] ECG: arrhythmias associated with sick sinus syndrome include: Atrial bradyarrhythmias: sinus bradycardia, sinus arrest (with or without junctional escape), sinoatrial exit block (Mobitz type I or Mobitz type II block), ectopic atrial bradycardia, atrial fibrillation with slow ventricular response greater than three-second pause following carotid massage, long pause following cardioversion of atrial tachyarrhythmias.

• #29 Sick Sinus Syndrome – Causes, Symptoms, Diagnosis, Treatment & Prevention

  https://www.medindia.net/health/conditions/sick-sinus-syndrome.htm

  Electrophysiological studies are done in cardiac catheterization laboratories. This helps in identifying the type of arrhythmia. They are rarely done to check for sinus node dysfunction and other electrical properties of the heart. […] Blood tests renal function tests, thyroid function tests, electrolytes, serum drug levels (eg digoxin).

• #30 Diagnosis and Treatment of Sick Sinus Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.html

  Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. […] Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. […] The diagnosis of sick sinus syndrome may be difficult because of the slow and erratic course of the syndrome. […] The most common method of diagnosis is Holter monitoring. […] If two 24-hour periods of Holter monitoring fail to reveal the dysrhythmias of sick sinus syndrome, but the symptoms are severe and intermittent, it is likely that the sinus node dysfunction is severe but intermittent. […] The diagnosis requires not only documentation of sinus node dysfunction but also correlation with the associated symptoms of sick sinus syndrome.

• #31 Differential Diagnosis of Vasovagal Syncope: Sick Sinus Syndrome | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-09102-0_15

  Sick sinus syndrome (SSS) can be diagnosed only when there is a clear correlation between symptoms and sinus node (SN) dysfunction. […] The results of some clinical studies, where head-up tilt testing and carotid sinus massage with the method of symptoms were performed in patients with syncope and sinus bradycardia, seem to confirm a reflex mechanism as the cause of syncope in most cases. […] However, a depressed SN automaticity, expressed by much prolonged SN recovery time, suggests a role of SN dysfunction in the origin of syncope. […] Patients with syncope and permanent mild sinus bradycardia, without much prolonged SN recovery time, should be managed as the patients with syncope and normal sinus rate. […] Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. […] An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. […] The natural course of untreated sick sinus syndrome and identification of the variables predictive of unfavorable outcome.

• #32 Sick Sinus Syndrome

  https://mobile.fpnotebook.com/CV/EKG/SckSnsSyndrm.htm

  Sick Sinus Syndrome requires correlation of Bradycardia and sinus pauses with symptoms. […] Asymptomatic Bradycardia alone is insufficient to make the diagnosis of Sick Sinus Syndrome. […] Consider other causes of Sinus Bradycardia. […] Consider Obstructive Sleep Apnea. […] Correlate symptom diary with ambulatory monitoring. […] External Patch Recorder (e.g. Zio monitor) or Holter Monitor. […] Continuous monitoring (Preferred) for 7-14 days. […] Consider repeating if non-diagnostic initially. […] Event Monitor. […] Consider for non-diagnostic Holter Monitor or less frequent symptoms. […] Other EKG testing to consider. […] Electrophysiology (less commonly indicated). […] Exercise Stress Test (if Exercise related). […] Chronotropic incompetence. […] Inadequate Heart Rate response to Exercise (maximum Heart Rate 80% of predicted).

• #33 Sinus node dysfunction – Wikipedia

  https://en.wikipedia.org/wiki/Sinus_node_dysfunction

  Sinus node dysfunction (SND), also known as sick sinus syndrome (SSS), is a group of abnormal heart rhythms (arrhythmias) usually caused by a malfunction of the sinus node, the heart’s primary pacemaker. […] Diagnosing sinus node dysfunction requires clinical symptoms as well as ECG abnormalities. If ECG findings cannot be identified, prolonged cardiac monitoring should be pursued either with a Holter monitor in an outpatient setting or telemetry while inpatient, due to the transient nature of abnormal ECG findings. […] The primary 12-lead electrocardiogram (ECG) finding in sinus node dysfunction is inappropriate sinus bradycardia. Sinus node dysfunction can also present with sudden sinus arrest with or without junctional escape, sinoatrial block, prolonged asystolic period followed by tachycardias, or tachycardia-bradycardia syndrome presenting as various atrial arrhythmias such as atrial fibrillation, flutter, tachycardia, or paroxysmal supraventricular tachycardia.

• #34 Sick Sinus Syndrome

  https://mobile.fpnotebook.com/CV/EKG/SckSnsSyndrm.htm

  Common for Sick Sinus Syndrome patients to fail to reach a Maximal Heart Rate over 120 bpm. […] Atrial Bradyarrhythmia (inappropriately). […] Sinus Bradycardia (50 bpm). […] Sinus pauses 3 sec. […] Sinus Arrest. […] May present as Junctional Rhythm or junctional escape beats. […] Sinoatrial Exit Block. […] May be associated with Tachycardia-Bradycardia Syndrome and Supraventricular Tachycardia. […] Second Degree Heart Block (Mobitz Type I or II). […] Atrial Fibrillation with slow ventricular response. […] Tachycardia-Bradycardia Syndrome (present in 50% of Sick Sinus Syndrome cases). […] Alternating Tachycardia-Bradycardia. […] Typically associated with Atrial Fibrillation or Atrial Flutter and higher risk of Cerebrovascular Accident.

• #35 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] This activity describes the pathophysiology, evaluation, and management of sick sinus syndrome and highlights the role of the interprofessional team in its management. […] The first step in evaluating sinus node dysfunction is to exclude reversible causes such as electrolyte abnormalities, metabolic abnormalities, or uncontrolled sleep apnea, and removal of possible offending medications (e.g., beta-blockers, calcium channel blockers). […] Given the episodic nature of the disease, diagnosis on 12 lead ECG is unusual and prolonged monitoring to detect and document bradycardic episodes is often indicated.

• #36 Sinus Node Dysfunction Differential Diagnoses

  https://emedicine.medscape.com/article/158064-differential

  Conditions to consider in the differential diagnosis of sinus node dysfunction (SND) include the following: […] There are no standardized criteria for establishing a diagnosis of SND, and the initial clues to the diagnosis are most often gleaned from the patients history. However, the symptoms of SND are nonspecific and the electrocardiographic (ECG) findings may not be diagnostic. Hence, the key to making a diagnosis of SND is to establish a correlation between the patient’s symptoms and the underlying rhythm at the time of the symptoms. […] A routine ECG and/or ambulatory ECG monitoring may confirm the diagnosis if typical ECG findings (eg, one or more periods of sinus bradycardia; sinus pause, arrest, and sinoatrial [SA] exit block; or alternating bradycardia and atrial tachyarrhythmias) can be correlated with the symptoms.

• #37 Sinus Node Dysfunction Differential Diagnoses

  https://emedicine.medscape.com/article/158064-differential

  Following a comprehensive history and physical examination, a resting 12-lead ECG, review of previous medical records and ECG tracings, and exercise stress testing are the keys to making a diagnosis of SND and establishing a symptom-rhythm correlation. […] In patients with medication use (eg, beta blockers, calcium channel blockers, digoxin, antiarrhythmics, and acetylcholine esterase inhibitors) suspected to result in symptomatic bradycardia, the patient should remain on an ECG monitor while the medications are withdrawn. If symptoms and ECG abnormalities persist following the withdrawal of the medications (ie, after 3-5 half-lives), then SND/sick sinus syndrome (SSS) may be diagnosed. […] If the diagnosis of SND cannot be definitively diagnosed following a thorough history and physical examination, an initial 12-lead ECG, and/or an ambulatory ECG monitoring [Holter] for 1 to 14 days, perform an event monitor for up to 4 weeks to identify symptomatic episodes of arrhythmias and to monitor average heart rates over extended periods of surveillance.

• #38 Differential Diagnosis of Vasovagal Syncope: Sick Sinus Syndrome | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-09102-0_15

  Sick sinus syndrome (SSS) can be diagnosed only when there is a clear correlation between symptoms and sinus node (SN) dysfunction. […] The results of some clinical studies, where head-up tilt testing and carotid sinus massage with the method of symptoms were performed in patients with syncope and sinus bradycardia, seem to confirm a reflex mechanism as the cause of syncope in most cases. […] However, a depressed SN automaticity, expressed by much prolonged SN recovery time, suggests a role of SN dysfunction in the origin of syncope. […] Patients with syncope and permanent mild sinus bradycardia, without much prolonged SN recovery time, should be managed as the patients with syncope and normal sinus rate. […] Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. […] An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. […] The natural course of untreated sick sinus syndrome and identification of the variables predictive of unfavorable outcome.

• #39 Differential Diagnosis of Vasovagal Syncope: Sick Sinus Syndrome | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-09102-0_15

  Sick sinus syndrome (SSS) can be diagnosed only when there is a clear correlation between symptoms and sinus node (SN) dysfunction. […] The results of some clinical studies, where head-up tilt testing and carotid sinus massage with the method of symptoms were performed in patients with syncope and sinus bradycardia, seem to confirm a reflex mechanism as the cause of syncope in most cases. […] However, a depressed SN automaticity, expressed by much prolonged SN recovery time, suggests a role of SN dysfunction in the origin of syncope. […] Patients with syncope and permanent mild sinus bradycardia, without much prolonged SN recovery time, should be managed as the patients with syncope and normal sinus rate. […] Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome. […] An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. […] The natural course of untreated sick sinus syndrome and identification of the variables predictive of unfavorable outcome.

• #40 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html

  Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function. […] Diagnosis may be challenging, and is ultimately made by electrocardiographic identification of the arrhythmia in conjunction with the presence of symptoms. […] The diagnosis of sick sinus syndrome requires correlating symptoms of end-organ hypoperfusion with the presence of bradyarrhythmia observed on cardiac monitoring. […] Sick sinus syndrome is diagnosed by correlating symptoms of end-organ hypoperfusion with the occurrence of bradycardia, with or without accompanying tachycardia. […] When 12-lead electrocardiography does not yield a diagnosis, prolonged cardiac monitoring should be considered. […] Although rhythm monitoring is the diagnostic standard, electrophysiologic studies are sometimes useful in the evaluation of sick sinus syndrome.

• #41 Sick sinus syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/sick-sinus-syndrome

  Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia. However, the link is often hard to prove. […] An electrocardiogram (ECG) may show abnormal heart rhythms related to this syndrome. […] Holter or longer term rhythm monitors are effective tools for diagnosing sick sinus syndrome. They may pick up very slow heart rates and long pauses, along with episodes of atrial tachycardias. […] An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and may not confirm the diagnosis.

• #42 Sick sinus syndrome | Altru Health System

  https://www.altru.org/health-library/conditions/sick-sinus-syndrome

  Holter monitor. This portable ECG device can be worn for a day or more during daily activities. It automatically records the heart’s activity for 24 to 72 hours. A person wearing a monitor might also keep a diary of symptoms. […] Event recorder. This portable ECG device is intended to be worn for up to 30 days or until you have an irregular heartbeat or symptoms. You typically press a button when symptoms occur. […] Other monitors. Some personal devices, such as smart watches, offer electrocardiogram monitoring. Ask your health care provider if this is an option for you. […] Implantable loop recorder. This small ECG device is implanted just under the skin of the chest. It’s used for continuous, long-term monitoring of the heart’s electrical activity, particularly for people who have infrequent symptoms. […] This test, also called an EP study, is rarely used to screen for sick sinus syndrome. However, it may be done to check the function of the sinus node and to evaluate other electrical properties of the heart.

• #43 Diagnosis and Treatment of Sick Sinus Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0415/p1725.html

  These measures and monitoring cardiac response to such agents as atropine and isoproterenol (Isuprel) should only be attempted while a patient is undergoing careful ECG monitoring. […] The treatment of choice for symptomatic bradyarrhythmias in patients with sick sinus syndrome is the placement of a pacemaker. […] Pacemaker therapy is warranted in many patients with sick sinus syndrome. […] It is essential to document symptoms concurrent with the dysrhythmia when evaluating whether pacemaker placement will be beneficial. […] The risks and benefits of these diagnostic modalities must be considered and discussed with the patient before they are used.

• #44 Sick Sinus Syndrome: Symptoms, Causes and Treatment.

  https://my.clevelandclinic.org/health/diseases/21789-sick-sinus-syndrome

  Any medical procedure has the possibility of complications. […] Sick sinus syndrome usually keeps getting worse slowly over many years, but some people never end up with other health issues connected to sick sinus syndrome. […] A pacemaker can help your symptoms and give you a better quality of life, but it may not extend your life expectancy. […] Contact your provider if you have sick sinus syndrome symptoms listed above or if you have a problem with your pacemaker. […] Since sick sinus syndrome usually gets worse over many years, its important to keep your appointments with your provider.

• #45 Sick Sinus Syndrome: Causes, Symptoms, and Treatment

  https://patient.info/doctor/sick-sinus-syndrome

  The treatment of choice for symptomatic bradyarrhythmias in patients with sick sinus syndrome is the placement of a pacemaker. […] Dual-chamber pacemakers provide effective relief of symptoms and lower the incidence of atrial fibrillation, thromboembolic events, heart failure and mortality, when compared with ventricular pacemakers. […] Patients with sick sinus syndrome who have tachy-brady syndrome or chronic atrial fibrillation are at risk for embolic cerebrovascular event.

• #46 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html

  The rhythm abnormalities of sick sinus syndrome occasionally are detected or suspected as an incidental finding during evaluation and treatment of other cardiac conditions. […] Permanent pacemaker placement is recommended only in patients with symptomatic sick sinus syndrome and documented bradycardia; it is the only effective treatment for chronic symptomatic sick sinus syndrome that is not caused by correctable extrinsic factors. […] Pacemaker therapy has not been shown to affect survival rates in this population.

• #47 Sick Sinus Syndrome: Symptoms, Causes and Treatment.

  https://my.clevelandclinic.org/health/diseases/21789-sick-sinus-syndrome

  Any medical procedure has the possibility of complications. […] Sick sinus syndrome usually keeps getting worse slowly over many years, but some people never end up with other health issues connected to sick sinus syndrome. […] A pacemaker can help your symptoms and give you a better quality of life, but it may not extend your life expectancy. […] Contact your provider if you have sick sinus syndrome symptoms listed above or if you have a problem with your pacemaker. […] Since sick sinus syndrome usually gets worse over many years, its important to keep your appointments with your provider.

• #48 Sinus node dysfunction – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/sinus-node-dysfunction/

  Sinus node dysfunction (SND), previously called sick sinus syndrome, is an abnormality in sinoatrial (SA) node action potential generation or conduction. Establishing a temporal correlation between symptoms of bradycardia and rhythm abnormalities of SND (e.g., on ECG, stress testing, cardiac monitoring) confirms the diagnosis. The identification of a temporal correlation between symptoms of bradycardia and rhythm abnormalities of SND is considered the gold standard for diagnosing SND. In hemodynamically unstable patients, start immediate treatment for unstable bradycardia without waiting for diagnostic confirmation. Correlate symptoms with rhythm abnormalities of SND. Obtain 12-lead ECG. Inconclusive ECG findings: Perform ambulatory cardiac monitoring. Symptoms on exertion: Perform exercise stress test. Evaluate for an underlying cause. Evaluate all patients for reversible causes of SND: including medication review, BMP, HbA1c, thyroid function tests. Obtain additional studies (e.g., nocturnal polysomnography, TTE) as needed. The preferred initial diagnostic study: 12-lead ECG. Supportive findings: The presence of any of the following rhythm abnormalities of SND with accompanying symptoms of end-organ hypoperfusion is diagnostic of SND.

• #49 Sinus Node Dysfunction Differential Diagnoses

  https://emedicine.medscape.com/article/158064-differential

  Following a comprehensive history and physical examination, a resting 12-lead ECG, review of previous medical records and ECG tracings, and exercise stress testing are the keys to making a diagnosis of SND and establishing a symptom-rhythm correlation. […] In patients with medication use (eg, beta blockers, calcium channel blockers, digoxin, antiarrhythmics, and acetylcholine esterase inhibitors) suspected to result in symptomatic bradycardia, the patient should remain on an ECG monitor while the medications are withdrawn. If symptoms and ECG abnormalities persist following the withdrawal of the medications (ie, after 3-5 half-lives), then SND/sick sinus syndrome (SSS) may be diagnosed. […] If the diagnosis of SND cannot be definitively diagnosed following a thorough history and physical examination, an initial 12-lead ECG, and/or an ambulatory ECG monitoring [Holter] for 1 to 14 days, perform an event monitor for up to 4 weeks to identify symptomatic episodes of arrhythmias and to monitor average heart rates over extended periods of surveillance.

• #50 Sick Sinus Syndrome: What It Is, Symptoms, Causes

  https://www.verywellhealth.com/sick-sinus-syndrome-7569324

  Sick sinus syndrome (SSS), also known as sinus node dysfunction, describes a group of problems that affect your heart rhythm. […] This article describes everything you need to know about sick sinus syndrome. It includes SSS types, causes, risk factors, symptoms, diagnosis, treatment, and outlook. […] Diagnosing sick sinus syndrome can be a challenge. Symptoms often resemble other types of heart problems, so finding their cause can require more than one type of evaluation. Symptoms may also be mild and intermittent, occurring well before people seek care. […] A diagnosis of sinus node dysfunction is reached when cardiac monitoring links your symptoms to bradyarrhythmia. Reaching this diagnosis can involve the following evaluations: Medical history and physical examination, Medication review to assess for potential drug-related causes, Basic chemical panel (blood test) and other laboratory tests needed to identify metabolic abnormalities such as hypothyroidism that may be the source of symptoms.

• #51 Sick sinus syndrome – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/sick-sinus-syndrome/

  Sick sinus syndrome can occur at any age, but it’s most common in people in their 70s or older. […] Your doctor will perform a physical exam and ask questions about your symptoms and medical history. […] Symptoms of sick sinus syndrome — such as dizziness, shortness of breath and fainting — only occur when the heart is beating abnormally. You may not have symptoms at the time of your doctor’s appointment. […] To determine if your symptoms are related to problems with the sinus node and heart function, your doctor may use the following tests: […] Electrocardiogram (ECG). During this test, sensors (electrodes) are attached to your chest and legs to create a record of the electrical signals traveling through your heart. The test might show patterns that indicate sick sinus syndrome, including a fast heart rate, slow heart rate or long pause in the heartbeat after a fast heart rate.

• #52 Diagnosis and treatment of sick sinus syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12725451/

  Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. […] Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor.

• #53 Sinus Node Dysfunction Differential Diagnoses

  https://emedicine.medscape.com/article/158064-differential

  Following a comprehensive history and physical examination, a resting 12-lead ECG, review of previous medical records and ECG tracings, and exercise stress testing are the keys to making a diagnosis of SND and establishing a symptom-rhythm correlation. […] In patients with medication use (eg, beta blockers, calcium channel blockers, digoxin, antiarrhythmics, and acetylcholine esterase inhibitors) suspected to result in symptomatic bradycardia, the patient should remain on an ECG monitor while the medications are withdrawn. If symptoms and ECG abnormalities persist following the withdrawal of the medications (ie, after 3-5 half-lives), then SND/sick sinus syndrome (SSS) may be diagnosed. […] If the diagnosis of SND cannot be definitively diagnosed following a thorough history and physical examination, an initial 12-lead ECG, and/or an ambulatory ECG monitoring [Holter] for 1 to 14 days, perform an event monitor for up to 4 weeks to identify symptomatic episodes of arrhythmias and to monitor average heart rates over extended periods of surveillance.

• #54 Sick sinus syndrome diagnosed after a sinus arrest during treatment for zygomatic fracture: a case report | BMC Oral Health | Full Text

  https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-023-03413-0

  This is the first report of an injury limited to the maxillofacial region leading to a diagnosis of sick sinus syndrome. […] If cardiogenic syncope remains undiagnosed and untreated, it may cause death or new trauma due to repeated syncope, making diagnosis of the cause of syncope extremely important.

• #55 Sick sinus syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/sick-sinus-syndrome/

  Sick sinus syndrome (also known as sinus node dysfunction) is a group of related heart conditions that can affect how the heart beats. „Sick sinus” refers to the sino-atrial (SA) node, which is an area of specialized cells in the heart that functions as a natural pacemaker. The SA node generates electrical impulses that start each heartbeat. These signals travel from the SA node to the rest of the heart, signaling the heart (cardiac) muscle to contract and pump blood. In people with sick sinus syndrome, the SA node does not function normally. In some cases, it does not produce the right signals to trigger a regular heartbeat. In others, abnormalities disrupt the electrical impulses and prevent them from reaching the rest of the heart. […] Sick sinus syndrome occurs most commonly in older adults, although it can be diagnosed in people of any age. The condition increases the risk of several life-threatening problems involving the heart and blood vessels. These include a heart rhythm abnormality called atrial fibrillation, heart failure, cardiac arrest, and stroke.

• #56 Sick Sinus Syndrome: What It Is, Symptoms, Causes

  https://www.verywellhealth.com/sick-sinus-syndrome-7569324

  Electrocardiography tests are also uses and include the following: (ECG or EKG) Electrocardiogram: A noninvasive diagnostic test that uses flat metal electrodes placed on your chest to evaluate the electrical activity of your heart during beating, Echocardiogram: A noninvasive ultrasound imaging test used to observe your heart and diagnose any structural defects, Holter monitor: A monitor worn externally as you go about your day that records the electrical activity of your heart for a period of 24 or 48 hours, and sometimes for several weeks, to evaluate any cardiac arrhythmias that may have occurred during the monitoring period. […] Getting the right diagnosis can help reduce your risk of problems with sick sinus syndrome. For most people with SSS, getting a pacemaker can improve their quality of life and long-term outlook.

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