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Sick Sinus Syndrome

Aka: Sick Sinus Syndrome, Tachycardia-Bradycardia Syndrome, Bradycardia-Tachycardia Syndrome
  1. Definition
    1. Disorder interfering with sinus node pacing function
  2. Causes
    1. Elderly (mean age 68 years old)
      1. Dysfunction associated with aging
      2. Most cases are idiopathic
      3. Structural heart disease
      4. Myocardial Ischemia (<33% of patients)
    2. Children
      1. Follows Congenital Heart Disease surgical correction
      2. Congenital abnormalities or SA node artery deficiency
  3. Associated Conditions
    1. Atrial Fibrillation
    2. Atrioventricular Node Block
  4. Symptoms (associated with sinus pause or Bradycardia)
    1. Palpitations or Angina Pectoris
    2. Fatigue
    3. Confusion or Altered Level of Consciousness
    4. Syncope
    5. Exercise intolerance
    6. Dizziness
  5. Signs: Monitor rhythm while performing procedures
    1. Valsalva response absent or minimal (no pulse increase)
    2. Carotid message induces Sinus Arrest >3 seconds
  6. Diagnostics: EKG Monitoring
    1. Correlate symptom diary with ambulatory monitoring
      1. Event Monitor or
      2. Holter Monitor for two 24 hour periods
    2. Atrial Bradyarrhythmia (inappropriately)
      1. Sinus Bradycardia
      2. Sinus Arrest
      3. Second Degree Heart Block (Mobitz Type I or II)
      4. Atrial Fibrillation with slow ventricular response
    3. Tachycardia (Tachycardia-Bradycardia Syndrome)
      1. Tachycardia alternates with Bradycardia
      2. Associated with Atrial Fibrillation or Atrial Flutter
    4. Other EKG testing to consider
      1. Exercise Stress Test
      2. Electrophysiology (less commonly indicated)
  7. Differential Diagnosis
    1. Hypothyroidism
    2. Hypothermia
    3. Hypoxia
    4. Hyperkalemia
    5. Cardiomyopathy
    6. Collagen vascular disease
    7. Metastatic cancer
    8. Medications
      1. Digoxin
      2. Quinidine
      3. Amiodarone
      4. Beta Blockers
      5. Diltiazem
      6. Verapamil
      7. Clonidine
  8. Complications
    1. Thromboembolism
    2. Myocardial Infarction
    3. Congestive Heart Failure
    4. Cerbebrovascular Accident
  9. Management
    1. Permanent implantable demand ventricular Pacemaker
      1. Sick Sinus Syndrome accounts for >50% pacers placed
    2. Tachyarrhythmia control (use only with Pacemaker)
      1. Beta Blocker
      2. Calcium Channel Blocker
      3. Digoxin
    3. Anticoagulation with Coumadin
      1. See Anticoagulation in Atrial Fibrillation
      2. Indications
        1. Atrial Fibrillation
        2. Tachycardia-Bradycardia Syndrome
  10. Prognosis
    1. Best prognosis with Sinus Bradycardia only
  11. References
    1. Faddis in Ahya (2001) Washington Manual, p. 153
    2. Behrman (2000) Nelson Pediatrics, p. 1422-3
    3. Wagner (2001) Marriott's Electrocardiography, p. 402
    4. Adan (2003) Am Fam Physician 67(8):1725-38

Bradycardia-tachycardia syndrome (C0221047)

Concepts Disease or Syndrome (T047)
ICD10 I49.5
SnomedCT 74615001
English BRADY-TACHY SYNDROME, BRADYCARDIA-TACHYCARDIA SYNDROME, Tachycardia-bradycardia syndrome, Bradycardia-tachycardia syndrome, tachy-brady syndrome, Bradycardia-tachycardia synd, tachycardia bradycardia, bradycardia tachycardia syndrome, brady-tachy syndrome, bradycardia-tachycardia syndrome, Tachycardia-bradycardia, Brady-tachy syndrome, Tachycardia-bradycardia (disorder), syndrome; tachycardia-bradycardia, tachycardia-bradycardia syndrome, tachycardia-bradycardia; syndrome, Syndrome, tachycardia-bradycardia
Dutch bradycardie-tachycardiesyndroom, syndroom; tachycardie-bradycardie, tachycardie-bradycardie; syndroom
French Syndrome de bradycardie-tachycardie
German Bradykardie-Tachykardie-Syndrom
Italian Sindrome bradi-tachicardica
Portuguese Síndrome de bradicardia-taquicardia
Spanish Síndrome de bradicardia-taquicardia, taquicardia - bradicardia (trastorno), taquicardia - bradicardia
Japanese 徐脈頻脈症候群, ｼﾞｮﾐｬｸﾋﾝﾐｬｸｼｮｳｺｳｸﾞﾝ
Czech Bradykardicko-tachykardický syndrom
Hungarian Bradycardia-tachycardia syndroma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Sick Sinus Syndrome (C0037052)

Definition (NCI) A constellation of signs and symptoms which may include syncope, fatigue, dizziness, and alternating periods of bradycardia and atrial tachycardia, which is caused by sinoatrial node dysfunction. (NCI)
Definition (NCI) A disorder characterized by a dysrhythmia with alternating periods of bradycardia and atrial tachycardia accompanied by syncope, fatigue and dizziness.
Definition (NCI) A constellation of signs and symptoms which may include syncope, fatigue, dizziness, and alternating periods of bradycardia and atrial tachycardia, which is caused by sinoatrial node dysfunction.
Definition (MSH) A condition caused by dysfunctions related to the SINOATRIAL NODE including impulse generation (CARDIAC SINUS ARREST) and impulse conduction (SINOATRIAL EXIT BLOCK). It is characterized by persistent BRADYCARDIA, chronic ATRIAL FIBRILLATION, and failure to resume sinus rhythm following CARDIOVERSION. This syndrome can be congenital or acquired, particularly after surgical correction for heart defects.
Concepts Disease or Syndrome (T047)
MSH D012804
ICD10 I49.5
SnomedCT 36083008, 155373001, 266307005
English Syndrome, Sick Sinus, SICK SINUS SYNDROME, SYNDROME SICK SINUS, Sick Sinus Syndrome, sick sinus syndrome, sick sinus syndrome (diagnosis), Sick Sinus Node Syndrome, Syndrome sick sinus, SSS, Sick Sinus Syndrome [Disease/Finding], sick syndrome sinus, sinus sick syndrome, Sick sinus syndrome, Sick sinus syndrome (disorder), sick sinus; syndrome, syndrome; sick sinus, Syndrome, sick sinus
Italian Sindrome del seno malato, Malattia del nodo del seno, Sick sinus syndrome, Sindrome bradicardia-tachicardica, Sindrome del nodo del seno
Spanish Síndrome del seno enfermo, Sick sinus syndrome, Sindrome del Seno Enfermo, Sindrome del Nodo Sinusal, Sindrome del Nodo Sino-Atrial, Síndrome del Seno Enfermo, Síndrome del Nodo Sinoatrial, Síndrome del Nodo Sino-Atrial, Sindrome del Nodo Sinoatrial, Síndrome Bradicardia-Taquicardia, Síndrome del Nodo Sinusal, Sindrome Bradicardia-Taquicardia, SINDROME DEL NODO SINUSAL ENFERMO, síndrome de disfunción sinusal (trastorno), síndrome de disfunción sinusal, síndrome del seno enfermo, Síndrome del nodo sinusal enfermo
Swedish Sjuka sinus-syndrom
Japanese ﾄﾞｳﾌｾﾞﾝｼｮｳｺｳｸﾞﾝ, 静脈洞機能不全症候群, 洞不全症候群, 徐脈-頻脈症候群, 徐脈頻脈症候群, 洞機能不全症候群, 病的洞結節症候群
Czech sick sinus syndrom, Syndrom chorého sinu, Sick sinus syndrom, syndrom chorého sinu, syndrom nemocného sinusového uzlu
Portuguese Síndrome do Nó Sinoatrial, Síndrome do Seio Enfermo, Síndrome do Seio Doente, Síndrome do Nó Sinusal, Síndrome Bradicardia-Taquicardia, DOENCA DO NO SINUSAL, Síndrome do nódulo sinusal
Finnish Sairas sinus -oireyhtymä
French Maladie rythmique auriculaire, Maladie du noeud sinusal, Maladie de l'oreillette, Syndrome de brady-tachycardie, MRA (Maladie Rythmique Auriculaire), MALADIE DU SINUS, Maladie du sinus, Syndrome de bradycardie-tachycardie, Syndrome de dysfonctionnement sinusal
Russian SINUSNOGO UZLA SINDROM SLABOSTI, SINUSNO-PREDSERDNOGO UZLA SLABOSTI SINDROM, СИНУСНОГО УЗЛА СИНДРОМ СЛАБОСТИ, СИНУСНО-ПРЕДСЕРДНОГО УЗЛА СЛАБОСТИ СИНДРОМ
German SICK SINUS SYNDROM, Sick-Sinus Syndrom, Sick-Sinus-Syndrom, Sinusknoten-Syndrom, Syndrom des kranken Sinusknotens
Korean 굴기능부전 증후군
Polish Zespół chorej zatoki, Zespół tachy-brady, Choroba węzła zatokowo-przedsionkowego, Niewydolność węzła zatokowego, Zespół chorego węzła zatokowego
Hungarian Sick-sinus-syndroma, Sinus csomó syndroma
Dutch sick sinus; syndroom, syndroom; sick sinus, sick-sinus syndrome, Sick sinus syndrome, Syndrome, sick sinus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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