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Sick Sinus Syndrome Treatment in Delhi, India
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Sick Sinus Syndrome, also known as sinus node dysfunction, is a disease in which the heart's natural pacemaker (usually located in the right atrium) is damaged and dysfunctional. The right atrium is situated in the upper right heart chamber of the heart and is responsible for maintaining the heartbeat at an average rate. It may result from medical conditions that damage the sinoatrial node (SA node) over time or from prolonged effects of certain medicines.
The sinus node is an area in the heart's upper right chamber that controls the heartbeat. Usually, the sinus node creates a steady pace of electrical impulses—the pace changes depending on the activity, emotional state, rest, and many other factors.
The electrical signals in sick sinus syndrome are paced abnormally. The heartbeat may be too fast, slow, or interrupted by long pauses. It can also present as an alternating combination of the above-listed rhythm issues. These arrhythmias may cause palpitations and tissue under-perfusion leading to fatigue, light-headedness, pre-syncope, and syncope. It is relatively uncommon, but the risk of developing it increases with age. Many people may eventually require a pacemaker to keep the heart in a regular rhythm.
Sick Sinus Syndrome Symptoms
Sick sinus syndrome may or may not present clinical symptoms. In case it does, symptoms include:
- Dizziness due to lack of adequate blood supply to the brain.
- Fainting
- Shortness of breath, especially on exertion: reduced overall blood supply to vital organs due to the dysfunctional sinoatrial node.
- Heart palpitations
- Chest pain
Sick Sinus Syndrome Causes
Conditions responsible for damaging the heart can also affect the SA node. These conditions include:
- Ageing (70 years)
- Coronary artery disease
- Heart failure or Cardiomyopathy
- Atrial fibrillation
- Medicines such as beta-blockers, digoxin, calcium channel blockers, antiarrhythmics
- Severe hypothyroidism
- Inflammatory conditions that involve the heart, such as rheumatic fever, myocarditis, Chagas disease, pericarditis
- Infiltrative heart diseases like sarcoidosis, scleroderma, amyloidosis, hemochromatosis
- Electrolyte abnormalities such as high potassium levels
- Rare familial disease
- Trauma
Hypothyroidism, hypothermia, and electrolyte problems are usually reversible.
Complications of the sinus node may include
- Sinus bradycardia: The sinus node produces an electrical charge at a rate slower than usual.
- Sinus arrest: The signals from the sinus node pause, resulting in skipped beats.
- Chronotropic incompetence: The heart rate at rest is normal but does not increase with physical activity.
- Bradycardia-tachycardia syndrome: The heart rate alternates between abnormally slow and fast rhythms, usually with a long pause (asystole) between heartbeats.
Sick Sinus Syndrome Diagnosis
The doctor could conduct a physical examination and ask questions about the persisting symptoms and in-depth medical history.
Some symptoms of sick sinus syndrome, such as dizziness, shortness of breath, and fainting, occur when the heart beats abnormally. One may be asymptomatic at the time of appointment.
To determine if the symptoms are related to problems with the sinus node and heart function, the doctor may advise the following tests:
- Electrocardiogram (ECG): Sensors or electrodes are attached to the chest and legs to record the electrical signals travelling through the heart. The test may record patterns that may indicate sick sinus syndrome, including a slow heart rate, fast heart rate or prolonged pause in the heartbeat after a rapid heart rate.
- Holter monitor: A portable ECG device carried in the pocket, belt, or shoulder strap pouch. It automatically records the activities of the heart for about 24 to 72 hours to assess the heart's rhythms for a prolonged period.
- Event recorder: A portable ECG device may be worn for up to a month. It enables the doctor to correlate symptoms and heart rhythm. A button is pushed on experiencing symptoms, and a brief ECG recording is saved.
- Other monitors: Certain personal devices like smartwatches may also offer electrocardiogram monitoring. One may consult the doctor if this is a suitable option.
- Implantable loop recorder: This small ECG device is implanted just under the chest skin. It monitors the heart's electrical activity continuously, particularly if a patient has infrequent symptoms.
- Electrophysiologic Testing: Electrophysiologic testing is a rarely used test to screen for sick sinus syndrome. In some cases, it can help assess the function of the sinus node and other electrical functions of the heart. During this test, thin, flexible tubes, known as catheters, are tipped with electrodes and are threaded through the blood vessels to different places along the electrical pathways in the heart. Once in place, the electrodes allow precise mapping of the spread of electrical impulses during each beat. It can help identify the source of heart rhythm problems.
Sick Sinus Syndrome Treatment
Sick sinus syndrome may present without symptoms. However, if the patient is symptomatic and requires treatment, the following are the available options:
- Change in medications: The doctor may change existing medicines that may be contributing to sick sinus syndrome.
- Pacemaker: Implanting a pacemaker is the most common treatment modality for patients with symptoms that do not have an identifiable reversible cause. Pacemakers are small, battery-operated devices that replace the SA node and regulate heart rate. It is placed under the skin of the chest under a minor surgical procedure. Wires are placed within the heart to monitor heart rate and stimulate heartbeats when needed.
Sick Sinus Syndrome Complications
When the heart's natural pacemaker does not work properly, the heart cannot function normally. This may lead to:
- Failure of the heart
- Stroke
- Cardiac arrest
Prognosis
Patients with sick sinus syndrome have a poor prognosis; the 5-year survival rate is about 45 to 70%. However, it is unclear whether the mortality rate is because of factors intrinsic to the sinus node or the concomitant heart disease.
Reviewed & Updated On
Reviewed by Dr. Arun Kumar Gupta, Associate Director, Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker, Interventional Cardiology on 29-May-2023.
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