Sick sinus syndrome is a disorder of the sinus node of the heart, which regulates heartbeat. With sick sinus syndrome, the sinus node fails to signal properly, resulting in changes in the heart rate.
Description
The sinus node in the heart functions as the heart's pacemaker, or beat regulator. In sick sinus syndrome, patients normally will experience bradycardia, or slowed heart rate. Also, it is not uncommon to see fluctuations between slow and rapid heart rate (tachycardia). This makes the diagnosis and treatment of sick sinus syndrome more complicated than most other cardiac arrhythmias (irregular heart beats). A sick sinus node may be responsible for starting beats too slowly, pausing too long between initiation of heartbeats, or not producing heartbeats at all.
Causes and symptoms
Sick sinus syndrome may be brought on by the use of certain drugs, but is most common in elderly patients. Cardiac amyloidosis, a condition in which amyloid, a kind of protein, builds up in heart tissue, may affect the sinus node. Other conditions, such as sarcoidosis (round bumps in the tissue surrounding the heart and other organs), Chagas' disease (resulting from the bite of a bloodsucking insect) or certain cardiac myopathies can cause fiber-like tissue to grow around the normal sinus node, causing the node to malfunction.
A patient may not show any symptoms of sick sinus syndrome. In general, however, the common symptoms are those associated with slow heart rate, such as light-headedness, or dizziness, fatigue and fainting. Patients may also experience confusion, heart palpitations, angina or heart failure.
Diagnosis
A slow pulse, especially one that is irregular, may be the first indication of sick sinus syndrome. Electrocardiography (ECGs) is a commonly used method of detecting sick sinus syndrome. ECG monitoring for 24 hours is most useful, since with this syndrome, heart rate may alternate between slow and fast, and the determination of this fact can help differentiate sick sinus syndrome from other arrhythmias.
Treatment
If drugs are causing the problem, their withdrawal may effectively eliminate the disorder. However, the treatment of sick sinus syndrome is normally delayed until a patient shows symptoms. Once treatment is indicated, most patients will receive a pacemaker. This is a permanent treatment involving implantation of a small device under the skin below the collarbone. Small electrodes run from the device to the heart; they deliver and regulate the electrical signals that cause the heart to beat. Patients with sick sinus syndrome should generally receive dual chamber pacing systems to prevent atrial fibrillation (involuntary contraction of the muscles of the atria). Some drugs are used to treat sick sinus syndrome, but digitalis should be used with caution. Often the use of drugs to regulate the heartbeat should be implemented only after the pacemaker has been placed, since these drugs may further worsen the slow heart rate.
Alternative treatment
The reduction or elimination of certain foods and substances, such as alcohol or caffeine, may be advised to control heart rate. Stress reduction may also assist with changes in rate. Homeopathic treatment can work on a deep healing level, while acupuncture and botanical medicine can offer supportive treatment for symptoms.
Prognosis
Patients with sick sinus syndrome face relatively normal lives if the disorder is controlled by a pacemaker. However, in some patients, the pacemaker does not adequately control the fluctuations in heart rate. Left untreated, or in severe cases, the heart could stop beating.
Prevention
Elimination of a drug therapy which aggravates sick sinus syndrome is the first line of treatment for some patients. Other causes of the syndrome are not preventable. However, proper treatment of those underlying conditions which affect the tissues of the heart may intervene to prevent sick sinus syndrome from becoming a significant problem.
BOOKS
Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.
National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. <http://www.nhlbi.nih.gov>.
Teresa Norris, RN
KEY TERMS
Arrhythmia—Irregular heart beat.
Atria—Plural for atrium. The atria are the upper chambers of the heart.
Bradycardia—A heart rate slower than normal.
Electrocardiograph (ECG)—A test of a patient's heartbeat that involves placing leads, or detectors, on the patient's chest to record electrical impulses in the heart. This test will produce a strip, or picture record of the heart's electrical functioning.
Myopathy—Weakness of muscle.
Pacemaker—A device implanted under the skin, below the collarbone, to regulate heartbeat. Leads from the device to the heart stimulate the electrical functions of the heart. Pacemakers are often used to control bradycardia and are usually smaller than a silver dollar.
