sick sinus syndrome

sick sinus syndrome

1. definition

   • a group of heart rhythm problems (arrhythmias) in which the sinus node doesn't work properly.

2. sinus node

   • specialized cells which have the ability to spontaneously produce action potential.

3. signs and symptoms

   • dizziness
   • angina
   • abnormal pulse
     • rate
       • tachycardia
       • bradycardia
     • rhythm
       • Regularly irregularly
         • Second degree atrioventricular block • Sinus arrhythmia
       • Irregularly irregular
         • Atrial Fibrillation Multiple ectopics
       • Occasionally irregular
         • Extrasystole
     • volume
       • High
         • physiological: Exercise\ Pregnancy Advanced Age
         • pathological: Arteriosclerosis \ Aortic regurgitation\ Arteriovenous fistula
       • Low
         •  LeftVentricular Failure\  Hypovolemia\  Peripheral arterial disease
       •  Varying
         • Atrial fibrillation\ VentricularTachycardia
     • character
       • Slow rising 
         • severe aortic stenosis
       • Anacrotic
         • Aortic Stenosis
       • Dicrotic
         • Cardiac Tamponade
   • fainting & fatigue
   • Unconsciousness
     • nervous causes
       • Traumatic brain injury
       • Brain hypoxia
       • Poisoning
       • Anaesthesia
     • pulmonary causes
       • asthma
       • Respiratory arrest
     • metabolic causes
       • Hyper/hypoglycaemia
       • hepatic failure
       • hypopituitarism
       • Myxoedema
     • cardiac causes
       • Electrical problems
       • ventricular fibrillation
       • cardiac arrest
       • coronary artery disease
       • heart attack
       • congenital heart disease

4. idiopathic cause (degeneration&fibrosis of SA-N)

5. diagnosis

   • ECG (findings)
     • Inappropriate sinus bradycardia
     • Sinus arrest
     • Sinoatrial block
     • Atrial fibrillation
     • Tachy-Brady Syndrome
   • Electrophysiologic testing
     • check the function of the sinus node

6. Treatment

   • anti-arrhythmic drugs
     • Amiodarone
       • Vasodilator and cardiac depressant. Prolong AP duration.
       • ADRS: Cardiac: heart block, hypotension, bradycardia, pneumonitis.

7. CPR

   • Airway
     • clear the airway
   • compression
     • restore blood circulation
   • Breathing
     • provide breathe for the person

8. conduction system

9. Arrhythmia

   • tachy-arrhythmia
     • abnormally fast rhythms (Heart rate > 100 beat/min).
   • brady-arrhythmia
     • abnormally slow rhythms (heart rate < 60 beat/min)

10. management

    • pacemaker
      • Dual-chamber pacemaker
      • Biventricular pacemaker
      • Single-chamber pacemaker
    • implantable cardioverter defibrillator
      • It is a battery-powered device that is placed under the skin which keeps tracking the heart rate.

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