Sick sinus syndrome

Diagnosis

The diagnosis of sick sinus syndrome starts from history taking about signs and symptoms, reviewing the medical history, physical examination, and further investigation can be confirmed by the following tests:

• Electrocardiogram (ECG or EKG). The heart’s electrical activity is assessed using this test. Legs and chest are equipped with sensors (electrodes). The sensors are connected to a computer by wires, which displays or prints the results. The rate of heartbeat can be determined via an ECG. In order to ascertain whether sick sinus syndrome is present, the doctor might examine signal patterns.
• Holter monitor. Wearing this portable ECG device throughout the day is possible for up to a day. For 24 to 72 hours, the heart’s activity is automatically recorded. A person who wears a monitor may additionally record their symptoms in a diary.
• Event recorder. This portable ECG device should be worn for up to 30 days, or until you have symptoms or an abnormal heartbeat. Typically, when symptoms appear, you have to press the button.
• Other monitors. Smart watches and other personal gadgets provide electrocardiogram monitoring. Find out if this is a possibility for you by speaking with your doctor.
• Implantable loop recorder. This tiny ECG device is inserted into the chest just beneath the skin. It is used to continuously and repeatedly monitor the electrical activity of the heart, especially in those who rarely sometimes experience symptoms.
• Electrophysiologic (EP) testing. An EP study test is scarcely used to determine sick sinus syndrome. It might be carried out, nonetheless, to examine the sinus node’s operation and the heart’s other electrical characteristics.

Thin, flexible wires with electrode tips are run into blood vessels to various locations within the heart during an EP examination. The electrodes can map the distribution of electrical signals throughout the heart once they are in place.

When the heart is beating irregularly, sick sinus syndrome symptoms such as lightheadedness, shortness of breath, and fainting, happen. On the day of the appointment, you might not be experiencing any symptoms.

Treatment

Treatment for sick sinuses syndrome aims to reduce or eliminate symptoms.
Among the possible treatments for sick sinus syndrome are:

• Routine checkups
• Medications
• Catheter procedures
• Implanting a device through surgery to keep the heartbeat regular (pacemaker)

Your doctor may normally advise routine checks to monitor your condition if you don’t have any symptoms. The majority of those with symptoms require surgery to install a device that keeps a normal heartbeat (pacemaker).

Medications

Some drugs, such as those prescribed for heart disease or high blood pressure, may impair sinus node function. Your doctor will probably review the medications you have already taken and may decide to change them or prescribe new ones. It may be necessary to use medications to stop or slow down rapid heartbeats.

If sick sinus syndrome is accompanied with atrial fibrillation or other abnormal heart rhythms linked to stroke, blood-thinners (anticoagulants) such as warfarin, dabigatran, or others may be administered.

Surgeries or other procedures

Most sick sinus syndrome patients eventually require a permanent device to regulate their heart rhythm (pacemaker). A pacemaker is a tiny, battery-operated device that is inserted through a small incision near the collarbone. To maintain the heart beating consistently, the pacemaker stimulates (paces) it as necessary.

The choice to implant a pacemaker if sick sinus syndrome symptoms are mild or uncommon will be depended on the ECG findings, your general health, and the possibility of more serious issues.

The kind of irregular heart rhythm you have will determine the type of pacemaker you require. Various pacemaker types include:

• Single chamber pacemaker. This kind often sends electrical impulses to the heart’s right lower chamber (ventricle).
• Dual chamber pacemaker. This type paces the right atrium separately from the right lower cardiac chamber (ventricle). Dual-chamber pacemakers are beneficial for the majority of patients with sick sinus syndrome.
• Biventricular pacemaker. Cardiovascular resynchronization treatment, commonly known as biventricular pacing, is used to treat patients with heart failure and irregular heartbeats. The right and left ventricles of the heart are stimulated by this kind of pacemaker to increase the heart’s efficiency.

After receiving a pacemaker, if your heart rate is still irregular, you may need medication, or a catheter-based surgery called cardiac ablation to regulate or control it. In order to block bad impulses and reestablish a regular heartbeat, cardiac ablation uses heat or cold energy to form microscopic scars inside the heart. Most frequently, catheters—thin, flexible tubes—that are put through veins or arteries are used. Ablation is occasionally carried out during cardiac surgery. Pacemaker users frequently undergo AV node ablation, a form of cardiac ablation, to manage their rapid heartbeats.