Sick Sinus Syndrome

Sick sinus syndrome (SSS) is a general name for a group of disorders caused by a malfunctioning sinus node. The sinus node acts as a pacemaker inside the heart. Sinus rhythm (the normal beating of the heart) is controlled by electrical impulses from the sinus node. Without the right impulses, the heart cannot beat properly.

Sick sinus syndrome is only a general term for multiple disorders that occur when the sinus node does not work properly. The resulting heart beat or rhythm will be different depending on the specific electrical activity at the sinus node.

The multiple disorders that characterize SSS include:

• sinus bradycardia (the heart beats very slowly)
• sinus arrest (the sinus node temporarily stops working or pauses, causing a change in the heart’s beating)
• sinoatrial block (the sinus node impulse is blocked from reaching the atria- the two upper chambers of the heart)
• bradycardia-tachycardia syndrome (the heart alternates between a very slow and very fast beat)

The risk of developing sick sinus syndrome increases with age. Having SSS at birth is called congenital sick sinus syndrome. Congenital heart conditions are the main cause of SSS in young children and adults.

Risk factors for SSS include:

• repaired congenital heart disease (even with repairs, the heart is still weak)
• congenital heart disease (a person is born with heart defects)
• coronary artery disease (the coronary artery becomes clogged, and blood flow to the heart is restricted)

SSS may be caused by a number of factors, including:

• damage or scarring of the heart’s electric system, caused by a disease or other health condition
• scar tissue from past heart surgery
• certain medications, such as calcium channel blockers or beta blockers used to treat high blood pressure, heart disease, and other conditions
• the breakdown of heart muscle due to age (most common)

The widely held belief is that the condition is linked to the breakdown of heart muscle cells. The breakdown of these cells causes a change in the system that sends electrical impulses through the heart. The sinus node begins to malfunction as a result, and the heart cannot beat normally (Herrmann, Fabritz, Layh, Kirchhof, & Ludwig, 2011).

Patients with SSS often display no symptoms. However, when the heart becomes compromised and cannot pump an adequate amount of blood, symptoms quickly become apparent.

Symptoms of SSS include:

• fainting or fainting sensations
• fatigue
• dizziness
• palpitations (abnormal heart beats)
• very slow pulse (bradycardia)
• difficulty breathing
• chest pain
• mental confusion
• memory problems
• disrupted sleep

See your doctor as soon as possible if you are experiencing any of the SSS symptoms.

However, see your doctor immediately if you experience the following symptoms, especially if you have a personal or family history of heart disease. These could be symptoms of a heart attack or early cardiac arrest:

• chest pain
• difficulty breathing
• profuse sweating
• dizziness
• pain or discomfort in the upper body
• mental confusion or panic
• abdominal pain
• dizziness
• vomiting
• blackouts

Diagnosing sick sinus syndrome can be difficult. Patients may have no symptoms or family history of heart disease. Doctors must rely on tests of the heart’s function to make a diagnosis. These tests include:

• electrocardiogram (ECG) (a test that records the electrical activity of the heart.
• echocardiogram (an ultrasonic imaging test of the heart)
• transesophageal echocardiogram (TEE) (a special ultrasound device is put down the patient’s throat and into the esophagus to get a clear image of the heart size, the contracting strength of the heart and it can detect any damage to the heart muscle.
• holter monitoring (an electrocardiogram monitor is attached to the chest and worn for at least one 24-hour period. The patient keeps a diary of his or her activities and symptoms while wearing the monitor.)

Treatment for mild or early cases of SSS involves relieving symptoms. Doctors may adjust or change your medication if that is the problem. They may also prescribe additional medications that may have a direct effect on the heart rhythm. Eventually, however, most individuals with SSS will need an artificial pacemaker implant when the sinus node is no longer able to adequately perform.

A pacemaker is a very small machine that is surgically implanted in the chest or abdomen to regulate your heartbeat. It does this through sending electrical pulses to the heart.

Almost one-half of pacemaker implantations are performed because of problems related to sick sinus syndrome (Herrmann, Fabritz, Layh, Kirchhof, & Ludwig, 2011). Pacemakers are generally tolerated well, and patients experience few complications.

Rare complications of a pacemaker implant include:

• myocardial perforation (accidental hole made in the heart during surgery)
• infection from the implant (bacteria brought in during surgery causes infection)
• venous thrombosis (blood clot within the body’s veins)
• collapsed lung

With modern technology, there is a growing interest in creating a biological pacemaker. This could be done by taking cells containing pace-making genes and implanting them in the heart. The cells would then grow into the heart and become a new pacemaker.

A second approach would be to use stem cells. Stem cells are immature cells capable of developing into any specific type of mature cell. The cells could potentially grow into the same type of heart tissue as the sinus node.

Improvements in pacemaker technology have greatly helped patient outlook for SSS. Pacemakers provide the missing electrical impulses from a defective sinus node. They are not a cure, but are a very effective treatment.

The outlooks for those who cannot or do not undergo treatment are more uncertain. A heart that beats irregularly is more susceptible to cardiac arrest, which can cause sudden death. Untreated SSS may also lead to heart failure. Those with untreated bradycardia-tachycardia syndrome are at greater risk for blood clots and stroke.