The term sick sinus syndrome is used to describe a series of cardiac arrhythmias, or arrhythmias, which are caused by a malfunction of the sinus node. This condition primarily affects the elderly, and it is one of the most common indications for implantation of a pacemaker.
What is sick sinus syndrome?
In healthy people, the sinus node is nothing more than a collection of specialized cells on the right ventricle of the heart that send out electrical signals at regular intervals. In people with sick sinus syndrome, these electrical impulses are delivered at the wrong intervals, resulting in a slowed or accelerated heart rhythm, or a combination of both. Basically, the term sick sinus syndrome includes a large number of heart diseases that, in addition to the sinus dysfunction that gives them their name, can also be due to a blockage in the conduction of excitation via the atria. A universally accepted definition of sick sinus syndrome is still pending. However, the term is used diagnostically to justify the indication of therapies with pacemakers and also when a tachycardia-brachycardia syndrome is present, a special form of sick sinus syndrome characterized by alternating occurrences of a sinus rhythm that is too slow followed by one that is too fast.
Causes
The causes of sick sinus syndrome are not infrequently idiopathic, that is, without a known cause. For example, small injuries to the sinus node tissue may occur during life, leading to the formation of scar tissue, which blocks conduction of the excitation. Sick sinus syndrome can also have mechanical causes, such as when there is overstretching of the right atrium during surgery. The most common cause, however, is high blood pressure, which puts a constant strain on the heart and can lead to overstretching due to the permanent overuse of the atria. Furthermore, sick sinus syndrome can also have its origin in an inflammation of the heart muscle; the same applies to a number of other heart diseases such as mitral valve defects and coronary heart disease. However, it is often difficult or nearly impossible to deduce the causes from a diagnosed sick sinus syndrome.
Symptoms, complaints, and signs
Sick sinus syndrome can manifest itself through various symptoms, complaints, and signs. First and foremost, cardiovascular symptoms occur: Palpitations and high blood pressure or low pulse, as well as cardiac arrhythmias. In addition, the symptoms are similar to those of an AV block, which can lead to circulatory problems, dizziness, cramps and stabbing chest pain. In extreme cases, sick sinus syndrome leads to cardiac arrest. Sick sinus syndrome also favors the development of cardiac insufficiency, which greatly reduces physical resilience and can trigger secondary diseases such as arteriosclerosis or arterial hypertension. Those affected experience increasing shortness of breath and a feeling of anxiety. An inner restlessness is characteristic, which leads to a growing feeling of malaise. As a result, psychological problems often develop, for example, fear of death or depression. The cardiac arrhythmia can also trigger visual disturbances. These are manifested by the patients seeing everything blurred or double. The visual complaints are temporary and occur mainly during physical exertion. They disappear again after a few minutes to hours. Nevertheless, they can have a negative impact on the quality of life and well-being of the sufferer. If sick sinus syndrome is treated in time, long-term consequences and serious complications can be avoided. An untreated cardiac arrhythmia can be fatal.
Diagnosis and progression
Sick sinus syndrome can be diagnosed when certain abnormalities are visible in the ECG findings, such as atrial fibrillation and other disturbances of the heart rhythm. The first choice means of diagnosis is the long-term ECG, which allows the physician to see if bradycardia, tachycardia, or even asystole are evident on the ECG. In addition to this diagnostic measure, an exercise ECG may also be necessary for diagnosis to determine if there is an increase in rate during physical exertion.Long-term blood pressure measurements or cardiac catheterization may also sometimes be necessary, but they remain exceptional as diagnostic tools for sick sinus syndrome.
Complications
In most cases of sick sinus syndrome, patients suffer from various cardiac symptoms. In the worst case, these can lead to the death of the affected person or significantly reduce life expectancy. Patients suffer from palpitations and also a low pulse. This can lead to a loss of consciousness and thus possibly to a fall and injury. Furthermore, the disease causes breathing difficulties and a general inner restlessness. The affected persons feel unwell and also suffer from severe visual disturbances. In most cases, the visual complaints are only temporary and disappear again. Especially during physical exertion, the complaints can occur and have a negative effect on the patient’s everyday life and quality of life. In most cases, a healthy lifestyle has a very positive effect on the disease and can limit many complaints. In severe cases, however, the use of a pacemaker is necessary to limit the symptoms of sick sinus syndrome. This can prevent further discomfort or complications. Further regular examinations by a doctor are also necessary in this case.
When should you see a doctor?
Sick sinus syndrome should always be treated by a doctor. Only early medical treatment can prevent further symptoms and complications that could otherwise limit the life expectancy of the affected person. In the worst case, the affected person suffers heart failure and dies from it. A doctor should be consulted for sick sinus syndrome if the patient suffers from symptoms of the heart. There is high blood pressure or palpitations, and these symptoms occur even without exertion and without any particular reason. Furthermore, severe cramps or dizziness may indicate this disease and significantly reduce the quality of life of the affected person. Most patients also suffer from shortness of breath and severe visual complaints. Not infrequently, cramps or dizziness also indicate sick sinus syndrome and should also be examined by a physician. The severity of the symptoms can vary greatly and is strongly dependent on the severity of the disease. As a rule, sick sinus syndrome is diagnosed and treated by a cardiologist. The disease may also reduce the life expectancy of the affected person. Since sick sinus syndrome can also lead to psychological upset or depression, a psychological examination and treatment should also be performed.
Treatment and therapy
The first-line treatment method must distinguish between chronic and acute cardiac arrhythmias. For example, in chronic sick sinus syndrome with bradycardia, phases in which the heart beats too slowly, implantation of a pacemaker is generally recommended. The pacemaker then takes over the function of the sinus node. Implantation of a pacemaker eliminates the symptoms and thus provides a significant improvement in the patient’s quality of life. If tachycardia, i.e. an excessive increase in cardiac activity, occurs in the course of a chronic sick sinus syndrome, it can often be treated with antiarrhythmic drugs and a pacemaker can only be considered after monitoring the course of the disease under drug administration. If bradycardia and tachycardia occur alternately, pacemaker implantation is inevitable. In addition, antiarrhythmic drugs must be taken to prevent tachycardic phases even after implantation. In acute cases of bradycardia, intravenous administration of atropine is performed. If the atrium is enlarged and atrial fibrillation occurs, therapy is usually with the administration of anticoagulants, drugs that inhibit blood clotting, to prevent complications such as stroke.
Prevention
There are hardly any prophylactic measures to prevent the occurrence of sick sinus syndrome, since the causes are usually individually different and often cannot even be determined with certainty. Regular checking of blood pressure and possible treatment of hypertension are likely to be one of the few concrete measures to prevent sick sinus syndrome.Basically, what is good for the heart is also good for preventing sick sinus syndrome. This means that through a healthy lifestyle, with sufficient exercise and a balanced diet, much is already done to maintain a healthy, functioning heart.
Follow-up
The affected person usually has few options for aftercare in sick sinus syndrome, so the patient should ideally see a doctor early on to prevent the onset of other symptoms and complications. As a rule, self-healing cannot occur, so that the affected person is always dependent on medical treatment. The sooner a doctor is consulted, the better the further course of this disease usually is. Many of those affected are dependent on taking various medications due to sick sinus syndrome. Regular intake and correct dosage should always be observed, and a doctor should always be contacted first in case of questions or uncertainties. The doctor should also be consulted in case of side effects. In many cases, the help of friends and relatives is also very important in everyday life to alleviate the symptoms. Also, contact with other patients can be useful in sick sinus syndrome, as it comes to an exchange of information, which could facilitate the everyday life of the affected person.
What you can do yourself
Patients with sick sinus syndrome should definitely pay attention to relieving the heart. In everyday life, emotional as well as physical stressors should therefore be reduced to a minimum. Physical overexertion leads to a stimulation of the activity of the cardiovascular system. Therefore, care should be taken to ensure that physical movements do not lead to severe stress. Sporting as well as professional activities should be adjusted to the organism’s specifications and should not be exceeded. As soon as the first irregularities or changes in health become apparent, breaks should be taken. The organism needs time for sufficient regeneration. If physical signals are not heeded, life-threatening complications can arise. In addition to physical stress, emotional stress factors must also be minimized. Conflicts, a hectic daily routine or numerous interpersonal disagreements can be an immense mental burden. Relaxation techniques help to better cope with and process the events of everyday life. In addition, cognitive techniques are to be applied when circling thoughts occur and the affected person experiences a strong inner restlessness. Breathing techniques and clear boundaries in everyday events can be helpful in achieving relief from symptoms. In states of anxiety, awareness processes help to minimize them. To the extent that the affected person needs help with this, he or she should seek the cooperation of a therapist.
