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Sick Sinus Syndrome

Sick Sinus Syndrome is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Collective term used to describe dysfunction in the sinus node's automaticity and impulse generation
  • Mechanism:
    • Caused by progressive degeneration of the intrinsic functions of the sinoatrial (SA) node
    • Characterized by periods of unexplained sinus node dysfunction leading to bradyarrhythmias, often without appropriate atrial or junctional escape rhythms
  • Syndrome includes:
    • Chronic SA nodal dysfunction
    • Frequently depressed pacemakers
    • Arteriovenous nodal conduction disturbances
    • Sluggish return of SA nodal activity after DC cardioversion
  • Presents in all age groups (mean age >65 yr)
  • Male/female ratio is 1:1

Etiology

  • Intrinsic causes:
    • Most common cause: Idiopathic degenerative fibrosis of sinus node
    • Coronary artery or SA nodal artery disease
    • Cardiomyopathy
    • Ion channel mutations/familial SSS
    • Leukemia and metastatic disease
    • Infiltrative cardiac or collagen vascular disease, including amyloidosis
    • Surgical trauma
  • Inflammatory diseases:
    • Rheumatic heart disease
    • Chagas disease
    • Pericarditis and myocarditis
  • Extrinsic causes (not true SSS but similar presentation):
    • Drugs:
      • β-blockers, calcium channel blockers, clonidine
      • Digoxin, amiodarone
      • Lithium, phenytoin
    • Autonomically mediated syndromes (cholinesterase deficiency)
    • Hyperkalemia/hypokalemia
    • Hypothyroidism
    • Hypothermia
    • Hypoglycemia
    • Sepsis/infection

Pediatric Considerations
Associated with congenital abnormalities and subsequent surgical repair, as well as with congenital SA nodal artery deficiency

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Citation

Rosen, Peter, et al., editors. "Sick Sinus Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307069/all/Sick_Sinus_Syndrome.
Sick Sinus Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307069/all/Sick_Sinus_Syndrome. Accessed April 26, 2019.
Sick Sinus Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307069/all/Sick_Sinus_Syndrome
Sick Sinus Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307069/all/Sick_Sinus_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sick Sinus Syndrome ID - 307069 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307069/all/Sick_Sinus_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -