Sick Sinus Syndrome SSS

Question 1

What is sick sinus syndrome (SSS)?

Answer 1

Sick Sinus Syndrome is a group of arrhythmias caused by dysfunction of the sinoatrial (SA) node, resulting in abnormal heart rhythms.

Question 2

What are the common types of arrhythmias seen in Sick Sinus Syndrome?

Answer 2

Sinus bradycardia, sinus arrest, sinoatrial exit block, and alternating bradycardia-tachycardia syndrome.

Question 3

What are the typical symptoms of Sick Sinus Syndrome?

Answer 3

Symptoms include fatigue, dizziness, syncope, palpitations, and dyspnoea.

Question 4

What is the aetiology of Sick Sinus Syndrome?

Answer 4

Causes include fibrosis of the SA node, ischaemic heart disease, cardiomyopathies, medications, and electrolyte imbalances.

Question 5

What is the pathophysiology of Sick Sinus Syndrome?

Answer 5

Dysfunction of the SA node leads to impaired impulse initiation, resulting in bradycardia, pauses, or irregular heart rhythms.

Question 6

What are the risk factors for developing Sick Sinus Syndrome?

Answer 6

Ageing, ischaemic heart disease, heart surgery, hypothyroidism, and the use of rate-slowing medications like beta-blockers or calcium channel blockers.

Question 7

What investigations are used to diagnose Sick Sinus Syndrome?

Answer 7

ECG, Holter monitoring, event recorders, and electrophysiological studies.

Question 8

What are the characteristic ECG findings in Sick Sinus Syndrome?

Answer 8

Sinus bradycardia, sinus pauses, sinus arrest, SA block, or alternating bradycardia-tachycardia patterns.

Question 9

What is the role of Holter monitoring in Sick Sinus Syndrome?

Answer 9

Holter monitoring records continuous ECG over 24-48 hours to detect intermittent arrhythmias.

Question 10

What are the complications of untreated Sick Sinus Syndrome?

Answer 10

Complications include syncope, falls, thromboembolism (e.g., stroke), and heart failure.

Question 11

What are the differential diagnoses for Sick Sinus Syndrome?

Answer 11

Atrioventricular block, atrial fibrillation, hypothyroidism, and medication-induced bradycardia.

Question 12

How is Sick Sinus Syndrome managed in symptomatic patients?

Answer 12

Management includes the implantation of a permanent pacemaker to regulate heart rhythm.

Question 13

What are the indications for a pacemaker in Sick Sinus Syndrome?

Answer 13

Symptomatic bradycardia, syncope due to sinus pauses, and alternating bradycardia-tachycardia syndrome.

Question 14

What are the non-pacemaker management options for Sick Sinus Syndrome?

Answer 14

Discontinuing or adjusting medications that exacerbate bradycardia and addressing reversible causes like electrolyte imbalances or hypothyroidism.

Question 15

What lifestyle advice is given to patients with Sick Sinus Syndrome?

Answer 15

Avoidance of excessive caffeine and alcohol, regular follow-up, and monitoring for symptoms like syncope or palpitations.

Question 16

What is the role of anticoagulation in Sick Sinus Syndrome?

Answer 16

Anticoagulation may be indicated in patients with atrial fibrillation or other arrhythmias to reduce the risk of thromboembolism.

Question 17

What is tachycardia-bradycardia syndrome?

Answer 17

A subtype of Sick Sinus Syndrome where periods of bradycardia alternate with episodes of supraventricular tachycardia, such as atrial fibrillation.

Question 18

What is the prognosis of Sick Sinus Syndrome?

Answer 18

Prognosis is generally good with appropriate management, particularly with pacemaker implantation, though underlying heart disease may affect outcomes.

Question 19

How is Sick Sinus Syndrome related to ageing?

Answer 19

Ageing leads to fibrosis and degeneration of the sinoatrial node, making Sick Sinus Syndrome more common in older adults.

Question 20

What is the role of electrophysiological studies in Sick Sinus Syndrome?

Answer 20

These studies are used to assess SA node function and identify conduction abnormalities in unclear cases.

Question 21

What medications can exacerbate Sick Sinus Syndrome?

Answer 21

Beta-blockers, calcium channel blockers, digoxin, and antiarrhythmics can worsen bradycardia or conduction abnormalities.

Question 22

What are the clinical signs of Sick Sinus Syndrome on physical examination?

Answer 22

Signs may include a slow or irregular pulse, hypotension, and evidence of underlying heart disease.

Question 23

What is sinus arrest?

Answer 23

Sinus arrest is a pause in sinus node activity resulting in the absence of P waves for a period, often followed by escape rhythms.

Question 24

What is sinoatrial exit block?

Answer 24

SA exit block occurs when impulses generated by the SA node fail to conduct to the atria, leading to dropped beats on ECG.

Question 25

Why is early diagnosis of Sick Sinus Syndrome important?

Answer 25

Early diagnosis and management reduce the risk of complications like syncope, falls, and thromboembolic events, improving quality of life.