Sick Sinus Syndrome – Diagnosis and Treatment
Diagnosis
Heart Rhythm Tracing with ECG
A heart rhythm tracing, often called an ECG, checks the electrical movements in the heart. You place sticky sensors on the chest and sometimes on the legs and arms.
The test picks up signals to show if the heartbeat is slow (bradycardia), fast (tachycardia), or has irregular patterns like atrial fibrillation or other arrhythmias.
The ECG can reveal specific problems, such as sinus bradycardia, pauses in the heartbeat (sinus arrest), or other types of sinus node dysfunction. In bradycardia-tachycardia syndrome, you can see episodes of a slow and fast heartbeat on the tracing.
Doctors check for abnormal patterns like supraventricular tachyarrhythmias or sinoatrial block using these results.
Quick Facts Table:
| What ECG Can Show | Description |
|---|---|
| Sinus bradycardia | Heart beats too slowly |
| Sinus arrest | Temporary stopping of the heartbeat |
| Bradycardia-tachycardia | Switching between slow and fast heart rhythms |
| Atrial fibrillation/flutter | Irregular heartbeats from the upper heart chambers |
Continuous Monitoring with Portable Devices
A portable heart monitor like the Holter device is another common test. You attach this small machine to the body with electrodes and wear it for one to three days. It checks the heartbeat during normal daily activities and sleep.
The device can capture random changes, such as sudden pauses, episodes of tachycardia, and other irregularities not always found in a short ECG.
You may keep a simple diary of any symptoms, noting when you feel dizzy or faint, which helps doctors connect symptoms to heart events. If symptoms do not happen daily, doctors may recommend an event monitor.
You can wear this tool for up to a month and press a button to record your heart’s activity if you feel warning signs like palpitations, chest pain, or skipped beats.
Personal devices, such as smartwatches with heart monitoring features, can also help track patterns over time. These devices can spot bradyarrhythmias or tachyarrhythmias outside the doctor’s office.
Specialized Electrical Signal Studies
An advanced exam—electrophysiological signal study—looks more closely at the heart’s electrical system. Doctors move flexible wires with sensors through blood vessels and place them inside the heart.
These sensors show how electrical signals travel across the heart, checking the sinoatrial node, atrial tissue, and other areas for dysfunction.
Doctors usually reserve this study for special cases, such as when they suspect other heart rhythm disorders like supraventricular tachycardia or ventricular tachycardia, or if results from other tests remain unclear.
Additional Tools and Details
Other methods sometimes help find the cause of repeated fainting or unexplained symptoms.
- Long-Term Recorders: An implantable loop recorder, placed under the skin, checks for rare irregular heartbeats over months or years.
- Echocardiogram: While not directly used for sick sinus syndrome diagnosis, this test can check for other heart problems that may be present.
These tests, when used together, help healthcare teams determine if someone has a heart rhythm disorder linked to the sinus node.
Treatment
Medicine Choices
Doctors often review all medicines a person is taking to see if any are making sick sinus syndrome worse. Sometimes, medicines for blood pressure or heart problems can affect the heart’s natural pacemaker and may need to be changed.
Other drugs may treat fast or irregular heartbeats. For people with atrial fibrillation or a higher risk of stroke, doctors may prescribe blood thinners like warfarin, dabigatran, or similar medicines to help prevent clots that could lead to a stroke.
Here’s a table of common medicines and their uses in sick sinus syndrome:
| Medication Type | Purpose |
|---|---|
| Blood thinners (anticoagulants) | Reduce stroke risk if arrhythmia present |
| Heart rate control agents | Slow down abnormally fast heartbeats |
| Other heart rhythm medicines | Stabilize heart rhythm or prevent episodes |
Note: The use of each medication depends on the patient’s unique symptoms, medical history, and needs. A healthcare provider makes adjustments carefully. Sometimes, certain drugs are stopped if they make symptoms worse.
Surgical Procedures and Device Implants
Doctors often recommend a pacemaker for people with symptoms. This small device helps control abnormal heart rhythms and is usually implanted just below the collarbone under the skin in a minor surgery.
Types of pacemakers include:
- Single-Chamber Pacemaker: Sends signals to one part of the heart, usually the right ventricle.
- Dual-Chamber Pacemaker: Sends signals to both the right atrium and right ventricle. Doctors often use this type for sick sinus syndrome.
- Biventricular Pacemaker: Doctors use this type for people with heart failure. It stimulates both lower heart chambers to help the heart pump better.
After implanting a pacemaker, people need regular appointments to make sure it works properly and to adjust settings if needed.
If symptoms are mild or happen rarely, doctors may decide to monitor the person instead of implanting a pacemaker right away.
Blocking the AV Node
Doctors may perform a procedure to intentionally block the electrical signals between the upper and lower chambers of the heart, called AV node ablation.
Steps in AV node ablation:
- A special tool uses radiofrequency waves to destroy the part of the heart that sends signals from the atria to the ventricles (the AV node).
- After doctors destroy this area, the irregular signals stop.
- Doctors then implant a pacemaker to control the heartbeat going forward.
Doctors usually perform AV node ablation for people who have serious fast heart rhythms and who already have or are getting a pacemaker.
Destroying Extra Heart Signal Sources
Cardiac ablation is a different procedure that helps stop abnormal heart rhythms without blocking the main signal path between the chambers.
A doctor uses thin tubes called catheters, guiding them through a vein or artery, usually from the groin up to the heart.
How cardiac ablation works:
- The doctor uses heat or cold to make tiny scars in areas that are causing the extra or irregular signals.
- These scars block the faulty signals so the heart can beat normally.
- Doctors often use this method when medicines and pacemakers do not fully control symptoms.
Cardiac ablation may target areas near the pulmonary veins or other places inside the heart known to trigger abnormal rhythms. Sometimes, doctors perform it alone, and sometimes in combination with a pacemaker.
Healthy Living Tips
Self-care plays an important role in supporting heart health. Eating habits make a difference. A heart-smart meal plan includes plenty of nonstarchy vegetables, fruits, and whole grains. Lean meats, fish, poultry, and dairy should be eaten in moderation.
Physical activity is also key. Most people should aim for 30 minutes of moderate exercise most days. Walking, biking, or swimming are all good options.
Maintaining a healthy weight is linked to lower chances of heart problems. Health care providers can help set realistic weight goals.
Keeping blood pressure and cholesterol at safe levels is vital. This may mean making certain lifestyle changes as well as taking any prescribed medicines.
Tobacco use is harmful to the heart. Avoiding smoking helps protect blood vessels and improves overall health. Those who need help quitting should reach out to their health provider or explore support groups or programs.
Alcohol use should be limited. For some, it’s best to avoid alcohol altogether. Discuss personal recommendations with a health care provider if unsure.
Other habits that support health include avoiding illegal drugs and finding healthy ways to manage stress. Exercise, relaxation methods, and connecting with others can help lower stress.
Regular visits to a health care provider are also recommended. Monitoring for new symptoms and following medical advice play a role in staying healthy and managing risks.
| Self-Care Area | Healthy Actions |
|---|---|
| Eating | Vegetables, fruits, whole grains, lean proteins |
| Physical Activity | At least 30 minutes of moderate exercise daily |
| Healthy Weight | Set goals with provider, maintain a suitable weight |
| Blood Pressure/Cholesterol | Monitor, follow treatment steps |
| Smoking | Avoid tobacco, seek help if needed |
| Alcohol Use | Limit or avoid, ask provider for guidance |
| Stress | Exercise, mindfulness, support connections |
| Medical Visits | Attend regular checkups, report new symptoms |
Getting Ready for Your Visit
Meeting with a healthcare provider about heart rhythm problems can seem stressful. Preparing before the appointment helps people provide accurate information and make the most of their visit.
Bringing Information and Support
Patients can:
- Write down their symptoms in advance, including how often they occur, how long they last, and what triggers them.
- List all current medications, including prescription drugs, over-the-counter medicines, herbal remedies, and supplements. Include the dosage and the name of the prescribing doctor for each medication.
- Note any recent changes in medications, such as starting, stopping, or changing doses.
- Bring along a complete medical history, including any diagnosis of heart disease, high blood pressure, high cholesterol, or diabetes.
- Prepare to answer questions about any family history of heart conditions.
Patients may want to make a table with this information. For example:
| Symptom | How Often | Duration | Triggers/Relief |
|---|---|---|---|
| Dizziness | 2x/week | 5 minutes | Walking upstairs |
| Heart palpitations | 1x/month | 10 minutes | Lying down |
Questions Healthcare Providers May Ask
During the appointment, the provider will likely have questions such as:
- Do you feel dizzy or lightheaded?
- Have you fainted or almost fainted?
- Do you notice a racing or pounding heartbeat?
- Do physical activities make symptoms worse?
- Has anything helped relieve the symptoms?
It helps if patients have written answers or notes for these questions ahead of time.
Bringing Someone Along
Bringing a friend or family member can help the patient remember information and write down important details from the visit. This support is especially helpful if the appointment involves many new instructions or complex information.
Making a List of Questions
Patients should write down their own questions for the provider, such as:
- What tests are needed to confirm the diagnosis?
- What are the treatment options?
- Are there side effects to the medication?
- Will a pacemaker or other device be needed?
- Are there any clinical trials available?
- What should I do if symptoms get worse before the next visit?
