(Sick sinus syndrome)

The term “sinus node dysfunction” includes a number of causes that lead to physiologically different atrial rate. The symptoms are minimal or show up in the form of weakness, exercise intolerance, palpitations and syncope. The diagnosis results from the ECG. Symptomatic patients need a pacemaker.

Sinus node dysfunction includes

The term “sinus node dysfunction” includes a number of causes that lead to physiologically different atrial rate. The symptoms are minimal or show up in the form of weakness, exercise intolerance, palpitations and syncope. The diagnosis results from the ECG. Symptomatic patients need a pacemaker. Sinus node dysfunction including sinus bradycardia inappropriate Switching between bradycardia and atrial tachyarrhythmias (bradycardia-tachycardia syndrome) sinus pause or stop sinoatrial (SA) Exit Block Sinus node dysfunction mainly affects older people and thereby v. a. those with impaired cardiac function, or diabetes mellitus. A sine pause is a temporary suspension of the sinus node activity, which manifests itself in the ECG as the absence of the P-waves over seconds or minutes. During the break, as a rule, the following pacing (atrial or junctional) take over the function of the sinus node and get the heart rate and cardiac function upright. However, long pauses cause dizziness and syncope. When SA block the sinus node is depolarized, but adversely affects the management of the pulses to the atrial tissue. When SA block first degree impulse conduction of the sinoatrial node is merely slows with normal ECG. When SA block II. Grade type 1 (Wenckebach type) are forwarded, the pulses in front of a blocking slower. The ECG P-P interval, which progressively decreases until the P-wave disappears completely shows. This creates a break and it grouped appear blows. The pause is shorter than the length of two P-P-cycles. When SA block II. Type 2 degree (Mobitz type) the impulse line is blocked without slowing down. This results in a break of a multiple (usually two-fold) the length of the P-P interval and it appear grouped strokes. When SA block III. Degree is the transfer block, the P-wave is missing, the ECG shows a sinus arrest. Etiology The most common cause of sinus node dysfunction is the SA node idiopathic fibrosis, which may be accompanied by a degeneration of the following components of the conduction system. Among the other causes include medications, excessive vagal tone and many ischemic, inflammatory and infiltrative diseases. Symptoms and complaints Many patients have no symptoms. It can, however, all symptoms of bradycardia or tachycardia occur, depending on heart rate. Diagnostic ECG A slow irregular pulse points to the diagnosis of sinus node dysfunction, which is confirmed by the ECG rhythm strip or a 24-hour ECG. Some patients have a VHF, the sinus node dysfunction underlying becomes apparent only after conversion to sinus rhythm. Prognosis The prognosis is different. Without treatment, die each year about 2% of patients, mainly on one of the sinus node dysfunction underlying structural heart disease. Each year, about 5% of patients develop VHF with the risk of heart failure or stroke. The treatment pacing therapy consists of the implantation of a pacemaker. The occurrence of VHF is significantly reduced when the implantation of a physiological (atrial pacemakers or dual-chamber system) instead of a Ventrikelschrittmachers. Newer dual-chamber pacemaker that minimizes ventricular pacing can further reduce the risk of atrial fibrillation. A therapy with antiarrhythmic drugs may be useful for the use of a pacemaker for preventing paroxysmal tachyarrhythmias. Theophylline and hydralazine are a therapeutic option to increase the heart rate in healthy younger patients with bradycardia, but without syncope.

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