Heart Disease Expert Forum
SINUS SICKNESS SYNDROME
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SINUS SICKNESS SYNDROME


  CAN YOU TELL ME ANYTHING ABOUT SINUS SICKNESS SYNDROME, AND, HOW IT MAY
  LEAD TO HAVING THE NEED FOR A PACEMAKER?
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Dear Peter, thank you for your question.  It's called sick sinus syndrome
(you were close) and it's a disorder of the conduction system of the heart
that does frequently require a pacemaker.  Normally, each heartbeat is
initiated in a part of the heart called the sinus node which is located in
the right atrium at the top of the heart.  This electrical impulse travels
through special conduction fibers across the AV node to the ventricles in
milliseconds.  Once the impulse reaches the ventricles, a heartbeat (contraction)
occurs.  When the sinus node is dysfunctional, other areas of the heart
can take over the task of starting an impulse but the heart rate is usually
rather slow when that happens.  As people age, the sinus node can develop
scar tissue and fibrosis and can stop generating regular impulses.  This
is sick sinus syndrome (SSS).  When the sinus node fails to generate impulses for
a few seconds, a pause results without a heartbeat which can be felt as
a skipped beat but can also cause someone to lose consciousness if the
pause is too long.  There is a subset of SSS called the tachy-brady syndrome
in which periods of slow heart rates and pauses alternate with periods of
abnormally fast heart rhythms.  The treatment for SSS is a pacemaker which
will initiate heartbeats when the sinus node fails to "fire."  Pacemakers
are very advanced these days and work very well.  The pacemaker has 1-2 leads
that are inserted into a vein below the collarbone and a battery/generator
that is inserted under the skin below the shoulder/collarbone.  The leads
and the battery are connected and everything remains under the skin.  Pacemakers
are evaluated regularly after implantation but this can often be done over the
phone.  When the tachy-brady syndrome is also present, medications are used
to slow the heart rate after a pacemaker is implanted to prevent the slow
heart rates.  There is no medical cure for SSS, but pacemakers are very
well tolerated by patients who require them.  Without a pacemaker, the risks
of SSS are losing consciousness and falling or getting into an accident.  Thus,
if SSS is present and symptoms are noted by the patient, a pacemaker should
be strongly considered.  I hope you find this information useful.
Information provided in the heart forum is for general purposes only.
Specific diagnoses and therapies can only be provided by your physician.




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