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Heart Disease (Expert Forum)
Where do i stand?
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Where do i stand?
by ridz, Apr 26, 2002 12:00AM
From what i know, there are different kinds of bradycardia...1stly it is the sinus bradycardia which is due to normal causes. It is usually found in people with excellent fitness. And the second one is the sick sinus syndrome. Previously i had undergo some test like the treadmill test, x-rays and ECGs. And the test was positive. They concluded i had excellent fitness. But now i m beginning to have chest pains and sometimes difficulty in breathing normally when i m resting. But when i exercise i m usually fine. But the fact that i m having chest pains which i don't get previously worries me. Could u tell me the other symptoms of the sick sinus syndrome? I would like to know where do i stand...thanx
Doctor's Answer
by CCF-M.D.-CRC, Apr 30, 2002 12:00AM
Dear ridz,
Sick sinus syndrome is now called sinus node dysfunction. Sinus node dysfunction (SND) is a term that encompasses any dysfunction of the sinus node and includes inappropriate sinus bradycardia, sinoatrial exit block, sinoatrial arrest and tachycardia-bradycardia syndrome. The etiologies of SND may be divided into intrinsic and extrinsic causes. Idiopathic degenerative disease is the most common cause of intrinsic SND and the incidence increases with age. Acute heart attacks are a common cause of bradyarrhythmias occurring in 25-30% of patients with myocardial infarction.
Clinical Presentation
The most dramatic presenting symptoms of SND are fainting and near-fainting, however, there is a wide range of presentation and some patients may be asymptomatic. Fatigue, angina and shortness of breath are more subtle consequences of SND. In the tachycardia-bradycardia syndrome the primary complaint may be palpitation and documentation of the arrhythmia may be difficult due to the sporadic and fleeting nature of the problem.
Testing for SND can be either noninvasive or invasive. Invasive testing is usually reserved for cases where noninvasive testing has failed to demonstrate an etiology.
The first step in evaluation of suspected SND is the 12-lead ECG followed by 24-48 hour ambulatory electrocardiographic monitoring if necessary. The use of a diary during the recording period can help to correlate symptoms with the cardiac rhythm. For less frequent events, a loop recorder or event recorder may be used to assess symptoms over a 2 -4 week period. Stress testing can be used to document the severity of chronotropic incompetence.
Therapy
Treatment for symptomatic sinus node dysfunction may be pharmacological, pacing or a combination of both. For patients on medication that suppress the sinus node (e.g. beta-blockers), the medication should be stopped. If this is not possible it may be necessary to place a pacemaker. For patients with tachycardia-bradycardia syndrome a pacemaker is often placed for treatment of the slow heart rates and antiarrhythmic drugs are added for treatment of the fast heart rates.
The indications for pacing in SND are determined by symptoms. Correlation of symptoms with a documented arrhythmia generally requires pacing. Another common indication for pacing is when drug therapy that causes SND cannot be stopped or changed.
Sick sinus syndrome is now called sinus node dysfunction. Sinus node dysfunction (SND) is a term that encompasses any dysfunction of the sinus node and includes inappropriate sinus bradycardia, sinoatrial exit block, sinoatrial arrest and tachycardia-bradycardia syndrome. The etiologies of SND may be divided into intrinsic and extrinsic causes. Idiopathic degenerative disease is the most common cause of intrinsic SND and the incidence increases with age. Acute heart attacks are a common cause of bradyarrhythmias occurring in 25-30% of patients with myocardial infarction.
Clinical Presentation
The most dramatic presenting symptoms of SND are fainting and near-fainting, however, there is a wide range of presentation and some patients may be asymptomatic. Fatigue, angina and shortness of breath are more subtle consequences of SND. In the tachycardia-bradycardia syndrome the primary complaint may be palpitation and documentation of the arrhythmia may be difficult due to the sporadic and fleeting nature of the problem.
Testing for SND can be either noninvasive or invasive. Invasive testing is usually reserved for cases where noninvasive testing has failed to demonstrate an etiology.
The first step in evaluation of suspected SND is the 12-lead ECG followed by 24-48 hour ambulatory electrocardiographic monitoring if necessary. The use of a diary during the recording period can help to correlate symptoms with the cardiac rhythm. For less frequent events, a loop recorder or event recorder may be used to assess symptoms over a 2 -4 week period. Stress testing can be used to document the severity of chronotropic incompetence.
Therapy
Treatment for symptomatic sinus node dysfunction may be pharmacological, pacing or a combination of both. For patients on medication that suppress the sinus node (e.g. beta-blockers), the medication should be stopped. If this is not possible it may be necessary to place a pacemaker. For patients with tachycardia-bradycardia syndrome a pacemaker is often placed for treatment of the slow heart rates and antiarrhythmic drugs are added for treatment of the fast heart rates.
The indications for pacing in SND are determined by symptoms. Correlation of symptoms with a documented arrhythmia generally requires pacing. Another common indication for pacing is when drug therapy that causes SND cannot be stopped or changed.
