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Sick Sinus Syndrome? Possible misdiagnosis?
Did get 2 diagnosis today from EKG, one i did expected and one i did not...
I had Lyme disease since 2006 november and treated it recently with antibiotics, so diagnosis of right bundle branch block is was not surprise to me since heart block is one of Lyme symptom and it should reverse after treatment. I mentioned it to cardiologist but he shook head and did not believed it will reverse after 5 years, he said it is (or may be) caused by scarring that developed from Lyme myocarditis (which is EXTREMELY rare!).
But Sick Sinus Syndrome is from another world. First i did read that it cannot be diagnosed by one EKG only but it does need more thorough inquiry, secondary he did mentioned it only once while it is serious disease and third is that Lyme can mime Sick Sinus Syndrome (i knew it, but since Lyme carditis is very rare maybe he did not?), and i have slow heart beat (asymptomatic bradycardia) when resting, i knew it, i monitored it myself over months and that developed during my long fitness training (half a year now) that includes 25-40 km and sometimes more bicycle riding on day. I TOLD HIM that i did everyday training and i am fit...still there remains diagnosis of Sick Sinus Syndrome i had never felt or suspected...
Whats going on?! Should i be afraid, should i be question diagnosis, should i get another cardiologist...
I had Lyme disease since 2006 november and treated it recently with antibiotics, so diagnosis of right bundle branch block is was not surprise to me since heart block is one of Lyme symptom and it should reverse after treatment. I mentioned it to cardiologist but he shook head and did not believed it will reverse after 5 years, he said it is (or may be) caused by scarring that developed from Lyme myocarditis (which is EXTREMELY rare!).
But Sick Sinus Syndrome is from another world. First i did read that it cannot be diagnosed by one EKG only but it does need more thorough inquiry, secondary he did mentioned it only once while it is serious disease and third is that Lyme can mime Sick Sinus Syndrome (i knew it, but since Lyme carditis is very rare maybe he did not?), and i have slow heart beat (asymptomatic bradycardia) when resting, i knew it, i monitored it myself over months and that developed during my long fitness training (half a year now) that includes 25-40 km and sometimes more bicycle riding on day. I TOLD HIM that i did everyday training and i am fit...still there remains diagnosis of Sick Sinus Syndrome i had never felt or suspected...
Whats going on?! Should i be afraid, should i be question diagnosis, should i get another cardiologist...
I don't have any medical knowledge to add but post to comment that sometimes members do not look in older threads so if you have a specific question you want answered you may want to start your own thread. You may also want to post in the Doctor forums for expert advice though I do believe there is a fee to do so but you would get professional advice there. This said, my heart goes out to you for all you have been through. Stay strong and I do hope you are able to get your health worked out.
Changes on Holter consistent with SSS (as far as I know):
- Remarkably long pauses after atrial ectopic activity like PACs, SVT and atrial fibrillation (prolonged sinus nodal recovery time) [I had a six second lag in my heart beat as it was converting from atrial fibrillation to sinus rhythm. I was on the prescribed meds when it occurred and 7 day zio monitor.]
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I had an electrophysiologist just diagnose me with SSS based on the above incidents which were caused by the prescribed medicine for PAF.
Does this constitute a diagnosis for SSS?
I wonder if this heart specialist is jumping the gun on my diagnosis and not looking at the whole picture.
My symptoms started when I remembered the abuse my father perpetrated on others and myself. He was a serial killer and a pedophile and forced me to watch him commit criminal acts. When the memories came back, I started having PAF episodes every time a memory surfaced.
Before the PAF, I had borderline bradycardia for years and bradycardia for years before that. My resting HR used to be 42. Prior to the PAF it was 52 to 54 lying down and 58 to 60 sitting up. It has been that way since 2003.
In 2008, I had thyrotoxicosis and was placed on metoprolol which caused my heart rate to plummet to 32. The doctor said not to ever take that med again due to my reaction to it. However, my cardiologist prescribed it for PAF to slow my racing heart with beats up to 214.
- Remarkably long pauses after atrial ectopic activity like PACs, SVT and atrial fibrillation (prolonged sinus nodal recovery time) [I had a six second lag in my heart beat as it was converting from atrial fibrillation to sinus rhythm. I was on the prescribed meds when it occurred and 7 day zio monitor.]
-----------
I had an electrophysiologist just diagnose me with SSS based on the above incidents which were caused by the prescribed medicine for PAF.
Does this constitute a diagnosis for SSS?
I wonder if this heart specialist is jumping the gun on my diagnosis and not looking at the whole picture.
My symptoms started when I remembered the abuse my father perpetrated on others and myself. He was a serial killer and a pedophile and forced me to watch him commit criminal acts. When the memories came back, I started having PAF episodes every time a memory surfaced.
Before the PAF, I had borderline bradycardia for years and bradycardia for years before that. My resting HR used to be 42. Prior to the PAF it was 52 to 54 lying down and 58 to 60 sitting up. It has been that way since 2003.
In 2008, I had thyrotoxicosis and was placed on metoprolol which caused my heart rate to plummet to 32. The doctor said not to ever take that med again due to my reaction to it. However, my cardiologist prescribed it for PAF to slow my racing heart with beats up to 214.
Indeed my hear skipped 2 beats during ekg and i do have occasional palpitations, especially when i'm stressed I guess that incomplete right bundle branch block may cause it as well.
I'm pretty sure that one EKG is not enough for definite diagnosis, he does not even know underlying cause but does guess it.
I'm pretty sure that one EKG is not enough for definite diagnosis, he does not even know underlying cause but does guess it.
I assume you know this is a patient only community; no doctors present.
Also, your question is very complicated and I don't think you will get it completely answered here. You can see another cardiologist for a second opinion, and/or ask your question in the Expert Forum ($20 fee).
If I should try to provide an answer:
I didn't know that SSS could be diagnosed with resting EKG. The normal method for diagnosing it is 48 hours Holter (preferrably, 24 is sometimes not enough) and if the Holter shows signs of SSS, an EP study is indicated to examine the sinus nodal function.
Changes on Holter consistent with SSS (as far as I know):
- Inappropriate bradycardia (like during exercise)
- Symptomatic bradycardia on several occations (fainting, dizziness with slow heart rate)
- Sinus pauses longer than 2,7 sec at daytime and 3 sec at night (diagnostic for SSS)
- Inappropriate alternation between rapid and slow heart rate.
- Atrial fibrillation triggered by bradycardia
- Heart rate below 30 at night
- Remarkably long pauses after atrial ectopic activity like PACs, SVT and atrial fibrillation (prolonged sinus nodal recovery time)
- Marked sinus arrhythmia not related to breathing
Not all those conditions are diagnostic of SSS but it may give the doctor hints toward the diagnosis. Long pauses are fairly diagnostic though, especially if they occur after atrial fibrillation.
I don't know what your doctor found on your EKG but your condition should possibly be further investigated? Also, keep in mind that all SSS conditions are not the same. They may vary from benign very mild variants, to severe variants with fainting and other arrhythmias. If so, treatment is pacemaker implant to secure that you have a "floor" in your heart rate; so it never can go below 50, while rapid heart rhythm is controlled with beta blockers.
I can't comment your Lyme myocarditis because I've never heard of it, but in general, myocarditis can cause a degeneration of sinus node, AV node, bundle branches; in general everywhere it causes inflammation.
You seem to be in great shape, so don't get too depressed about this. I would see another cardiologist for a second opinion.
Take care :)
Also, your question is very complicated and I don't think you will get it completely answered here. You can see another cardiologist for a second opinion, and/or ask your question in the Expert Forum ($20 fee).
If I should try to provide an answer:
I didn't know that SSS could be diagnosed with resting EKG. The normal method for diagnosing it is 48 hours Holter (preferrably, 24 is sometimes not enough) and if the Holter shows signs of SSS, an EP study is indicated to examine the sinus nodal function.
Changes on Holter consistent with SSS (as far as I know):
- Inappropriate bradycardia (like during exercise)
- Symptomatic bradycardia on several occations (fainting, dizziness with slow heart rate)
- Sinus pauses longer than 2,7 sec at daytime and 3 sec at night (diagnostic for SSS)
- Inappropriate alternation between rapid and slow heart rate.
- Atrial fibrillation triggered by bradycardia
- Heart rate below 30 at night
- Remarkably long pauses after atrial ectopic activity like PACs, SVT and atrial fibrillation (prolonged sinus nodal recovery time)
- Marked sinus arrhythmia not related to breathing
Not all those conditions are diagnostic of SSS but it may give the doctor hints toward the diagnosis. Long pauses are fairly diagnostic though, especially if they occur after atrial fibrillation.
I don't know what your doctor found on your EKG but your condition should possibly be further investigated? Also, keep in mind that all SSS conditions are not the same. They may vary from benign very mild variants, to severe variants with fainting and other arrhythmias. If so, treatment is pacemaker implant to secure that you have a "floor" in your heart rate; so it never can go below 50, while rapid heart rhythm is controlled with beta blockers.
I can't comment your Lyme myocarditis because I've never heard of it, but in general, myocarditis can cause a degeneration of sinus node, AV node, bundle branches; in general everywhere it causes inflammation.
You seem to be in great shape, so don't get too depressed about this. I would see another cardiologist for a second opinion.
Take care :)
So i am one freaking heart patient who does ride 30-40 km on day endurance cardio and feels GOOD? :)
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