Sick Sinus Syndrome

Aster Hospital recently received its first International cardiac patient, a 35 year old Nigerian lady, banker by profession who presented with dizziness and multiple episodes of visual blackouts for the last 8 years and increasing frequency since last 1 year. She was previously seen by local practitioners in Nigeria and was managed as generalized weakness and nutritional deficiency. Upon recent evaluation by a Cardiologist in Nigeria, she was diagnosed to have Sinus Node dysfunction and was advised further management.

The patient chose Aster Hospital, Mankhool (Dubai) as her preferred healthcare service provider and visited Dubai especially for her treatment. On presentation, the patient had bradycardia with heart rate of 40/min. Her ECG was showing Junctional Bradycardia with narrow QRS escape with heart rate of 43/min. ECHO showed bi-atrial enlargement moderate mitral regurgitation and moderate tricuspid regurgitation, PAH with normal bi ventricular function suggestive of restrictive disease. Holter monitor showed bradycardia with lowest heart rate of 33 and more than 90% of rhythm was bradycardia with less than 50/min. Diagnosis of possible restrictive heart disease with Sinus Node dysfunction with symptomatic Junctional Bradycardia was made with the plan of insertion of dual chamber MRI safe permanent pace maker. After technical difficulty, the patient underwent successful placement of ventricular and atrial leads due to significant tricuspid regurgitation and hugely dilated right atrium, with good lead parameters. Patient was discharged in stable condition with the advice of MRI heart to rule out infiltrative heart disease and prognosis.

Sick sinus syndrome (SSS) or sinoatrial node disease (“SND”), is a group of abnormal heart rhythms (arrhythmias) presumably caused by a malfunction of the sinus node, the heart’s primary pacemaker. While the syndrome can have many causes, it usually is idiopathic. Patients may experience syncope, pre-syncope, palpitations, or dizziness; however, they often are asymptomatic or have subtle or nonspecific symptoms. Sick sinus syndrome has multiple manifestations on electrocardiogram, including sinus bradycardia, sinus arrest, sinoatrial block, and alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome). Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. The mainstay of treatment is atrial or dual-chamber pacemaker placement, which generally provides effective relief of symptoms and lowers the incidence of atrial fibrillation, thromboembolic events, heart failure, and mortality, compared with ventricular pacemakers.

Dr. Naveed Ahmed 

Specialist Interventional Cardiologist 

Aster Hospital, Mankhool

         

X- Ray Chest Showing Cardiomegaly                    ECG – Junctional Bradycardia