Sick Sinus Syndrome
Sick Sinus Syndrome - a general concept characterized by violation of rhythm and the resulting decrease or absolute cessation of work of automatic atrial and sinus.With sick sinus syndrome occur certain processes in which broken pulses education and conducting from SU in atrium in the form of signs of bradycardia and arrhythmias associated ectopic nature.In these patients with sick sinus syndrome may suddenly come cardiac arrest.
Basically, this anomaly is frequently diagnosed in people after sixty years, with no benefits sexually.However, the disease is sometimes detected among these patients, both children and adolescents.
dysfunction SU is formed as a consequence of the nature of organic lesions, as well as a consequence of drug and autonomic disorders of the automatism, which eliminated the appointment of the necessary preparations for the restoration of cardiac function, or the cancellation of those drugs, which are characterized by participation in the formation of
sick sinus syndrome causes
Among etiological factors affecting the development of the primary form of anomalies noted dysfunction due to organic lesions of the sinoatrial area character.This is primarily cardiac pathology - hypertension, heart disease, cardiomyopathy, coronary artery disease, myocarditis, surgical trauma etiology and heart transplantation.Reasons also include degenerative diseases and infiltrative nature, hypothyroidism, changes in the bones and muscles, senile amyloidosis etiology, malignant tumors of the heart, the heart of scleroderma, sarcoidosis.
sick sinus syndrome can be triggered by ischemia, which causes artery stenosis, and she, in turn, feeds and SU zone sinoatrial character.As well as a variety of inflammation and infiltration, degeneration, hemorrhage, necrosis and sclerosis are considered contributing factors of this syndrome.
Secondary causes symptoms of sick sinus syndrome associated with exogenous factors that directly affect the SU.Among them are factors such as hypercalcemia, hyperkalemia, drug therapy, which reduces the work of SU (Clonidine, verapamil, dopegit, b-blockers, Cordarone, cardiac glycosides).
External factors influencing the formation of sick sinus syndrome refers VPSU (autonomic dysfunction SU).It is often celebrated with the vagus nerve hyperactivation property that causes bradycardia and processes, lengthens Refractory this site.The vagus nerve may acquire increased tone and during sleep and urination, dyspepsia, during swallowing and cough, as well as during the Valsalva maneuver tests.The appearance of abnormal activity of the nerve can be caused by inflammatory processes in the throat, digestive tract and urinary system, which differ by the presence of abundant innervation.All this can happen at rise in temperature and intracranial pressure, sepsis and hyperkalemia.
In addition, the true form of sick sinus syndrome in people involved in professional sport, can be combined with other pathologies arrhythmias resulting degeneration of the heart muscle.
Sick Sinus Syndrome symptoms
Symptoms of sick sinus syndrome consists of several course options: latent, compensated, decompensated and bradisistolichesky type with constant atrial fibrillation.
latent variant of sick sinus syndrome is characterized by the absence of clinical symptoms and ECG displays.But this node dysfunction defined by electrophysiological studies.Also not marked limitation of ability to work, and in this form of the syndrome is no need to implant the pacemaker.
Compensated variant of sick sinus syndrome is divided into two subspecies: bradisistolichesky and braditahisistolichesky.In the first case, the patient's clinical symptoms strongly expressed in the form of complaints to the feeling of weakness and dizziness appear.It is noted in the partial restriction of employability, but surgery to implant a pacemaker is not carried out.In the second case, braditahisistolii to clinical manifestations of the second embodiment join tachyarrhythmias of paroxysmal nature.The pacemaker is implanted in the decompensation of the disease with the purpose of antiarrhythmic treatment.
Decompensated option of sick sinus syndrome is also divided on the course with bradysystole and braditahisistoliey.The first form is characterized by persistent severe SB (sinus bradycardia), and manifestations of disorders of cerebral circulation, inadequate functioning of the heart because of bradyarrhythmias.At the same time patients have limited ability to work, and the implantation of a pacemaker is indicated in asystole and restoration, SC for more than three seconds.For the second form (Short syndrome) is characterized by all the symptoms of the previous form of sick sinus syndrome with the addition of supraventricular tachycardia, atrial flutter and atrial fibrillation.In this case, the patients completely lose the ability to work, and therefore the implant is indicated for the same indications as in bradisistolicheskom type decompensated versions.
At constant bradysystole atrial fibrillation characterized by symptoms and bradisistolicheskie tahistolicheskie.The first version is limited ability to work, and there are no specific indications for surgical intervention.In the second case - the pacemaker is implanted in the symptoms of cerebral character and heart failure.
for sick sinus syndrome is characterized by acute and chronic diseases with possible relapses.The acute form develops as a consequence of myocardial infarction.A recurrence of sick sinus syndrome may have a progressive course in a stable or slow form.
reasons for the formation of the primary forms of sick sinus syndrome are the sine and atrial lesion areas, and in the secondary - dysregulation of the autonomic system.
Symptoms variants of this syndrome is characterized by a variety of clinical manifestations.In particular cohort of patients symptoms of sick sinus syndrome for a long time can not be themselves and other patients is expressed heart rhythm disorder, accompanied by pain in the head, seizures of Morgagni-Adams-Stokes and dizziness.In addition, developing cardiac asthma type, pulmonary edema and angina pectoris, and in rare cases - myocardial infarction.
Basically the whole clinic sick sinus syndrome is based on the cerebral and cardiac symptoms.The first variant is expressed in the patient's fatigue, his irritability, forgetfulness and emotional lability and elderly patients is reduced intelligence and memory.But with the progression of the pathology, all symptoms of cerebral character begins to gradually increase.In this case, there are signs presyncopal then pale skin becomes cold and covered with cold sweat, and the pressure drops sharply.
To promote the emergence of syncope can be: tight collar, a sharp head movement and coughing.Typically, these fainting pass without medical care, but in protracted forms - emergency care is a must.
When expressed signs of bradycardia enhanced dizziness, memory loss appear, irritability, paresis, insomnia and swallowing the words.
Signs of cardiac symptoms associated with the occurrence of a sustained pulse sensation or irregular filling, as well as the pain of the chest, due to a lack of function of the coronary circulation.Later joined arrhythmia in the form of shortness of breath, failure in the functioning of the heart, heartbeat, weakness and lack of development of the chronic form of the heart.
At the time of progressive course of sick sinus syndrome appears tachycardia or fibrillation ventrikulyatnogo nature, which increases the risk of SCD (sudden cardiac death).There are also other organic manifestations of the disease - is oliguria, intermittent claudication, disturbances in the gastric and intestinal tract, weakness in the muscles as a result of oxygenation.
An objective examination reveals bradycardia at night, which can take place with loads of physical properties;sinoatrial block or ectopic rhythms of nature.
sick sinus syndrome in children
It is a complex condition that involves a reduced ability to perform a variety of options for SU impulse conduction.This pathology in children is an irreversible process of destruction SU and centers that lie below it, which reduce the heart rate.Sick sinus syndrome manifested organic nature of violations SU and requires early detection of patients with this pathology and timely surgical intervention in order to prevent the sun's syndrome (sudden death).To do this screening only children born to prevent deaths among children of different ages in the future.
Symptoms of sick sinus syndrome in children is characterized by such forms as transient (in the background of inflammatory diseases of the heart muscle), constant (for heart defects) or progressive (with cardiomyopathy, with the syndrome Romano-Ward), but mainly affects the vascular system.
difficulty in diagnosing sick sinus syndrome in children are asymptomatic cases in which the Armed Forces due to VF or asystole may be the only sign of a pathological process.Therefore, analysis of the symptoms of the disease debuting in children and especially its detection saved from all actuality.
50% of children have this pathology occurs without symptoms and signs of the disease are detected by chance.The remaining half of sick children suffering syncopal attacks, headaches, weakness, heart rhythm disruptions, dizziness.These children on the ECG revealed sinus bradycardia pacemaker or migration.And in the absence of treatment, 40% of the developing sinoatrial block, and fully rejects SU.But even in asymptomatic disease syndrome progresses slowly.
electrocardiographic sick child marked bradycardia, migration rate, supraventricular tachycardia, fly-out rhythms.
In the first variant of sick sinus syndrome in the heart of the state of syncopal or appear predsinkopalnogo character.The second option pathology develops depending on the specific situation of electrophysiological nature have a single child.With existing latent ways of additional properties, formed a third option, a syndrome characterized by the occurrence of tachycardia bradycardia.But already at the fourth embodiment, sick sinus syndrome observed severe persistent bradycardia and asystole.It also notes bradikarditicheskaya form of fibrillation and atrial flutter.
Almost 40% of young patients feel dizziness, severe weakness, blackout, and 50% have expressed disturbances in the circulation of the brain.These children rapidly become pale, they may suddenly stop breathing and convulsions appear.Therefore, it is often the fourth version of the pathological process referred to kardionevropatiyam.
sick sinus syndrome treated
Medical actions of sick sinus syndrome will depend on the degree of conduction disturbances SU, etiological factors, severity of symptomatic picture of the disease.
With minor forms of sick sinus syndrome is prescribed therapeutic treatment of primary disease and monitoring by a cardiologist.But the use of drugs is used when a minor bradyarrhythmias and tachyarrhythmias, although in this case they did not have a significant effect.
basic and effective method of treatment of sick sinus syndrome is the implantation of a pacemaker.When expressed clinical manifestations characteristic pathology of implantation of the device, which generates pulses at a specific heart rate falling to the lowest levels.
for pacemaker implantation into account the presence of a single attack on Edems Morgagni-Stokes, bradycardia with heart beats per minute less than forty, dizziness, state presinkopalnogo nature, lack of coronary circulation, high blood pressure and bradycardia in combination with other arrhythmias.
Thus, we must always remember that in the absence of appropriate treatment of sick sinus syndrome, patients can live for an average of a few weeks, and it will depend on the extent of the disease.In general, this pathology has a large variability, which is characterized by a lifetime without treatment week to ten years, and in some cases even more.