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Sick Sinus Syndrome, Emergency Medicine

David F. M. Brown and Nirma D. Bustamante Reviewed 06/2017
 


Basics

Description

  • Collective term used to describe dysfunction in the sinus node's automaticity and impulse generation

  • Mechanism:

    • Caused by progressive degeneration of the intrinsic functions of the sin...

Diagnosis

Signs and Symptoms

Symptoms represent CNS hypoperfusion from bradydysrhythmia or traditional cardiovascular presentations 

History

  • Asymptomatic

  • Palpitations/fatigue

  • Syncope/presyncope/dizziness

  • An...

Treatment

Pre-Hospital

  • Advanced life support transport

  • Oxygen supplementation

  • Cardiac monitoring

  • Atropine if bradycardic and hemodynamically unstable

  • Transcutaneous pacing for unstable patients

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • New onset

  • Symptomatic: CHF, syncope, chest pain, dizziness

  • Persistent bradyarrhythmia or tachydysrhythmia

  • Advanced age; >60 yr

  • Patients should be admitted to a te...

Pearls and Pitfalls

  • Patients who are asymptomatic on ED arrival may have normal EKGs. Consider obtaining a rhythm strip or Holter monitor if clinical suspicion remains high.

  • Use of any nodal agents (BB...

Additional Reading

  • Adán  V, Crown  LA. Diagnosis and treatment of sick sinus syndrome. Am Fam Physician.  2003;67(8):1725–1732.

  • Anderson  JB, Benson  DW. Genetics of sick sinus syndrome. Card Elec...

Codes

ICD9

427.81 Sinoatrial node dysfunction 

ICD10

I49.5 Sick sinus syndrome 

SNOMED

  • 36083008 Sick sinus syndrome (disorder)

  • 233913007 Familial sick sinus syndrome (disorder)

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