Sick sinus syndrome

Description:

Sick sinus syndrome – easing or the termination of automatism of a sinus node as pacemaker owing to his defeat by any pathological process. It is characterized by alternation of the periods of bradycardia and tachycardia, arises because of reduction of number of specialized cells in a sinus node, proliferation of connecting fabric.

Reasons of a sick sinus syndrome:

It can be caused by ischemia of area of a node (quite often at a myocardial infarction, especially zadnediafragmalny as a passing or resistant complication), a cardiosclerosis (atherosclerotic, postmiokarditichesky, especially after diphtheria), myocarditis, a cardiomyopathy, and also infiltrative damages of a myocardium. The syndrome of weakness of a sinus node can be also manifestation of inborn feature of the carrying-out system. The process which caused emergence of a syndrome of weakness of a sinus node sometimes extends also to other pieces of the carrying-out system.

Classification:

The disease combines at least three main clinical groups:
1. Weakness of a sinus node of the organic nature.
2. Regulatory (vagal) weakness of a sinus node.
3. Medicinal (toxic) weakness of a sinus node.

Symptoms of a sick sinus syndrome:

The main manifestations of a sick sinus syndrome are the resistant sinus bradycardia or a sinoauricular block which are combined with ectopic arrhythmias.
Patients in whom this syndrome is found can complain of weakness, dizziness, heartbeat and "interruptions" in heart. Attacks of a loss of consciousness are less often noted.

Treatment of a sick sinus syndrome:

Treatment of a sick sinus syndrome is carried out by the following principles:

First of all cancel all drugs which can promote conductivity disturbance.
In the presence of a syndrome of "takhi-brada" tactics can be more flexible: at a combination of a moderate sinus bradycardia which yet is not the indication to installation of a constant electrocardiostimulator, and frequent "bradizavisimy" paroxysms of a ciliary arrhythmia in certain cases perhaps trial appointment of Allapinin in a small dose (on 1/2 tab. 3-4 of time a day) with the subsequent obligatory control at holterovsky monitoring.

Disopyramidum can serve as an alternative.

However over time progressing of disturbances of conductivity can demand cancellation of drugs with the subsequent installation of an electrocardiostimulator.

At preservation of bradycardia simultaneous use of Belloidum according to 1 tab. 4 times a day or Teopeka of 0,3 g on 1/4 tab. 2-3 of time a day is admissible.

The exception of a hyperpotassemia or hypothyroidism at which the patient can be wrong напрвлен on installation constant EX-is necessary!

At suspicion on a sick sinus syndrome follows abstain from purpose of the drugs suppressing a sinus node before carrying out holterovsky monitoring and special tests.
At detection of vegetative dysfunction of a sinus node careful correction of the vegetative status is carried out (verapamil of 120-160 mg/days in combination with Belloidum of 1 tab. 4-5 of times a day.

Purpose of beta-blockers in combination with cholinomimetics is inexpedient.

Often successfully Clonazepam korrigirut vegetative frustration atypical benzodiazepine (0.5-1 mg for the night, perhaps additional purpose of 0,5 mg in the morning or in the afternoon). Drug possesses nonspecific antiarrhytmic action.

In cases of acute development of a sick sinus syndrome first of all etiotropic treatment is carried out.
At suspicion on its inflammatory genesis administration of Prednisolonum of 90-120 mg in/in or 20-30 mg/days inside is shown).

Actually SSSU carry out the emergency therapy depending on its weight:
In cases of an asystolia, attacks of Morganyi-Edems-Stoksa resuscitation actions are necessary.
The expressed sinus bradycardia worsening a hemodynamics and/or provoking tachyarrhythmias demands purpose of atropine of 0,5-1,0 ml of 0,1% of solution п / to 4-6 times a day under control of the monitor.
With the preventive purpose the temporary endocardial stimulator can be established.