Sick Sinus syndrome

Signs and symptoms
1. unconsciousness /Syncope (causes)
  1. No-cardiac
    1. Toxic
      1. Endogenous toxicosis
      2. Exogenous toxicosis
    2. Endocrine
      1. Hypoglycaemia
      2. Hyperglycaemia
    3. Cerebral
      1. Epilepsy
      2. Apoplexy
      3. Intracerebral bleeding
    4. Psychical
      1. Hysteria
    5. Anoxaemic
      1. Asphyxia
    6. Others
      1. Alcohol
      2. Exercise
  2. Cardiac
    1. Stroke
    2. Shock
    3. Cardiac arrest
2. Dyspnea
3. Chest pain
Psychology
1. Threat to employment and financial status
2. Frightening from Life threatening event
3. Reduced life expectancy
4. Being treated differently by other people
5. Fears for family and partner being left alone
6. Depression
Diagnosis
1. Investigation
  1. ECG
    1. Normal
    2. SSS
  2. chest x-ray
  3. cardiac CT
  4. Cardiac MI
  5. Echocardiogram
  6. Angiography
2. History taking
Treatment
1. CPR
  1. 1.Check the scene and the person 2.Call 998 for assistance 3.Check for breathing 4.Open the airway 5.Push hard, push fast 6.Deliver rescue breaths 7.Continue CPR steps
2. Non-surgical (anti-arrythmia drugs)
  1. Amiodarone
3. Surgical (artificial pacemaker)
  1. Temporary
    1. Heart attack
    2. heart surgery
    3. overdose
  2. Permanent
    1. bradycardia
    2. heart block
4. Life style changes
Physiology
1. Mechanism of excitation, contraction & coupling
2. Cardiac action potential
3. Pacemaker physiology
  1. 60 - 100 b/m
  2. 40 - 60 b/m
  3. 20 - 45 b/m
4. Conduction system of the heart
  1. SA node
    1. AV node
      1. bundle of his
        bundle branches
        Purkinje fibers
5. Electrical behavior of the myocardium
  1. anatomy
    1. Atrial msucle
    2. Ventricular muscle
    3. Specialized excitatory /conductive muscle ﬁbers
  2. Special structures
    1. Intercalated discs
    2. gap junctions
  4. mechanism
    1. has long action potential and plateau
    2. Refractory Period of Cardiac Muscle is longer
      1. Absolute refractory period
      2. Relative refractory period
    3. Calcium Ions and the Transverse Tubules
Definition
1. Group of disorders that are caused by malfunction of the sinus node
Types
1. Sinus Tachycardia
2. Sinus Bradychardia
3. Sinus arrest
4. Sinus Bradychardia-Tachychardia
Causes
1. Fibrosis of SA node
2. Acute MI
3. Myocarditis

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Sick Sinus syndrome

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