What Are the Different Types of Compartment Syndrome Treatment?

Sick sinus syndrome is referred to as sick sinus syndrome, also known as sinus node dysfunction, which is caused by sinus node pulsation and / or sinus conduction conduction dysfunction caused by pathological changes in the sinus node and adjacent tissues. A syndrome of arrhythmias and clinical symptoms. In the case of sick sinus syndrome, in addition to the pathological changes of the sinoatrial node, pathological changes of the atrium, atrioventricular junction, and the heart's total conduction system can be combined. Among them, most patients develop symptoms over the age of 40, and are most common between the ages of 60 and 70.

Basic Information

nickname: Sinus syndrome, sinus node insufficiency
English name: sick sinus syndrome; SSS

Visiting department: cardiology
Multiple groups: 60 70 years old
Common symptoms: Dizziness, fatigue, poor memory, darkening, syncope, etc.

Etiology of sick sinus node syndrome

Common causes are cardiomyopathy, coronary heart disease, and myocarditis, and are also found in connective tissue disease, metabolic or invasive disease, and the etiology of many cases is unknown. In addition to the sinoatrial node and its adjacent tissues, the rest of the cardiac conduction system may also be affected, causing multiple potential pacing points and conduction dysfunction. When combined with atrioventricular junction pacing or conduction dysfunction, it is also called double knot disease. If the left and right bundle branches are involved at the same time, it is called a total conduction system disease.

The course of most of the sick sinus syndromes develops slowly, from 5 to 10 years or longer from the onset of symptoms to severe symptoms. A few acute attacks are seen in acute myocardial infarction and acute myocarditis.

Clinical manifestations of sick sinus node syndrome

Clinical manifestations vary, with intermittent episodes. Symptoms caused by insufficient blood supply to the brain, heart, kidney and other organs caused by slow heart rate, especially symptoms caused by insufficient blood supply to the brain.

Mild persons may develop fatigue, dizziness, dizziness, insomnia, poor memory, slow response or irritability, etc., and are often easily misdiagnosed as neurosis, especially the elderly are also easily misdiagnosed as stroke or aging syndrome.

In severe cases, it can cause transient darkening, threatened syncope, syncope, or Alzheimer's syndrome. Some patients with short-onset supraventricular tachyarrhythmias, also known as slow-fast syndrome. When a tachyarrhythmia occurs, the heart rate may suddenly accelerate up to 100 beats / min or more, and the duration may vary. When the tachycardia is abruptly stopped, there may be a cardiac pause with or without a syncope.

In addition to palpitations caused by severe bradycardia or tachycardia, it can also aggravate the symptoms of existing heart disease and cause heart failure or angina. In addition, when the cardiac output is too low, the perfusion of the kidneys and the like is seriously affected, resulting in less urine and indigestion. Slow-fast syndrome may also cause symptoms of vascular embolism.

Examination of sick sinus node syndrome

1. 24-hour ECG monitoring can record a variety of characteristic ECG manifestations of sick sinus syndrome. If the result is negative, it can be repeated in a short period of time: severe sinus bradycardia, less than 50 beats per minute; sinus arrest and (Or) sinoatrial block; bradycardia and tachycardia appear alternately. Among them, bradycardia is often sinus bradycardia, and tachycardia is often supraventricular tachycardia, atrial fibrillation, or atrial flutter. In addition, chronic atrial fibrillation often cannot be converted to sinus rhythm after cardioversion; persistent and slow atrioventricular borderline rhythms, and some patients can be combined with atrioventricular block and bundle branch block.

2. To rule out the effects of changes in autonomic tone, atropine test and isoproterenol test can be done. If the heart rate cannot be increased 90 times per minute after injection, it indicates that the sinus node function is low. But negative results cannot rule out the eigen. Use with caution in patients with glaucoma or markedly enlarged prostate.

3. For patients with sick sinus syndrome, the sinus node recovery time (SNRI) and sinus conduction time (SACT) measured by the atrial pacing method are often significantly longer than the normal high limit. Detection of sinus node function through transesophageal or direct atrial pacing is a more reliable diagnostic method for the diagnosis of diseased sinus syndrome, especially in combination with the effects of drugs blocking the autonomic nervous system, which can increase sensitivity.

4.24-hour ambulatory ECG monitoring can understand the fastest and slowest heart rate, sinus arrest, sinus atrial block and other arrhythmia.

5. In the treadmill or treadmill exercise test, if the heart rate does not increase significantly after exercise, it indicates that the sinus node function is poor. It must be closely monitored to prevent accidents.

Diagnosis of sick sinus node syndrome

Diagnosis steps of sick sinus syndrome:

1. May have a history of organic heart disease, some have a family history. There are also unknown reasons.

2. Hidden onset and slow course

The mild condition may be asymptomatic, and the severe condition may have clinical manifestations of inadequate blood supply to the brain, heart, and kidneys, and may even cause Alzheimer's syndrome and sudden death due to sinus arrest.

3. Sinus node dysfunction

Precautions such as drugs, neurological or metabolic disorders should be excluded.

4. Excitation test or exercise test

Intravenous atropine or isoprenaline and electrophysiological tests to detect sinus node function can be used for the diagnosis of sick sinus syndrome. The positive indicators of the atropine test are: sinus heart rate is less than or equal to 90 beats per minute after administration; borderline rhythm occurs; sinus bradycardia, sinus block or sinus arrest; induced atrial fibrillation.

5. Misdiagnosed diseases

The ECG manifestations are mainly based on sinus node dysfunction, and vagus nerve function or drug effects should be ruled out. Early or atypical cases of sinus node dysfunction may be intermittent, or sinus bradycardia is the main or only manifestation, often difficult to confirm.

Treatment of sick sinus node syndrome

Treatment principle

For sick sinus syndrome, medication is often difficult. Among them, drugs that treat tachyarrhythmias can induce bradycardia, such as digitalis, quinidine, procainamide, and beta-blockers; and drugs that treat bradycardia are often Induces tachyarrhythmias, including tachyarrhythmias, such as isoproterenol or ephedrine, and often lack long-term therapeutic effects. Various antiarrhythmic drugs often have significant and intolerable side effects. Therefore, it is necessary to grasp the timing and control the dose in drug treatment.

2. First, the cause should be as clear as possible

If the coronary arteries are significantly narrowed, percutaneous coronary angioplasty can be performed, and nitroglycerin can be used to improve coronary blood supply. For acute myocarditis, you can use energy mixture, high-dose vitamin C intravenously or intravenously.

3. Symptomatic treatment

(1) For patients without tachyarrhythmia, try atropine, ephedrine or isoprenaline to increase heart rate. In addition, nicotinamide is added intravenously in 10% glucose solution, and drugs that slow heart rate, such as beta blockers and calcium antagonists, are avoided.

(2) Implantation of on-demand artificial cardiac pacemaker It is best to use atrial pacing or frequency response pacemaker. On this basis, antiarrhythmic drugs can be added to control tachyarrhythmia.

Prevention of sick sinus node syndrome

Sick sinus node syndrome is often caused by degenerative lesions or fibrosis of the sinoatrial node and its surrounding tissues. You should actively search for the cause and remove the cause to prevent further development of the disease. If the heart rate is too slow, an artificial pacemaker can be implanted. To maintain normal life and work.

1. Actively treat primary disease

Such as active treatment of myocarditis, acute myocardial infarction and myocardial ischemia, restore electrolyte balance.

2. Use or discontinue various drugs that inhibit sinoatrial node function with caution

Such as -blockers, verapamil, digitalis and other anti-arrhythmic drugs.

3. Change your lifestyle

Daily life and proper diet. Keep your mood comfortable, pay attention to the combination of work and rest, and exercise appropriately, such as Tai Chi, walking, etc.

4. Acute sinus node dysfunction treatment

Should actively treat the cause, temporarily increase the sinus heart rate, so as not to evolve into chronic disease sinus syndrome; For the diagnosis of chronic disease sinus syndrome, should actively take the combination of traditional Chinese and western medicine to improve sinus node function. For those with poor drug treatment or obvious clinical symptoms, a permanent pacemaker should be implanted early to prevent the occurrence of sudden death.