Sick Sinus Syndrome

What is Sick Sinus Syndrome?

Combination of uncommon cardiac rhythm related problem is collectively termed as Sick Sinus Syndrome. This condition arises due to the SA node of the heart, which is also known as natural heart pacemaker does not function properly and an arrhythmic condition arises. Heart beats become fast or slow can associate with Sick Sinus Syndrome.

The arrhythmic conditions which cause disorder of the heart rhythm includes:

• Sinus bradycardia — SA node generates slow heart rates.
• Sinus pauses or arrest — Functionality of the SA node becomes stop for a certain period of time.

Even the heart beat distribution is not similar for all the chambers of the heart, which include:

• Atrial tachycardia — The upper chambers (atria) of the heart have  fast heart rates
• Alternate Bradycardia & tachycardia – irregular, fast and slow heart rhythms. ^(1,2)

Symptoms

Sick Sinus Syndrome is asymptomatic or not specific, as the arising symptoms are quite similar as other cardiac disorders:

• Angina or intense chest pain
• Alteration of mental status or development of the confusion
• Sudden unconsciousness or nearly becomes unconscious
• Little physical exhaustion causes tiredness
• Dizziness
• Vertigo
• Palpitation or heart beat can feel
• Little physical activity followed with Shortness of breath. ^(2,3)

Causes

The exact cause of the Sick sinus syndrome is not always identified. But usually incidence is common in elderly persons (50 years or above), but may children also affect with this condition.

It has been noted that damage in the cardiac conduction system  is common. The reason of damage may vary from case to case. The possible ailments which interfere the cardiac conduction system  include hypertension, CAD (coronary artery disease; valve disorders, though maximum cases the presence of these cardiac diseases may not interfere with sick sinus syndrome. ^(4,5)

Risk Factors

The cause of sick sinus syndrome is not certain, but some considerable risk factors are:

• Age
• History of myocardial infarction or heart attack
• Certain antihypertensive drugs and cardiac drugs like  digitalis, anti-arrhythmics calcium channel blockers, and beta-blockers insist SSS
• Abnormal thyroid gland function
• Nocturnal breathing cessation
• Cardiac operation

Some rarely interfering aliments or conditions are also involved

• Diphtheria is an infecting disorder that can damage the cardiac muscle
• Excess iron in the blood (Hemochromatosis)
• A hereditary muscular degenerative condition and clinically termed as muscular dystrophy.
• Amyloidosis is a condition in which amyloid (a protein) is deposited in tissues or organs. ⁽²⁾

Diagnosis

Symptomatic analysis for sick sinus syndrome is not possible; as sick sinus syndrome is generally asymptomatic.

• Medical history assessment, including regular consumption medications and physical examinations, including hearing of heartbeat by using a stethoscope and found irregular in positive association with the disease. Other included diagnostic tests are:
• ECG or Electrocardiogram is the graphical interpretation of impulse generation and transmission in the cardiac muscle. The experts interpret the result to diagnose the presence of cardiac arrhythmia and the type of arrhythmia.

• Holter test provides the prolonged (24-hour period (or longer) report of cardiac rhythm, which assists to detect the type of arrhythmia depending upon its origin.
• Event monitors can be possible by a medical device which records the event which insist arrhythmia, which may not be recorded within a 24-hour period.
• Electrophysiology study (EPS) also helps to doctors in determining the type of arrhythmia   based on the mapping of the cardiac muscle and electrical impulses in a cardiac catheterization laboratory. ^(4.6)

Treatment

• Surgical intervention for insertion of artificial pacemaker can use to solve the bradycardia (slow heart rate). Recent development of medical science produce atrial or dual-chamber pacemakers generally offer effective relief from symptoms and the rate of incidence of thromboembolic events, atrial fibrillation, cardiac failure and related mortality become lower in with ventricular pacemakers.
• Certain medications like beta-blockers, digoxin  and quinidine may be prescribed to control the tachycardia in combination of incorporation of a pacemaker.
• Anticoagulation therapy will be incorporated in case of atrial fibrillation. (4,6)

Complications

Frequent fainting is a common complication due to slow heart rate.

Prolonged alteration of heart rhythm can cause increased work load in cardiac muscle, which increases the cardiac work load to fulfill the body’s need. This may lead to Congestive heart failure.

Alternate bardicardia and tachycardia syndrome cause thrombus formation in the coronary artery and leads to stroke.

Atrial fibrillation often leads to tachycardia and upper pooling of the blood may assist to thrombus travels to brain and cerebral stroke can be a complication.

Insufficient blood supply in cardiac muscle can cause Myocardial infarction that leads to sudden cardiac death. (4,5)

ICD 9 code

Billable medical coding or ICD-9-CM is 427.81. This can be utilized as to specify a diagnosis on a financial compensation claim. , The code number 427.81 is applicable only used for claims with a date of service on or prior to September 30, 2015. (7)

References

1. Michael A. Chen, (2014); Sick sinus syndrome; Retrieve from: https://www.nlm.nih.gov/medlineplus/ency/article/000161.htm
2. Sick Sinus Syndrome, (2016); The New Work Times; Retrieve from:
   http://www.nytimes.com/health/guides/disease/sick-sinus-syndrome/overview.html
3. Sick Sinus Syndrome; Heart Rhythm Society; Retrieve from:  http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Sick-Sinus-Syndrome
4. Sick sinus syndrome (2014), Mayo Clinic; Retrieve from:  http://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/basics/complications/con-20029161
5. Sick Sinus Syndrome (2015); Texas Heart Institute; Retrieve from: http://www.texasheart.org/HIC/Topics/Cond/sicksinus.cfm
6. Dr Colin Tidy (2014); Sick Sinus Syndrome; Retrieve from: http://patient.info/in/doctor/sick-sinus-syndrome
   ICD Code; Retrieve from: http://www.icd9data.com/2013/Volume1/390-459/420-429/427/42