Sick Sinus Syndrome

What is sick sinus syndrome?

Sick sinus syndrome is the name for heart rhythm problems that happen because your sinoatrial node (or sinus node) isn’t working right. The sinus node acts like a pacemaker that kicks off each heartbeat. Also called the SA node, the sinus node is like a drummer starting and keeping the beat for others to follow. Musicians listen to the drummer so they know when to start and stop. In this case, your SA node is telling the other areas of your heart when it’s time to do their part.

When your SA node isn’t working right, you can have a heartbeat that’s too slow (bradycardia).

What is the difference between sick sinus syndrome and atrial fibrillation (afib)?

With sick sinus syndrome, your SA node isn’t working correctly.

With atrial fibrillation, rogue electrical signals in your upper chambers override your SA node’s normal signals. This gives your upper chambers an abnormal beat.

What is the difference between sick sinus syndrome and AV block?

Sick sinus syndrome is a problem with your sinoatrial (SA) node, which sends signals to your upper heart chambers.

Atrioventricular (AV) block is a problem with your AV node, which sends signals to your lower heart chambers.

Who does sick sinus syndrome affect?

Healthcare providers usually see sick sinus syndrome in people who are older than 60 years of age.

How common is sick sinus syndrome?

Sick sinus syndrome isn’t common. American providers diagnosed 78,000 new cases in 2012 but expect to see 172,000 new cases in 2060.

What are the symptoms of sick sinus syndrome?

Often, especially at the start of the disease, people with sick sinus syndrome have no symptoms. If they do have symptoms, they include:

• Fainting.
• Lightheadedness or dizziness.
• Heart palpitations.
• Exhaustion.
• Shortness of breath.

While exercising, you may:

• Feel tired.
• Have trouble breathing.

What causes sick sinus syndrome?

Sick sinus syndrome has several causes. Sometimes, providers don’t know the cause.

Known causes of sick sinus syndrome include:

• Injury or breakdown of your heart’s electrical route or SA node due to aging.
• Injury to your SA node (from surgery for a heart transplant).
• Some medicines for high blood pressure or arrhythmia.
• Your genetics (a rare problem with your genes).
• Metabolic problems.

Other heart conditions can cause sick sinus syndrome, including heart failure and atrial tachyarrhythmias.

Other health problems can cause sick sinus syndrome, such as sarcoidosis, collagen vascular disease, inflammation, muscular dystrophy or cancer that has spread.

What are the risk factors for sick sinus syndrome?

You’re more likely to get sick sinus syndrome if you:

• Are older.
• Had heart surgery.
• Take medicines such as beta blockers or calcium channel blockers.
• Have a metabolic problem like high potassium or low calcium levels.
• Had other diseases like rheumatic fever, sarcoidosis or diphtheria.
• Have certain genetic mutations.

How is sick sinus syndrome diagnosed?

To diagnose sick sinus syndrome, your provider will want to make sure you don’t:

• Have a lack of essential minerals (electrolytes).
• Have sleep apnea.
• Take certain heart medicines that can cause problems with your SA node.
• Have a problem with how your body handles its chemical reactions.

Your provider will need to see a definite link between your symptoms and a slow heart rate (bradycardia) to diagnose sick sinus syndrome.

What tests will be done to diagnose sick sinus syndrome?

Your provider may order one or more of the following:

• Electrocardiogram (EKG).
• Heart rhythm monitors you wear at home.
• Electrophysiology study (EPS).
• Stress test.

How is sick sinus syndrome treated?

If you don’t have symptoms, you might not need any treatment. Depending on your symptoms, you may need medicine or a medical procedure. Sick sinus syndrome is the reason for one out of every two pacemakers in use in America.

What medications or treatments are used for sick sinus syndrome?

Your provider may want to do one or more of these treatments:

• Permanent pacemaker for slow heart rate (bradycardia).
• Medicine for a fast heart rate (tachycardia).
• Catheter ablation for a fast heart rate (tachycardia).

What are the complications of the treatment?

Any medical procedure has the possibility of complications. Those related to a pacemaker include:

• A lead (wire that connects your heart to the device) can get out of place.
• Your lung could collapse.
• You could get an infection.

If you have a catheter ablation, there’s a risk of:

• Bleeding.
• Blood clots.
• Infection.
• Abnormal heart rhythm.
• Injury to your heart or blood vessels.

How long does it take to recover from this treatment?

It may take several days to a week to recover from pacemaker surgery. You should recover completely in about a month.

How do I take care of myself with sick sinus syndrome?

• Be sure to avoid certain medicines if your provider told you to do so.
• Take medicines your provider ordered.
• Keep your follow-up appointments with your provider.

How can I reduce my risk of sick sinus syndrome?

Although you can’t control risk factors like your genetics or your age, there are some things you can do to reduce your risk of sick sinus syndrome:

• Take care of your heart to prevent heart disease.
• Check with your doctor to see if the medicines you take put you at risk.
• Keep your follow-up appointments for other health conditions that could put you at risk.

How can I prevent sick sinus syndrome?

Usually, you can’t prevent sick sinus syndrome.

What can I expect if I have sick sinus syndrome?

Sick sinus syndrome usually keeps getting worse slowly over many years, but some people never end up with other health issues connected to sick sinus syndrome. A pacemaker can help your symptoms and give you a better quality of life, but it may not extend your life expectancy.

How long does sick sinus syndrome last?

Sick sinus syndrome is a long-term problem that slowly gets worse over a number of years.

What is the outlook for sick sinus syndrome?

Getting a pacemaker gives you a great outlook. There is only a low risk of sudden cardiac death with sick sinus syndrome.

How do I take care of myself with sick sinus syndrome?

• If your provider ordered medicines for you, be sure to keep taking them as instructed.
• If you received a permanent pacemaker, follow your provider’s instructions for maintaining it.
• Be sure to keep any follow-up appointments with your provider.

What are the complications of sick sinus syndrome?

Other problems that can happen if you have sick sinus syndrome include:

• Heart failure.
• Fainting (and possibly getting hurt while fainting).
• Less of an ability to exercise.

When should I see my healthcare provider?

Contact your provider if you have sick sinus syndrome symptoms listed above or if you have a problem with your pacemaker.

When should I go to the ER?

Go to the ER if you have passing out spells.

What questions should I ask my doctor?

• Do you know the cause of my sick sinus syndrome?
• Will I need a pacemaker?
• How often will I need checkups if I get a pacemaker?

Is sick sinus syndrome hereditary?

Yes, but it’s a rare cause of sick sinus syndrome. Most people get it from other causes that are not inherited.

Can I exercise with sick sinus syndrome?

Yes, but it can be difficult. Once you get a pacemaker, you should be able to exercise more easily.

A note from Cleveland Clinic

Although some people with sick sinus syndrome don’t have symptoms, others can have fainting, chest pain or other problems. Since sick sinus syndrome usually gets worse over many years, it’s important to keep your appointments with your provider. They can catch anything that starts to develop and help you treat it right away.