Sick Sinus Syndrome
Treatment
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Treating Sick Sinus Syndrome depends on the individual. If
a person has no symptoms, regular checkups to monitor the
condition may be all that's required for the short term. Patients
with symptoms, however, usually require one or more of the
following treatments:
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The primary treatment for sick sinus
syndrome is a permanent
pacemaker.
This small, implanted
device continuously monitors the heart's natural rhythm. It
delivers an electrical impulse to stimulate (pace) the heart's
muscle contractions if the heart rate drops below a certain
number of beats per minute. The electrical signals are mild
and the patient does not feel them. Pacemakers also can help
manage a too-fast heart rate.
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Medications
that might be contributing to the slow heart rhythm can
sometimes be reduced or changed. Sometimes these adjustments
in medications are sufficient to correct the slow heart
rhythm without a pacemaker. |
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Pacemakers |
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Implanted Pacemakers
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A pacemaker is a small, electronic device
that monitors and regulates the rhythm of the heart. It
is implanted under the skin near the collarbone. One or
more special wires called "leads" are positioned in the
heart. The leads monitor the heart's rhythm and send signals
to the pacemaker. If needed, the pacemaker sends signals
back to the heart to keep it beating normally. |
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The pacemaker itself is a small generator that contains
a battery, electronic circuitry and computer memory.
The pacemaker is programmed by an electrophysiologist
(a cardiologist who specializes in heart rhythm problems)
or another physician who is an expert in pacing.
The pacemaker is programmed to stimulate, or "pace,"
the heart at a rate that is best for each patient. The
doctor's instructions can be changed, if needed, with
a device called a programmer. A wand (much like a computer
mouse) is placed on the patient's chest directly over
the pacemaker. Information is sent back and forth between
the pacemaker and the programmer using radio waves.
The procedure is painless and the radio waves are not
harmful to the patient.
After five to 7 years, the batteries in a pacemaker
wear down and the pacemaker must be replaced. The function of the
pacemaker and the strength of the battery are monitored
at regular intervals by the doctor or other professional.
Sometimes, a pacemaker can be tested with signals sent
over the telephone. In this technique, the patient is
given a number to call. He or she places the telephone
receiver over the pacemaker and information is sent
through the telephone line.
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can be changed with a device called a programmer.
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There Are Three
Basic Types of Pacemakers
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Single-Chamber Pacemakers. In a single-chamber pacemaker,
only one wire (pacing lead) is placed into a chamber of the heart. Sometimes it is the
upper chamber, or atrium. It also may be placed in a lower chamber, or ventricle.
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Dual-Chamber Pacemakers
In dual-chamber pacemakers, wires are placed in two chambers of the heart.
One lead paces the atrium and one paces the ventricle. This more closely matches the natural
pacing of the heart. Also, this pacemaker can follow the heartbeats originating in the atrial
(upper) heart chamber and pace the ventricular (lower) heart chamber to maintain coordinated
function between the atria and ventricles. |
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In the largest clinical trial of pacemakers conducted
in the U.S., researchers found that patients with
Sick Sinus Syndrome
benefit from dual chamber pacemakers.
They are less likely to develop atrial
fibrillation or mild forms of heart
failure compared to people who are treated with
single-chamber pacemakers.
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Rate-Responsive
Pacemakers have sensors that automatically adjust to changes in a person's physical
activity. As the level of exercise increases, so does the pacing of the heart rate.
This mimics the natural pacemaker function of the heart, and seems more "natural" to
many pacemaker wearers. Rate responsive pacemakers may be either single- or dual-chamber
devices.
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Medications |
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Medications
called anti-arrhythmics are sometimes prescribed for sick sinus
syndrome. For certain types of SSS, beta-blockers or drugs called
antiorrhythmic agents may be prescribed to treat the fast rhythms
or tachycardias. Other people may need medications to correct
electrolyte imbalances. Blood thinners (anti-coagulants) usually
are prescribed for patients with atrial
fibrillation or other abnormal heart rhythms that increase
the risk for stroke. Many people with
SSS take medications in addition to having a pacemaker.
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Treating Underlying Conditions
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Patients with heart rhythm disorders also may have other diseases
or conditions that contribute to the problem, or affect the
success of treatments for the arrhythmia. If you have other
medical problems in addition to sick sinus syndrome or another
arrhythmia, it is important that your personal physician and
any specialists involved in your care work together to coordinate
treatments. Some medications
prescribed for conditions such as coronary artery disease and
high blood pressure, for example, may cause or contribute to
heart rhythm disorders. Some slow down the heart rate, which
can have serious potentially life-threatening consequences for
people with sick sinus syndrome or other types of bradycardia.
In this case, an electrophysiologist or other expert in arrhythmias
should be consulted to be certain that medications prescribed
for other problems will not put a patient at risk of a dangerously
slow heart rate. Examples of treatments that may be needed to
prevent worsening of the symptoms of SSS or other arrhythmias
include:
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surgery or other
procedures may be needed to repair heart valve
problems
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angioplasty or coronary
artery bypass surgery to open or bypass clogged
blood vessels that supply oxygen and nutrients to the
heart muscle
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medications to control
conditions such as high blood pressure, diabetes, thyroid
disease or infection.
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Toxins in the environment
also can contribute to bradycardia, should be taken to
reduce or eliminate exposure to these substances. |
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Lifestyle Changes
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make changes in their lifestyle to improve their overall health
and/or minimize the symptoms of disease to maintain an active,
normal lifestyle. For example: |
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get regular exercise,
including physical rehabilitation programs if you have
serious heart disease.
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eat
a healthy diet that is low in fat, includes plenty
of fruits and vegetables and contains needed amounts of
vitamins, minerals and fiber. People with heart disease
who have symptoms of edema (swelling) should be especially
careful to avoid sodium (salt).
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don't smoke
and avoid exposure to secondhand smoke.
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avoid or limit intake
of alcoholic beverages. Excessive alcohol use can
damage the heart muscle and make SSS and other heart disorders
worse. It also is a major cause of heart
failure.
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avoid substances
that can cause heart rhythm disorders.
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avoid or limit
caffeine. Caffeine causes palpitations or other
irregular heart rhythms in some people.
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maintain a desirable
weight. Excess weight puts a burden on the heart.
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reduce
or control stress. When you are stressed and anxious,
your body releases hormones and other substances that
put an extra strain on the heart.
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keep
all doctor or clinic appointments and have regular
checkups. If you have an abnormal heart rhythm, ask your
doctor if you should consult with an electrophysiologist,
a cardiologist who specializes in rhythm disorders.
If you have a pacemaker or defibrillator you must keep
follow up appts to provide optimal programming and monitor battery life.
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