🤧🫀🤔 Sick Sinus Syndrome (a.k.a. Sinus Node Dysfunction) is a disorder of the Sino-Atrial Node which causes patients to have a host of sinus-related dysrhythmia. This can include, but is not limited to: Sinus Bradycardia, Sinus Tachycardia, Sinus Arrhythmia, Sinus Pauses / Arrests, Sinus Exit Blocks, Wandering Atrial Pacemaker or Multifocal Atrial Tachycardia, Atrial Fibrillation, AV Nodal Reentrant Tachycardia, Atrioventricular Reentrant Tachycardia (if accessory pathways are present), Ectopic Atrial Rhythms, and Junctional or Ventricular Escape Rhythms. SSS is often accompanied by Tachy-Brady Syndrome, where patients experience both inappropriate paroxysmal bradycardias and tachycardias. SSS patients can be broadly categorized into those who experience tachyarrhythmias (more common) and those who only have bradyarrhythmias. These dysrhythmias are usually intermittent, and symptoms of instability associated with SSS are as well, coming and going as patients experience periods of these rhythms. Symptoms and instability are rate related, with pts experiencing low cardiac output from tachycardic or bradycardic rates. Symptoms may present as syncope or near syncope, palpitations, a feeling of a racing heart rate, weakness, fatigue, or patients may be asymptomatic. Causes of SSS are broad ranging and largely fall into intrinsic or extrinsic categories. Intrinsic causes are those primarily related to the heart itself, such as channelopathies, cardiomyopathies, ischemia, fibrosis, myocarditis, etc. While extrinsic causes are systemic, such as electrolyte imbalances, drug toxicity (especially digoxin), hyper and hypo thyroidism, etc. Emergent treatment for symptomatic unstable dysrhythmias associated with SSS should follow standard ACLS bradycardia or tachycardia algorithms, and definitive treatment outside of extrinsic reversible causes often requires permanent pacemaker placement. All EKG recordings are from the EKG rhythm generator on my website (LII rhythms only for now, 12Ls are in beta and coming soon), be sure to check it out for more software generated
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