Clinical Significance

Symptoms of SSS are due to the effects of either fast or slow heart rate. Common symptoms include syncope or near-syncope, palpitations, dyspnea, chest pain, and cerebrovascular accidents.

A wide variety of cardiac diseases can affect the sinus and AV nodes, producing the dysrhythmias of SSS: ischemic and rheumatic disorders, myocarditis and pericarditis, rheumatologic disease, metastatic tumors, surgical damage, or cardiomyopathies.

Conditions such as abdominal pain, increased intracranial pressure, thyrotoxicosis, and hyperkalemia, which increase vagal tone, may exacerbate the abnormalities of SSS and cause increased symptoms. Drugs such as digoxin, quinidine, procainamide, disopyramide, nicotine, b-adrenergic antagonists, or calcium channel blockers also cause increased symptoms.

Ambulatory ECG monitoring or EP studies are usually necessary for the diagnosis of SSS, since a routine ECG will not normally demonstrate the intermittent dysrhythmias common in this syndrome. The demonstration of increased sensitivity of the sinus node to carotid sinus massage, the Valsalva maneuver, or atropine suggests sinus node dysfunction but is not conclusive proof for the diagnosis of SSS.

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