Sick Sinus Syndrome (SSS)

S. Umarani1, N. Indhumathi2

1Assistant Nursing Superintendent, Kauvery Heartcity, Trichy, India

2Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India

*Correspondence: Tel No: +91 8508698000; nursing.heartcity@kauveryhospital.com

Abstract

Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. While the syndrome can have many causes, it usually is idiopathic. Patients may experience syncope, pre-syncope, palpitations, or dizziness; however, they often are asymptomatic or have subtle or nonspecific symptoms. Sick sinus syndrome has multiple manifestations on electrocardiogram, including sinus bradycardia, sinus arrest, sinoatrial block, and alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome). Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. The mainstay of treatment is atrial or dual-chamber pacemaker placement, which generally provides effective relief of symptoms and lowers the incidence of atrial fibrillation, thromboembolic events, heart failure, and mortality, compared with ventricular pacemakers.

Permanent pacemaker insertion plays a key role in the management of heart rhythm disorders and heart failure. The number of permanent pacemaker insertions has been steadily increasing. Pacemaker is an electronic device approximately the size of a pocket watch that senses intrinsic heart rhythms and provides electrical stimulation when indicated.

Single chamber pacemaker: With this device one pacing lead is implanted in the right atrium or ventricle.

Dual chamber pacemaker: With this device two pacing leads are implanted (one in the right ventricle and another one in the right atrium). This is the most common type of implanted pacemaker.

Biventricular pacing cardiac resynchronization therapy: With this approach,s in addition to single or dual chamber right heart pacing leads, a lead is advanced to the coronary sinus for left ventricular epicardial pacing.

This case report presents Ms. XX, 64 years old female, who was diagnosed with Sick Sinus Syndrome. In view of the same, the patient was advised PPI.

Details of present Illness

Patient C/O giddiness 10 days ago for which she was initially evaluated at an outside hospital and advised Holter monitoring. Holter showed 3° AV block (longest pause 8:4 sec) sinus arrhythmia.

Past illness

Type II DM – 4 years, CAD.

Examination

CVS: S1 S2 SPO2: 98%
RS: B/LAF BP: 140/80mmHg
P/A: Soft HR: 44b\m
CNS: NFND RR: 24b\m
Temp: 986Fdeg GRBS: 120mg/dl

Diagnosis:

  1. Sick Sinus Syndrome.
  2. Tachy Brady Syndrome.
  3. Underlying? CAD.
  4. Type II DM

ECG: Illustrates several sinus node impulse abnormalities

several-sinus-node-1
several-sinus-node-12
several-sinus-node-3
several-sinus-node-4

Nursing Management

  1. Patient was received from Cath lab to CCU contiune cardiac monitring.
  2. Nurses maintained an every 15mins check BP chart. BP was stablized with inotropes and IV fluids.
  3. Doctors explained the patient condition to the attenders nurses obtained consent for the clinical procedure after proper concelling.
  4. Nurses used AIDET techniques – acknowledge, introducing duration, explanation and thank you while communication with patient and attenders to give their confidence and improve the satisfaction level.
  5. Patient monited to I/O chart.
  6. Dressing was obtained.
  7. Patient stablized discharge followed as per doctors advice.

Out come

On discharge, patient was hemodynamically stable.

Umarani

Ms.Umarani

Assistant, Nursing Superintendent

Indumathi

Ms. Indumathi

Nursing Incharge

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