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Diagnosing sinus node dysfunction requires clinical symptoms as well as ECG abnormalities. If ECG findings cannot be identified, prolonged cardiac monitoring should be pursued either with a Holter monitor in an outpatient setting or telemetry while inpatient, due to the transient nature of abnormal ECG findings. [ 5 ]
Sinus bradycardia is commonly seen in normal healthy persons and athletes in the absence of pathophysiological diseases or conditions. [1] Different factors or etiologies could lead to the dysfunction of the sinus node, causing a malformation or prolongation of the impulse. In terms of pathophysiological diseases, sinus rhythm may be caused by:
Sinus node dysfunction also known as sick sinus syndrome is a group of irregular heartbeat conditions caused by faulty electrical signals of the heart. When the heart's sinoatrial node is defective, the heart's rhythms become abnormal—typically too slow or exhibiting pauses in its function or a combination, and very rarely faster than normal ...
Junctional rhythm is seen equally in men and women, and can be seen intermittently in young children and athletes, especially during sleep. It occurs commonly in patients with sinus node dysfunction. 1/600 cardiology patients over the age of 65 have sinus node dysfunction. [1]
Sinus pause and arrest involve slowing or arresting of automatic impulse generation from the sinus node. This can lead to asystole or cardiac arrest if ventricular escape rhythms do not create backup sources of cardiac action potentials. [2] Sinoatrial exit block is a similar non-respiratory phenomenon of temporarily lost sinoatrial impulses.
Treatment is rarely required because, in most cases, it is asymptomatic. If symptoms develop, medication can be pursued for symptomatic relief. In the setting of suspected sinus node dysfunction manifesting as wandering atrial pacemaker, evaluation for pacemaker placement may be done due to sinus node damage. [2]
Sinus tachycardia is a sinus rhythm of the heart, with an increased rate of electrical discharge from the sinoatrial node, resulting in a tachycardia, a heart rate that is higher than the upper limit of normal (90-100 beats per minute for adult humans). [1] The normal resting heart rate is 60–90 bpm in an average adult. [2]
An impulse (action potential) that originates from the SA node at a relative rate of 60–100 bpm is known as a normal sinus rhythm. If SA nodal impulses occur at a rate less than 60 bpm, the heart rhythm is known as sinus bradycardia. If SA nodal impulses occur at a rate exceeding 100 bpm, the consequent rapid heart rate is sinus tachycardia ...