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Sick Sinus Syndrome is included in the categories of "mai chi", ":tin ji" , ":xuan yun" , "xiong hi", "jue zheng" , etc.
1. Coronary heart disease, myocarditis and myocar-diopathy are the common causes of sick sinus syndrome. Other organic heart diseases such as rheumatic heart disease, hyper-tensive heart disease, pericardial disease, degenerative disease and metabolic disease of the heart may be the causes. Some pa-tients have no definite cause.
2. The commonest clinical manifestation is persistent si-nus bradycardia, usually less than 50 beats / min. Based on bradycardia the patient may have sinus nodal arrest, sinoauric-ular block, and atrioventricular block. Some patients may have tachyarrhythmia such as atrial fibrillation or paroxysmal supraventricular tachycardia. Sometimes there is bradycardia. Therefore, the disease is also called bradycardia-tachycardia syndrome. The change of heart rate or heart rhythm may cause decreased perfusion of the brain, heart and kidney, re-sulting in such symptoms as dizziness, syncope, chest distress, angina pectoris and even shock or sudden death.
3. Provocative tests:
(1) Exercise test: In the submaximal exercise test, when the heart rate can not reach 100 beats / min or the sinoauricu-lar block and escape rhythm appear, it is considered to be posi-tive. But in this test there are more false-positive results.
(2) Atropine test: After intravenous injection of atropine 1~2mg, the electrocardiograms at 1, 2, 3, 5, 10 and 15 minutes are recorded. If the heart rates are less than 90 beats / rain or junctional rhythm or ectopic tachycardia appears, it is considered to be positive. Atropine test is superior to the exercise test.
(3) Determinations of sinus node recovery time (SNRT), sinoatrial conduction time (SACT), and intrinsic sinus rate can be performed by atrial pacing through esophagus or elec-trophysiological study through catheterization. Among them, SNRT is most valuable and exceeds 2000 milliseconds in sick sinus syndrome.
The evaluation of the results from aforesaid tests should be carried out in combination with clinical data. In performing these tests, unless the effect of vagus nerve and sympathetic nerve on heart rate is eliminated, the results are less clinically significant.