Is your heart beating irregularly? Let's talk about Sick Sinus Syndrome!

Have you ever felt like your heart is beating out of sync? Sometimes it beats very fast, and other times it beats incredibly fast. If you have this strange feeling, or if someone close to you has this problem, it is important to be aware of this condition we are talking about today, called Sick Sinus Syndrome. Don't worry, let's talk about it simply.

Simply put, what is Sick Sinus Syndrome?

Think of our heart as a musical ensemble. To give this ensemble the right rhythm, that is, to make the heart beat properly, there is a small natural 'pacemaker'. In medicine, we call this the sinoatrial node, or `SA node`. To be precise, this is the main electrical signal that tells the heart to "beat now."

Now, in this condition called `Sick Sinus Syndrome`, what happens is that the heart's natural pacemaker, the `SA node`, stops working properly. It can't keep the rhythm right. This can mainly be caused by a few things:

• A very slow heart rate: This is called ``bradycardia''. The heart rate is much slower than normal.
• Alternating between fast and slow: Sometimes the heart beats very fast, then suddenly starts beating very slowly again. This is also called ``tachy-brady syndrome``.
• Heartbeat stops for a moment: Sometimes the SA node can stop sending any signals for about three seconds. We call this a sinus pause or arrest. At this time, another part of the heart tries to send a signal. But if that doesn't work, you may faint and lose consciousness.

This condition is not very common, but the likelihood of it occurring increases with age.

What are the symptoms of this condition?

In most cases, there may be no symptoms in the early stages of this disease. However, if symptoms occur due to an abnormally low or high heart rate, they may look like this:

Why does this situation occur?

Sometimes it's impossible to find a reason for this, but there are a few known causes.

• Aging (most common cause): As we age, like everything else in our body, the heart's electrical signaling system and the SA node can gradually weaken.
• Heart surgery: The SA node can be damaged during heart surgery.
• Certain medications: Certain medications for high blood pressure, irregular heartbeats (arrhythmias) (e.g., beta-blockers, calcium channel blockers) can cause this condition.
• Other medical conditions: This can also be caused by things like heart disease, heart muscle weakness (cardiomyopathy), and conditions that occur after a heart attack.
• Other diseases that affect the body: Diseases such as `(Sarcoidosis)` and `(amyloidosis)` can also affect the heart.
• Congenital problems: Some people can be born with these types of heart problems.

Who is at higher risk of developing this condition?

You may be at slightly higher risk of developing this condition if you:

• If you are over 70 years old.
• If you have previously undergone heart surgery.
• If you are using certain medications, as we discussed earlier.
• If you have diabetes or high blood pressure.
• If you have had other medical conditions such as rheumatic fever.
• If there are genetic influences.

Can't the risk be reduced?

We can't really control things like genes and aging. But there are things we can do. The most important thing is to take good care of your heart. If you have conditions like diabetes or high blood pressure, control them properly. Talk to your doctor regularly and ask about the risks of the medications you take.

How is the diagnosis made?

When you go to see a doctor, he will first listen to your symptoms and then do a physical examination. To confirm this condition, there must be a clear link between your symptoms and a slow heart rate (bradycardia).

The doctor may perform several tests for this:

• ECG (Electrocardiogram): This tests the electrical activity of the heart.
• Blood tests: Check for other causes, such as an imbalance of minerals (electrolytes) in the body.
• Heart rate monitor: You may be given a small device to wear at home for 24 hours or more. This will record your heart rate throughout the day.
• Electrophysiology study (EP study): In some cases, a special test that checks the electrical pathways of the heart may be done in the hospital.

What are the treatments? Is it something to be afraid of?

There is nothing to worry about at all. There are good treatments for this. Treatment depends on whether you have symptoms or not.

• If you have no symptoms: If you have no symptoms, you probably don't need any treatment. Your doctor will monitor you.
• If it's caused by medication: If the cause of this condition is a medication you're taking, your doctor may be able to change the medication or reduce the dosage.
• If there are symptoms: If there are symptoms such as dizziness and extreme fatigue, the most common treatment is to implant a permanent pacemaker.

What is this pacemaker?

This is a very small, battery-operated device. It is surgically implanted under the skin of your chest through a very small incision. It continuously monitors your heart rate. If your heart rate is too fast, the pacemaker sends a small electrical signal to help your heart beat normally. This can help to almost completely eliminate your symptoms and allow you to live a normal life.

When should I see a doctor?

If you have any of these symptoms, seek medical advice immediately.

• If you feel faint and lose consciousness, go to a hospital's Emergency Department (ETU) immediately. This is something that should not be delayed.
• If you have the symptoms we discussed earlier (dizziness, chest pain, difficulty breathing), see your doctor immediately.
• If you already have a pacemaker implanted and think there is a problem with it (e.g. swelling, pain at the implant site, or a return of old symptoms), talk to your doctor.

It's also a good idea to ask your doctor these questions:

• What do you think is causing this situation for me?
• Will I need a pacemaker?
• If I have a pacemaker, how often do I need to be checked?

This condition usually gets worse over time. Therefore, it is very important to see a doctor at the scheduled time for a check-up. That way, any changes can be identified quickly and the necessary treatment can be given.

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