Sick sinus syndrome causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Sick sinus syndrome can result in many abnormal heart rhythms (arrhythmias), including sinus arrest, sinus node exit block, sinus bradycardia, and other types of bradycardia (slow heart rate). Sick sinus syndrome may also be associated with tachycardias (fast heart rate) such as paroxysmal supraventricular tachycardia (PSVT) and atrial fibrillation. Tachycardias that occur with sick sinus syndrome are characterized by a long pause after the tachycardia.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Myocardial infarction
• Myocarditis

Common Causes

Common causes of sick sinus syndrome:

• Atrial fibrillation
• Athletic training
• Drugs or toxins, including:
  • Toluene
  • Organophosphates
  • Tetrodotoxin
  • Cocaine
• Infections:
  • Lyme disease
  • Legionella
  • Psittacosis
  • Typhoid fever
  • Typhus
  • Listeria
  • Malaria
  • Leptospirosis
  • Dengue fever
  • viral hemorrhagic fevers
  • Guillain-Barre
• Medications:
  • Beta blockers
  • Calcium channel blockers
  • Digoxin
  • Sympatholytic medications
  • Antiarrhythmic medications
  • Lithium
• Cardiac surgery
• Electrolyte abnormalities
• Hypothermia
• Hypoxemia, hypercarbia, acidosis
• Coronary artery disease

Cardiovascular	Amyloidosis, atherosclerosis, atrial septal defect, cardiac surgery in children, cardiomyopathies, carotid sinus hypersensitivity, congenital heart disease, coronary artery disease, Ebstein anomaly, electrolyte imbalance, hemochromatosis, hyperkalemia, hypertension, hypocalcemia, hypoxia, ischemic heart disease, Lyme disease, myocardial infarction, myocarditis, neurocardiogenic syncope, pericarditis, rheumatic fever, sinus node fibrosis, tachycardia-bradycardia syndrome
Chemical/Poisoning	Grayanotoxin, rhododendron sp
Dental	No underlying causes
Dermatologic	Lyme disease, systemic lupus erythematosus
Drug Side Effect	Amiodarone, antiarrhythmics, beta blockers, calcium channel blockers, cimetidine, clonidine, digitalis, disopyramide, guanethidine, lanatoside C, lidocaine, lithium, methyldopa, phenytoin, procainamide, propranolol, quinidine, reserpine, verapamil
Ear Nose Throat	No underlying causes
Endocrine	Amyloidosis, hemochromatosis, hypocalcemia, hypothyroidism
Environmental	No underlying causes
Gastroenterologic	Hemochromatosis, sarcoidosis, scleroderma
Genetic	Friedreich ataxia, HCN4 mutation, hemochromatosis, muscular dystrophy, myotonic dystrophy
Hematologic	Hemochromatosis
Iatrogenic	No underlying causes
Infectious Disease	Chagas disease, diphtheria, Lyme disease, pericarditis, rheumatic fever, sepsis
Musculoskeletal/Orthopedic	Friedreich ataxia, hemochromatosis, muscular dystrophy, myotonic dystrophy, systemic lupus erythematosus
Neurologic	Friedreich ataxia, hypothermia, muscular dystrophy, myotonic dystrophy, sleep apnea
Nutritional/Metabolic	Amyloidosis, electrolyte imbalance, hyperkalemia
Obstetric/Gynecologic	No underlying causes
Oncologic	Neoplasm
Ophthalmologic	Hypertension
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Hypoxia, sarcoidosis, scleroderma
Renal/Electrolyte	Electrolyte imbalance, hyperkalemia, hypertension, hypocalcemia, systemic lupus erythematosus
Rheumatology/Immunology/Allergy	Amyloidosis, rheumatic fever, sarcoidosis, scleroderma, systemic lupus erythematosus
Sexual	No underlying causes
Trauma	Cardiac surgery in children
Urologic	No underlying causes
Miscellaneous	Hypothermia, idiopathic

Causes in Alphabetical Order

Amiodarone Amyloidosis Antiarrhythmics Atherosclerosis Atrial septal defect Beta blockers Calcium channel blockers Cardiac surgery in children Cardiomyopathies Carotid sinus hypersensitivity Chagas disease Cimetidine Clonidine Congenital heart disease Coronary artery disease Digitalis Diphtheria Disopyramide Ebstein anomaly Electrolyte imbalance Friedreich ataxia Grayanotoxin Guanethidine HCN4 mutation Hemochromatosis Hyperkalemia Hypertension Hypocalcemia Hypothermia Hypothyroidism

Hypoxia Idiopathic Ischemic heart disease Lanatoside C Lidocaine Lithium Lyme disease Methyldopa Muscular dystrophy Myocardial infarction Myocarditis Myotonic dystrophy Neoplasm Neurocardiogenic syncope Pericarditis Phenytoin Procainamide Propranolol Quinidine Reserpine Rheumatic fever Rhododendron sp Sarcoidosis Scleroderma Sepsis Sinus node fibrosis Sleep apnea Systemic lupus erythematosus Tachycardia-bradycardia syndrome Verapamil