Also, can sick sinus syndrome induce hypertension and precipitate coronary artery diseases? What treatment protocol should be instituted in patients showing signs of arrhythmia, bradycardia and hypertension?
I think it depends on the variation in HR in the setting of SSS. If the pt has more SND with bradycardia and no significant tachycardia then anti-HTN options that would not affect the heart may be desirable such as ACEIn and ARBs or some of CCB like nifedipine/amlodipine, etc. I am not aware of SSS causing HTN or CAD.
Your choice of anithypertensive will depend on comorbidities. SSS usually indicates an already sick heart and is a result of existing HTN, CAD, or cardiomyopathy.
May use ACEIs, ARBs, dihydropyridine CCBs (least desirable). If there is known CAD, you could also add a nitrate with hydralazine (must use together to avoid coronary steal in patients with known CAD).
Avoid any AV nodal blockade / anything with a negative chronotropic effect -- beta blockers, nondihydropyridine CCBs (diltiazem, verapamil), or clonidine unless a pacemaker is placed and gives you that safety net with the bradycardia.
With concurrent tachyarrhythmias, a pacemaker is usually needed so that you can utilize effective AV nodal blockade (labetolol, metoprolol, sotolol, cardizem, verapamil and certain other select antiarrhythmics) without inducing symptomatic bradycardia.
ACEIs, dihydropiridine CCBs , or combinations of this drugs.
Or ARBs.
ACE inhibitor/ARB, +- diuretic (thiazide), CCB dihydropiridine, alpha blockers.
As an old cardiologist with an experience in emergency cardiology, I should say
1. Do not try to convert ( brady) arrhythmias or use betablockers, since
a) atrial fibrillation may be an escape "protectic" rhythm,and
b) there is always a possibility of concealed binodal disease,
2. use "indifferent" drugs as ACE inhibitors or modern Ca-blockers with or without diuretics (chlortalidon, hydrochlorothiazide)
3. electrophysiologic investigation in non-emergency cases is an obligate demand.
I donot know that sick sinus syndrome does play any role in the pathophysiology of hypertension. It is imperative to choose the antihypertensive drugs that have no effects on conduction system of the heart e.g ACEI ;ARBs,diuretics, dihydrpyridine CCBs. When pacemaker is implanted in SSS patients there is no difference in choosing antihypertensives including betablockers or non-dihydropyridine CCBs. One shold keep in mind that one of the indications of pacemaker implantation in SSS is the need of using drugs that may reduce hear ratet . As for example when there is frequent SVTs, in a SSS patient we need to have the patient pacemaker for the control of SVTs.
Simple answer
Use sa node and Av node neutral drugs
Rest is ur choice
Etiology as a first step (if possible)
Use AV-node neutral drugs dependent of etiology
Idiopathic - beta blockers
Simptomatic bradicardia - pacemaker implantation
Post op.resistant symptomatic bradicardia - pacemaker
PLE after Fontan and bradicardia - pacemaket
Posttransplantation bradicardia with low CO - pacemaker
how we can treatment pospartum severe hypertention with sinus bradicardia and chestpain and plural e ffusion
Beta blockers (which are not first line drugs) can be used in SSS with hypertension safely
- Badges
- Science topic
- Similar topics
- Linguistics
- Composition Studies
- Publication