{"id":49,"date":"2008-11-17T14:57:40","date_gmt":"2008-11-17T14:57:40","guid":{"rendered":"http:\/\/cardiophile.info\/?p=49"},"modified":"2008-11-17T14:57:40","modified_gmt":"2008-11-17T14:57:40","slug":"sinus-node-dysfunction","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/","title":{"rendered":"Sinus node dysfunction"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/Xm2KQD6q2iA\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">Sinus node dysfunction<\/span><\/h2>\n<p><strong>Symptoms of sinus node dysfunction<\/strong><\/p>\n<p>Most frequent symptoms are syncope and presyncope. Other possible symptoms are fatigue, angina and shortness of breath. Elderly patients may present with subtle symptoms like gastrointestinal distress or a change in mental status. Symptoms can be intermittent and documentation can be difficult at times. Marked sinus bradycardia \/ pause may be asymptomatic occasionally.<\/p>\n<p><strong>Investigations in sinus node dysfunction<\/strong><\/p>\n<p>Noninvasive methods of investigation include ECG, 24 hour Holter monitoring, exercise testing and autonomic testing. If symptoms are infrequent, invasive electrophysiologic testing or the use of an implantable monitor (implantable loop recorder) may be needed for documentation.<\/p>\n<p><strong>Monitoring the ECG<\/strong> and correlating bradycardia during syncope is diagnostic of sinus node dysfunction. But this is rarely achieved from the simple ECG. If symptoms are frequent a 24- or 48-hr ambulatory Holter monitoring is useful. It is essential to document symptoms in a diary during Holter monitoring for correlation. Futility of treating asymptomatic pauses has to be borne in mind. Length of the pause has poor correlation with symptoms and prognosis. If symptoms are infrequent a loop recorder, a home recording device or an implantable loop recorder is needed to pick out the pauses.<\/p>\n<p><strong>Autonomic Testing in sinus node dysfunction<\/strong><\/p>\n<p>Pharmacologic interventions \/ maneuvers test reflex responses of the heart rate. Carotid sinus massage causing pauses of more than 3 seconds is considered significant. Occasionally such pauses may occur in asymptomatic elderly individuals. Intrinsic heart rate (IHR) is the heart rate during complete autonomic blockade with atropine, 0.04 mg\/kg + propranolol, 0.20 mg\/kg.<\/p>\n<p><em><strong>Intrinsic heart rate (IHR) = 118.1 &#8211; (0.57 \u00d7 age [in years])<\/strong><\/em><\/p>\n<p>In a case of clinical bradycardia, a low IHR suggests intrinsic sinus nodal dysfunction while a normal IHR indicates abnormal autonomic regulation.<\/p>\n<p><strong>Invasive testing<\/strong> is reserved for symptomatic patients whose bradycardia cannot be documented by noninvasive means. Sinus node recovery time and sinoatrial conduction time are measured. But the ability to provide a definitive diagnosis by these parameters is limited.<\/p>\n<p>Concomitant AV nodal disease is seen in about 17% of patients with sinus nodal dysfunction. New AV conduction abnormalities develop at the rate of 2.7% \/ year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sinus node dysfunction<\/p>\n","protected":false},"author":1,"featured_media":38550,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6],"tags":[],"class_list":["post-49","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Sinus node dysfunction - presents with syncope and presyncope<\/title>\n<meta name=\"description\" content=\"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sinus node dysfunction - presents with syncope and presyncope\" \/>\n<meta property=\"og:description\" content=\"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2008-11-17T14:57:40+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Sinus node dysfunction\",\"datePublished\":\"2008-11-17T14:57:40+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/\"},\"wordCount\":347,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"articleSection\":[\"ECG \\\/ Electrophysiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/\",\"name\":\"Sinus node dysfunction - presents with syncope and presyncope\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"datePublished\":\"2008-11-17T14:57:40+00:00\",\"description\":\"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#primaryimage\",\"url\":\"\",\"contentUrl\":\"\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/sinus-node-dysfunction\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Sinus node dysfunction\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Sinus node dysfunction - presents with syncope and presyncope","description":"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/","og_locale":"en_US","og_type":"article","og_title":"Sinus node dysfunction - presents with syncope and presyncope","og_description":"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.","og_url":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2008-11-17T14:57:40+00:00","author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Sinus node dysfunction","datePublished":"2008-11-17T14:57:40+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/"},"wordCount":347,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#primaryimage"},"thumbnailUrl":"","articleSection":["ECG \/ Electrophysiology"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/","url":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/","name":"Sinus node dysfunction - presents with syncope and presyncope","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#primaryimage"},"thumbnailUrl":"","datePublished":"2008-11-17T14:57:40+00:00","description":"Sinus node dysfunction: Most frequent symptoms are syncope and presyncope. Long term monitoring is the most commonly used investigation.","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#primaryimage","url":"","contentUrl":""},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/sinus-node-dysfunction\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Sinus node dysfunction"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/49","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=49"}],"version-history":[{"count":0,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/49\/revisions"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=49"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=49"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=49"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}