Nursing care of patient with Sick Sinus Syndrome

Jaya Menon1, Jasmine Rajareegam Princely2, Tamilselvi3

1Nursing Superintendent, Kauvery Heart city, Trichy, Tamil Nadu

2Non-Critical Ward Nursing Supervisor, Kauvery Heart city, Trichy, Tamil Nadu

3Non-Critical Ward Staff Nurse, Kauvery Heart city, Trichy, Tamil Nadu

Abstract

Sick Sinus Syndrome, also known as Sinus node dysfunction, is a group of abnormal heart rhythms usually caused by a malfunction of the sinus node, the heart’s primary pacemaker. Tachycardia-bradycardia syndrome is a variant of sick sinus syndrome in which the arrhythmia alternates between fast and slow heart rates.

Other names: Sick sinus syndrome or sinoatrial node disease

Signs and Symptoms

SyncopePalpitations
BradycardiaChest pain
Transient near fainting Shortness of breath
Confusion, Headache
FatigueNausea

Complications

The most common complications are atrial tachycardia, atrial fibrillation and flutter these rhythms increases the risk of clot formation in the atrium, embolization, and stroke. Sinus arrest, sinus node exit block, sinus bradycardia, atrio-ventricular block, and other types of abnormal rhythms are also common complications.

Causes

  • Coronary artery disease
  • Prior Heart attack
  • Atrial fibrillation
  • Heart failure or cardiomyopathy
  • Taking certain medicines such as Beta blockers, Calcium channel blockers, Digoxin, and Antiarrhythmics
  • Severe hypothyroidism
  • Inflammatory conditions that involve the heart (rheumatic fever, chagas disease, pericarditis, myocarditis)
  • Infiltrative heart diseases (sarcoidosis, Amyloidosis, scleroderma, hemochromatosis)
  • Electrolyte abnormalities such as high potassium levels
  • Rare familial disease
  • Trauma
  • Hypothyroidism, hypothermia, and electrolyte problems are generally reversible.

Past Medical History of the patient

A 74-year-old male, euglycemic and normotensive, known case of hypothyroidism, Coronary Artery Disease, Post Angiogram – Double Vessel Disease, Post PCI to Proximal to Mid LAD (2022), PCI to Mid to distal RCA 27/06/2025, history of giddiness 24 days back, found to have bradycardia. Holter suggested and attached for 72 hours and diagnosed as sick sinus syndrome. He was advised to implant Permanent Pacemaker for further management. On admission, he was conscious and oriented. After an informed written consent, patient was taken up for Permanent Pacemaker Implantation on 25/08/2025

Permanent Pacemaker

A small, battery-powered electronic device surgically implanted in the chest to regulate an abnormal heart rhythm by delivering electrical impulses to the heart. It consists of a pulse generator and one or more pacing leads that connect to the heart, ensuring it maintains a steady beat.

Conductive System

Diagnosis

  1. Primary hypothyroidism, coronary artery disease
  2. S/P CAG – Double Vessel Disease S/P PCI to Proximal to Mid LAD (2022)
  3. S/P CAG – Double vessel disease
  4. S/P PCI to Mid to distal RCA 27/06/2025
  5. Normal LV systolic function
  6. Sick sinus syndrome

Diagnostic Evaluation

  • ECG
  • ECHO
  • Holter monitor
  • Treadmill Test
  • Collecting family history
  • Patient and present history

ECHO report

  • Sinus bradycardia during study
  • Normal chambers dimension
  • No RWMA
  • Normal lv systolic function (EF-65%)
  • Grade 1 Diastolic dysfunction
  • Aortic valve thickened
  • No Aortic Stenosis / Aortic Regurgitation
  • No Tricuspid Regurgitation /Pulmonary Artery Hypertension
  • Septae intact
  • No pericardial effusion / clot

Impression

  • S/P PCI to LAD & RCA
  • No RWMA at rest
  • Normal LV systolic function
  • Grade 1 Diastolic Dysfunction
  • Thickened aortic valve

ECG

Holter Report

Nursing Management Pre Management

  • Routine blood investigations such as CBC and RFT and Electrolytes were done for Permanent Pacemaker procedure.
  • Every four hours, vital signs monitored
  • Physicians explained the patient situation.
  • After thorough counseling, nurses were able to secure consent for the clinical procedures.
  • When speaking with patients and visitors, nurses employed the AIDET strategy (Acknowledge, Introduce, Duration, Explanation and Thank you) to build trust and raise satisfaction levels.
  • Intravenous (IV) insertion performed using aseptic technique
  • The patient’s hemodynamic status monitored.
  • Skin preparation was done
  • NPO instructions were explained to the patient and maintained to ensure an empty stomach.
  • IV Antibiotic prophylaxis followed as per order
  • Patient shifted to the Cath lab

Post op Management and Education

  • Incision Site Care: Monitoring signs of infection, redness, swelling, or discharge at the insertion site.
  • Activity Restrictions: Instructing the patient to avoid raising the arm on the side of the pacemaker above heart level for several weeks to prevent displacement.
  • Symptom Monitoring: Checking for signs of pacemaker malfunction, such as dizziness, fatigue, or irregular heartbeat.
  • Electrical Interference Avoidance: Teaching the patient to keep strong magnetic fields (like from stereo speakers or jewelry) at a distance from the pacemaker generator.
  • Cell Phone Use: Advising the patient to keep cell phones at least 6 to 12 inches away from the pacemaker and not to carry them in a shirt pocket.

Long-Term Management

  • Regular Follow-up: Explaining the need for routine check-ups to monitor pacemaker function and battery life.
  • Battery Monitoring: Informing the patient that battery replacement is a minor outpatient procedure and discussing signs of impending battery depletion.

Outcome

The Patient was treated conservatively with necessary supportive measures. Patient condition improved and being discharged in a stable condition.

Reference

  • Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. (20 August 2019). “2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society”. Circulation. 140 (8): e382 – e482. doi:10.1161/CIR.0000000000000628. PMID 30586772.
  • Dobrzynski H, Boyett MR, Anderson RH (10 April 2007). “New Insights Into Pacemaker Activity: Promoting Understanding of Sick Sinus Syndrome”. Circulation. 115 (14): 1921–1932. doi:10.1161/CIRCULATIONAHA.106.616011. PMID 17420362.
  • Tse G, Liu T, Likh, Laxton V, Wong AO, Chan YW, et al. (March 2017). “Tachycardia-bradycardia syndrome: Electrophysiological mechanisms and future therapeutic approaches (Review)”. International Journal of Molecular Medicine. 39 (3): 519–526. doi:10.3892/ijmm.2017.2877. PMC 5360359. PMID 28204831.

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