TACHY-BRADY SYNDROME
Presented by
dr. MULIA ULFAH
Mentor
dr. Yudi Imawanto SpEM-KEC
OVERVIEW
• PACEMAKER , SAN (SINO-ATRIAL NODUS)
• EPIDEMIOLOGY, DEFINITION,
PATHOPHYSIOLOGY, SYMPTOMS , DIAGNOSTIC
• ECG
• THERAPY
PACEMAKER
• SAN (SINO-ATRIAL NODUS)
• THIS NATURAL PACEMAKER
PRODUCES ELECTRICAL SIGNALS THAT TRIGGER EACH HEARTBEAT.
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SA NODE
• FROM THE SINUS NODE,
ELECTRICAL SIGNALS TRAVEL ACROSS THE ATRIA TO THE VENTRICLES, CAUSING THEM TO CONTRACT AND PUMP
BLOOD TO THE LUNGS AND BODY
• P CELL & T CELL
EPIDEMIOLOGY
• SINUS NODE DYSFUNCTION IS A DISEASE OF OLDER ADULTS, ALTHOUGH IT CAN OCCUR AT ANY AGE
• THE MEAN AGE IS 68 YEARS OLD
• MALES AND FEMALES ARE EQUALLY AFFECTED
• SINUS NODE DYSFUNCTION DEVELOPS IN ONE OF EVERY 600 CARDIAC PATIENTS OF 65 YEARS OF AGE OR OLDER.
• MORE THAN 50% OF THE PACEMAKER IMPLANTATIONS IN THE UNITED STATES IN THE 1990S MEANWHILE 20-30% IN EUROPE
Saksena S, Camm AJ, boyden PA, et al. Electrophysiological !isorders of the Heart. Philadelphia; Ellsevier
Saunders, 2012
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DEFINITION
SND (SINUS NODAL DYSFUNCTION )
• ABNORMALITIES IN SINUS NODE IMPULSE FORMATION AND PROPAGATION
• A UNSTEADY PACE OF ELECTRICAL IMPULSES IRREGULARLY PACED
• WITH SYMPTOMS , ITS CALLED ‘3S’ SICK SINUS SYNDROME
• SICK SINUS SYNDROME IS A GROUP OF HEART RHYTHM PROBLEMS DUE TO PROBLEMS WITH THE SINUS NODE, SUCH AS:
• THE HEARTBEAT RATE IS TOO SLOW, CALLED SINUS BRADYCARDIA
• THE HEARTBEAT PAUSES OR STOPS, CALLED SINUS PAUSES OR SINUS ARREST
• EPISODES OF A FAST HEART RATE
• SLOW HEART RHYTHMS THAT ALTERNATE WITH FAST HEART RHYTHMS, CALLED BRADYCARDIA-TACHYCARDIA OR "TACHY-BRADY SYNDROME"
SICK SINUS SYNDROME
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ETIOLOGY
MAY BE MULTI- FACTORIAL IN ORIGIN. CAUSES
CAN BE
CONSIDERED EITHER INTRINSIC
OR EXTRINSIC .
PATHOPHYSIOLOGY
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EWHA WOMENS UNIVERSITY MEDICAL CENTER
SYMPTOMS
(1) PALPITATIONS
(2) FAINTING, NEAR-FAINTING, OR
DIZZINESS (SYNCOPE, PRE-SYNCOPE, OR LIGHT-HEADEDNESS).
(3) FATIGUE AND WEAKNESS.
(4) CONFUSION
(5) CHEST PAIN (ANGINA)
(6) DISTURBED SLEEP.
DIAGNOSTIC
• ECG
• MONITOR HOLTER
• IMPLANTABLE LOOP RECORDER
• TREADMILL EXERCISE
• AUTONOMIC MODULATION TESTING
• ELECTROPHYSIOLOGY (EP) TESTING
• ECHO
• LABORATORY
Briignole M, Auricc io A, Baron G, etal.2013. ESC Guidelines oncardiac pacing and cardiac resynchrronization therapy: ThE Task 5orce on cardiac pacing and resynchroniization therapy of the European Society of Cardiology (ESC) !eveloped in collaboration EHRA, 2013
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0
AMBULATORY CARDIAC MONITORING
DEVICES
Wahls SA. Sick sinus syndrome. Am Fam Physician. 1985;31(3):117-124.
ECG APPEARANCE
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ECG
SINUS BRADIKARDI
SINUS ARREST - Irregular
- Prolonged absence of sinus node activity (absent P waves) > 3 seconds
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SA EXIT BLOCK
TAKI-BRADI SINDROME
• Runs of tachycardia interspersed with long sinus pauses (up to 6 seconds).
• Intermittent episodes of slow and fast ratesfrom the SA node or atria Rate during bradycardia = 43 bpm
Rate during tachycardia = 130 bpm
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THERAPY
• EVALUATION OF SND
• LOOK FOR INTRINSIC/EXTRINSIC ETIOLOGY
• DO MORE INVESTIGATION (E.G HOLTER)
• MEDICATION
• PACEMAKER IMPLANTATION
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PACEMAKER IMPLANTATION
HIGHLY RECCOMENDATION
TREATMENT ALGORITHM
Eipstein AE, Dimarco JP, Ellenborgen $A, et al. ACC/AHA/HRS 2008 Guidelines for device, based therapy of cardiac rhytim abnormalities E A report
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of the American Heart Association task force on practice guideline (FrittingCommitte to revise the ACC/AHA/NASPE 2002 guideline update
TRANSCUTANEOUS PACING
• EXPLAIN THE PROCEDURE
• ADMINISTER IV SEDATION
• APPLY SELF-ADHESIVE PACING PADS
• SET THE PACING MODE , SET THE HEART RATE, SET STARTING CURRENT OUTPUT LEVEL
• TURN PACER ON, ELECTRICAL CAPTURE & MECHANICAL CAPTURE
• IF CAPTURE HAS TAKEN PLACE , RECHECK !!!
TRASCUTANEOUS PACING
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CITATION
• GUIDE TO ESSENTIAL EMERGENCY, THIRD EDITION
• YANG Y,BATRES Y, ROTTMAN JN, BERGER SS, ET AL. SINUS NODE DYSFUNCTION.2015, H TTP://EMEDICINE.MEDSCAPE.COM@ARTICLE@158064OVERVIEW
• SAKSENA S, CAMM AJ, BOYDEN PA, ET AL. ELECTROPHYSIOLOGICAL !ISORDERS OF THE HEART.
PHILADELPHIA; ELLSEVIER SAUNDERS, 2012
• BRIIGNOLE M, AURICCHIO A, BARON G, ETAL.2013. ESC GUIDELINES ONCARDIAC PACING AND CARDIAC RESYNCHRRONIZATION THERAPY: THE TASK 5ORCE ON
CARDIAC PACING AND RESYNCHRONIIZATION THERAPY OF THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) DEVELOPED IN COLLABORATION EHRA, 2013
• ZIMETBAUM P, GOLDMAN A. AMBULATORY ARRHYTHMIA MONITORING: CHOOSING THE RIGHT DEVICE. CIRCULATION. 2010;122(16):1629-1636.
• WAHLS SA. SICK SINUS SYNDROME. AM FAM PHYSICIAN. 1985;31(3):117-124
• EIPSTEIN AE, DIMARCO JP, ELLENBORGEN $A, ET AL. ACC/AHA/HRS 2008 GUIDELINES FOR DEVICE, BASED THERAPY OF CARDIAC RHYTIM ABNORMALITIES E A REPORT
OF THE AMERICAN HEART ASSOCIATION TASK FORCE ON PRACTICE GUIDELINE (FRITTINGCOMMITTE T O REVISE THE ACC/AHA/NASPE 2002 GUIDELINE UPDATE
• HTTPS://WWW.YOUTUBE.COM/WATCH?V=ZMGHYJIAJUS
