Sick sinus syndrome

Overview

Sick sinus syndrome is a heart condition where your heart’s natural pacemaker (the sinus node) does not work properly. This can cause your heart to beat too slowly, too fast, or alternate between the two.

It is fairly common in older adults, especially those with other heart conditions. It becomes more likely as you age.

Sick sinus syndrome mainly affects adults over 65, but it can occur at any age, including in children who have had heart surgery or have certain heart defects.

Symptoms

Common symptoms

• Feeling tired or weak
• Dizziness or lightheadedness
• Fainting (syncope) or nearly fainting
• A sensation of a fluttering or fast heartbeat (palpitations)
• Shortness of breath with activity

Symptoms in children

• Poor feeding and slow growth in infants
• Unusual tiredness or lack of energy (lethargy)
• Skipped or extra heartbeats that may be noticed by a doctor

Symptoms in older adults

• Falls or trouble walking
• Confusion or memory problems that come and go
• Feeling tired even after resting

Causes

Main causes

• Age-related scarring or fibrosis of the sinus node tissue
• Damage from coronary artery disease or heart attack
• Certain medications that slow the heart rate (always talk to your doctor before stopping any medicine)

Risk factors

• Older age (over 65)
• High blood pressure
• History of heart disease, such as coronary artery disease or heart failure
• Previous heart surgery

When to see a doctor

See a doctor urgently if:

• Fainting or nearly fainting
• Chest pain or shortness of breath that comes on suddenly
• A heart rate that feels dangerously slow (under 40 beats per minute) with symptoms

Book a routine appointment if:

• Ongoing tiredness or fatigue that is not explained
• Feelings of lightheadedness or dizziness that happen from time to time
• Palpitations (fast or irregular heartbeats) that bother you

Diagnosis

Doctors use an electrocardiogram (ECG) to record your heart's electrical activity. Because symptoms can come and go, you may need to wear a small portable heart monitor for a day or longer.

Tests that may be done

• Electrocardiogram (ECG) — a quick, painless test that records your heart rhythm at a single point in time
• Holter monitor — a portable ECG you wear for 24–48 hours to catch irregular rhythms
• Event monitor — a device you can wear for weeks to record symptoms when they happen
• Echocardiogram — an ultrasound of your heart to check for structural problems

What to expect at your appointment

The tests are painless and non-invasive. You may need to keep a diary of your symptoms while wearing a monitor. Ask your doctor how long the results take.

Treatment

Treatment depends on how bad your symptoms are. If you have no symptoms, you may not need treatment. For bothersome symptoms, doctors often recommend a pacemaker to keep your heart rate steady.

Self-care at home

• Stay well hydrated and avoid alcohol or caffeine if they trigger symptoms
• Stand up slowly from sitting or lying down to prevent dizziness
• Keep a symptom diary to share with your doctor

Medical treatments

Doctors may prescribe medicines to control fast heart rhythms, but these are used carefully because they can also slow the heart too much. A pacemaker is the most common and effective treatment — it corrects both slow and fast rhythms and greatly improves quality of life.

When is surgery considered?

If you need a pacemaker, the procedure is minor and usually done under local anaesthetic. A small device is placed under your collarbone, and thin wires lead to your heart. Recovery is quick, and most people go home the same day or the next day.

Living with this condition

With a pacemaker, most people can return to normal activities, including work, hobbies, and driving (with medical approval). You will need regular device checks — usually every few months via a remote monitor or in clinic.

Lifestyle tips

• Attend all follow-up appointments for your heart monitor or pacemaker
• Carry a pacemaker ID card and tell other doctors or airport security about your implant
• Avoid strong magnetic fields (such as large MRI machines) unless your pacemaker is MRI-safe

Diet and exercise

Eat a heart-healthy diet rich in fruits, vegetables, and whole grains. Stay active with moderate exercise like walking or swimming, but check with your doctor before starting a new exercise programme. Avoid exercises that put pressure on your chest (like heavy weightlifting) right after surgery.

Mental health and emotional wellbeing

Living with an irregular heartbeat can cause anxiety or fear of fainting. It is normal to feel worried. Talk to your doctor or a counsellor. If you feel overwhelmed, reach out to a mental health professional or crisis support line.

Prevention

Sick sinus syndrome cannot always be prevented, because it is often related to aging. But you can lower your risk by treating high blood pressure, heart disease, and diabetes, and by staying physically active.

Vaccines

Get the annual flu vaccine and talk to your doctor about the pneumonia vaccine — these can help prevent infections that could worsen heart conditions.

Screening programmes

There is no routine screening for sick sinus syndrome. If you have risk factors or symptoms, your doctor may recommend an ECG or monitor. Ask your doctor if a check-up is right for you.

Complications

If left untreated

• Frequent fainting spells that can lead to falls and injuries
• Heart failure (the heart cannot pump enough blood to the body)
• Atrial fibrillation (a fast, irregular heart rhythm that increases stroke risk)

Long-term outlook

With proper treatment, most people with sick sinus syndrome live full, active lives. A pacemaker corrects the rhythm problem in nearly all cases, and complications are rare when the condition is managed. Your doctor will work with you to keep your heart healthy and your symptoms under control.

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