Date:
Patient:
Reason for Visit:
Follow-up for sick sinus syndrome (SSS)
Assessment of symptoms and heart rhythm
Evaluation of response to treatment (if applicable)
Management plan discussion
History:
Presenting Illness:
Date of initial SSS diagnosis
Predominant symptoms (bradycardia, slow heart rate, syncope – fainting, dizziness, palpitations)
Frequency and severity of symptoms
Triggers for symptoms (e.g., exertion, emotional stress)
Past Medical History (PMH):
Underlying medical conditions that may contribute to SSS (e.g., coronary artery disease, heart failure, valvular heart disease)
Previous surgeries or procedures involving the heart
History of other cardiac arrhythmias
Social History:
Medications (prescription and over-the-counter) – some medications can worsen SSS
Alcohol and caffeine use (can affect heart rhythm)
Physical Exam:
Vital Signs: Heart rate (focus on slow or irregular rhythm), blood pressure
Cardiovascular: Assess for heart murmurs or other abnormalities on physical exam.
Diagnostic Tests:
Electrocardiogram (ECG): Shows abnormal heart rhythm patterns like bradycardia, sinus pauses, or atrial fibrillation.
Holter monitor: Ambulatory ECG worn for 24-48 hours to capture heart rhythm throughout daily activities.
Event recorder: Portable ECG worn for a longer period (days or weeks) to capture specific episodes of symptoms.
Echocardiogram: May be used to assess heart function and identify structural abnormalities.
Assessment:
Type of SSS: Based on the predominant heart rhythm abnormality (e.g., bradycardia-dominant, tachy-brady syndrome).
Severity of SSS: Correlated with frequency and severity of symptoms, impact on daily life, and risk of complications (e.g., syncope, heart failure).
Potential causes of SSS: Consider underlying medical conditions and medications that might be contributing.
Plan:
Treatment approach based on symptom severity and risk:
Non-surgical management:
Lifestyle modifications: Avoiding triggers, regular exercise (if tolerated).
Medications: Pacemaker therapy (most common) to regulate heart rate, medications to control heart rate (rarely used alone).
Catheter ablation (minimally invasive): May be considered for specific types of SSS to destroy abnormal electrical pathways in the heart (usually done by an electrophysiologist).
Cardiac implantable electronic device (CIED) selection: Discuss the type of pacemaker needed (single-chamber, dual-chamber) based on the specific rhythm abnormality.
Patient education: Provide information about SSS, its causes, treatment options, and the importance of medication adherence.
Explain the role of pacemakers and potential risks and benefits.
Discuss activity restrictions and precautions (if any).
Instruct on recognizing and reporting symptoms of worsening SSS.
Follow-up:
Schedule for follow-up appointments:
More frequent visits for patients with new device placement, unstable symptoms, or high risk of complications.
Less frequent visits for patients with well-controlled symptoms and stable device function.
Monitor symptoms, heart rhythm with ECG or Holter monitoring, and device function (pacemaker interrogation).
Adjust medications or pacemaker settings as needed based on response to treatment.
Consider referral to an electrophysiologist for complex cases or catheter ablation procedures.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of sick sinus syndrome