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Sick sinus syndrome with normal atropine response--a case report
1Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi = the Kaohsiung Journal of Medical Sciences
|November 1, 1994
Summary
Recurrent syncope in an elderly woman was caused by sick sinus syndrome, despite a normal atropine test. A permanent pacemaker effectively resolved her symptoms, highlighting the importance of electrophysiologic studies.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Recurrent syncope is a common and potentially serious symptom in the elderly.
- Sinus node dysfunction, or sick sinus syndrome, can present with bradycardia and syncope.
Observation:
- A 76-year-old woman presented with recurrent syncope.
- 24-hour Holter monitoring revealed sinus bradycardia and prolonged sinus pauses (up to 2.24 seconds).
- Intravenous atropine administration did not significantly improve sinus node function.
Findings:
- Electrophysiologic study demonstrated marked prolongation of sinus node recovery time.
- Sick sinus syndrome was diagnosed despite a normal response to atropine.
- Permanent pacemaker implantation led to complete resolution of syncope.
Implications:
- Electrophysiologic study is crucial for diagnosing sick sinus syndrome, especially when autonomic testing is inconclusive.
- Permanent pacemaker implantation is an effective treatment for symptomatic sick sinus syndrome.
- This case underscores the importance of comprehensive cardiac evaluation in elderly patients with syncope.