Newly Published
Images in Anesthesiology  |   October 2019
Sick Sinus Syndrome: Sinus Node Dysfunction in the Elderly
Author Notes
  • From the Departments of General Anesthesiology (S.K., R.S., K.R.), Outomes Research (S.K., K.R.), Critical Care Medicine (R.S.), and Cardiothoracic Anesthesiology (C.T.), Cleveland Clinic Foundation, Cleveland, Ohio.
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Khanna: khannas@ccf.org
Article Information
Images in Anesthesiology / Cardiovascular Anesthesia / Geriatric Anesthesia
Images in Anesthesiology   |   October 2019
Sick Sinus Syndrome: Sinus Node Dysfunction in the Elderly
Anesthesiology Newly Published on October 14, 2019. doi:https://doi.org/10.1097/ALN.0000000000003004
Anesthesiology Newly Published on October 14, 2019. doi:https://doi.org/10.1097/ALN.0000000000003004
Sick sinus syndrome is a clinical syndrome characterized by sinus node dysfunction. It presents in elderly patients with bradyarrhythmias and nonspecific symptoms such as fatigue or syncope. Consequently, the diagnosis is often overlooked. Anesthesia can unmask sinus node dysfunction, which then manifests as significant atrial dysrhythmias and “rarely” asystole.1–3  The accompanying images demonstrate this circumstance and are from an elderly patient who underwent pericardial drainage under propofol sedation. While marked sinus bradycardia is seen on the preoperative electrocardiogram (top image), the postprocedure electrocardiogram demonstrates supraventricular tachycardia (bottom image A) that eventually transitions to asystole (bottom image B).
Although asymptomatic sinus bradycardia does not necessitate postponement of surgery, presence of a significant bradyarrhythmia requires consultation. Regardless of how slow the heart rate is, a clinically important bradyarrhythmia is distinguished by the presence of symptoms such as syncope, confusion, and dyspnea. Bradycardia-mediated reduction in cardiac output compromises cerebral perfusion, resulting in syncope. Additionally, severe bradycardia increases left ventricular end-diastolic pressure, precipitating pulmonary congestion and dyspnea.