A thorough medical history and physical examination must be performed to diagnose SSS because erroneous diagnosis and incorrect interpretations of clinical signs can lead to the misuse of medications. Syncope is a clinical sign commonly present in patients with dysfunction of the sinus node, and episodes of syncope were reported by the owner of the dog referred to in the present report. The diagnosis of SSS is limited to cases in which the patient does not present with abnormalities in an electrocardiogram. It is usually diagnosed based on clinical signs and the presence of sinus bradycardia and sinus pauses in electrocardiograms or Holter monitoring. Currently, clinical signs are absent.ĭiscussion: Sinus node dysfunction is one of the main reasons for pacemaker implantation. Three weeks after diagnosis, a pacemaker device was implanted. After the start of treatment, there was a reduction in the frequency of episodes of syncope. The prescribed medications were aminophylline 20 mg/ kg TID, enalapril maleate 0.5 mg/kg BID, spironolactone 1 mg/kg SID and furosemide 2 mg/kg BID. The patient presented with significant episodes of syncope during outpatient care, and based on the clinical manifestation, drug therapy was initiated. A Holter monitor was used to establish the diagnosis of SSS. The electrocardiogram showed the presence of sinus arrest with escape rhythms, pauses of 10 s and the presence of bradycardia-tachycardia syndrome. Also during cardiac auscultation, a holosystolic heart murmur was verified, with a focus on the mitral and tricuspid valves. During the physical examination, cardiac auscultation revealed the heart rate to be 56 beats per minute (bpm), and there was a presence of pauses. The owner mentioned convulsive episodes, but a thorough medical history and patient assessment revealed that the dog exhibited episodes of syncope. The present work aims to describe clinical aspects and findings from tests related to sick sinus syndrome (SSS) and presents the case of a female schnauzer with SSS.Ĭase: A 10-year-old female dog (schnauzer, 8.6 kg) attended the Veterinary Hospital of the FMVZ-UNESP - Botucatu. Reports of clinical signs by animal owners are not always clear and precise, which may result in erroneous interpretations by veterinarians consequently, the use of inappropriate therapies. It commonly occurs in elderly dogs, especially miniature schnauzers however, it is also detected in dachshunds and pugs. Universidade Estadual Paulista (UNESP), Botucatu.īackground: Sick sinus syndrome is characterized by the presence of arrhythmias, including persistent sinus bradycardia, sinus arrest and paroxysmal atrial tachyarrhythmia. Pacemakers do not reduce mortality, but they can decrease symptoms and improve quality of life.Departamento de Clínica Veterinária, Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.ĭepartamento de Cirurgia e Anestesiologia Veterinária, Faculdade de Medicina Veterinária e Zootecnia (FMVZ), Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.ĭepartamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu (FMB), Treatment of sick sinus syndrome includes removing extrinsic factors, when possible, and pacemaker placement.
Electrophysiologic studies also may be used but are not routinely needed. If electrocardiography does not yield a diagnosis, inpatient telemetry monitoring, outpatient Holter monitoring, event monitoring, or loop monitoring may be used.
Diagnosis may be challenging, and is ultimately made by electrocardiographic identification of the arrhythmia in conjunction with the presence of symptoms. Cerebral hypoperfusion is most common, with syncope or near-fainting occurring in about one-half of patients. They are commonly related to end-organ hypoperfusion. Signs and symptoms are often subtle early on and become more obvious as the disease progresses. Extrinsic factors can be pharmacologic, metabolic, or autonomic. Intrinsic causes include degenerative fibrosis, ion channel dysfunction, and remodeling of the sinoatrial node. Sick sinus syndrome results from intrinsic causes, or may be exacerbated or mimicked by extrinsic factors. At least 50 percent of patients with sick sinus syndrome develop alternating bradycardia and tachycardia, also known as tachybrady syndrome. Predominantly affecting older adults, sick sinus syndrome comprises various arrhythmias, including bradyarrhythmias with or without accompanying tachyarrhythmias. Sick sinus syndrome refers to a collection of disorders marked by the heart's inability to perform its pacemaking function.
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