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Abstract: This patient came to the hospital with recurrent symptoms of heartburn, generalized dryness and sweating. He reported that he had a history of the disease for more than 10 years but was not treated formally. Recently, his symptoms worsened before he came to our hospital. During the examination, the patient was found to have a slow and irregular heartbeat with cardiac arrest, and was diagnosed with sinus node dysfunction. After treatment with a pacemaker, the patient’s symptoms improved significantly, her condition was basically stable, and her heart rate returned to normal.
[Basic information] Female, 70 years old
Disease Type】Sinus node dysfunction
Hospital】 Zhongshan Hospital of Fudan University
Consultation time】May 2019
Treatment plan】Surgical treatment (double-chamber permanent artificial pacemaker implantation)
Treatment Period】7 days in hospital, regular outpatient review
Treatment effect】Basically stable, heart rate returned to normal
I. Initial consultation
Patient Li, a 70-year-old woman, came to the clinic with symptoms such as sweating, panic attacks, and fatigue. The patient reported that she had symptoms such as generalized dryness, sweating, and recurrent panic attacks more than 10 years ago. The patient reported that he had symptoms such as generalized dryness, sweating, and recurrent panic attacks more than 10 years ago. Six months ago, the symptoms of intermittent panic and sweating worsened, and a dynamic electrocardiogram showed paroxysmal bradycardia combined with sinus arrest, which led to the diagnosis of sinus node dysfunction. In order to treat the disease completely, he came to our hospital.
II. Treatment process
After a detailed history, the patient’s physical examination showed a slow pulse rate of less than 50 beats per minute, normal respiration, body temperature and blood pressure, and poor mental status. Cardiac auscultation showed absolute arrhythmia and no murmur was detected. The results of dynamic electrocardiogram showed sinus bradycardia with prolonged cardiac arrest. Hypothyroidism, potassium abnormalities and coronary artery disease were excluded, and the patient was diagnosed with pathological sinus node syndrome, which was considered to be caused by degenerative changes in the sinus node with age, resulting in abnormal conduction.
Through communication with the patient and the patient’s family, the patient was advised to undergo dual-chamber pacemaker implantation, and was informed that the procedure was relatively mature and less invasive, which eventually led to the patient’s consent. The patient was advised to avoid getting cold and to keep his bowels open before surgery. The patient met the preoperative preparation and was given a dual-chamber permanent artificial pacemaker implantation, and the procedure went smoothly.
III. Treatment effect
The patient’s heart rate returned to normal and stabilized at about 65 beats per minute after the procedure, and the preoperative symptoms of panic, sweating and fever did not recur. After 7 days of hospitalization, the patient was discharged with good wound healing and satisfactory treatment results. The patient was discharged successfully. The patient was instructed to follow up regularly after discharge.
IV. Notes
I was very happy to see that the patient’s body gradually improved and was discharged from the hospital. The patient needs to pay attention to the following situations in daily life.
1. In terms of daily diet, attention needs to be paid to a balanced diet. Foods with higher nutrition and richer dietary fiber, such as celery and eggs, should be consumed to replenish nutrients and to avoid constipation at the same time.
2, if the patient himself has constipation symptoms and the situation is more serious, he can choose to take oral lactulose solution and other drugs to relieve.
3, patients still need to pay attention to monitoring heart rate after discharge, while observing whether there is still panic, weakness and other uncomfortable symptoms, follow the doctor’s instructions for regular follow-up, if there are uncomfortable symptoms, do not ignore again, need to promptly seek medical advice.
4. In the early stage after discharge, the upper limb of the side where the pacemaker is installed should not move too much to avoid affecting the contact effect of the pacing lead.
V. Personal insight
Degenerative changes in the sinus node and surrounding tissues due to metabolic, infectious, and even immune pathologies may cause sinus node dysfunction or sinus conduction abnormalities, resulting in bradycardia. Symptoms such as intermittent panic attacks, weakness and sweating may occur, as in this case. In severe cases, black haze, fainting and even heart failure or sudden death may occur. Generally, the symptoms can be significantly improved by pacemaker implantation; however, most people may resist the surgery because they do not know about this treatment, so patient explanation is needed.
For some patients with sinus node dysfunction without obvious symptoms, close observation may be an option. In some cases, appropriate medication can be chosen for the transition, such as atropine sulfate injection, isoprenaline hydrochloride injection, etc.; the final treatment option for severe patients is still the installation of a permanent pacemaker.