Treatment of Sick Sinus Syndrome (SSS) in Germany
Best hospitals and doctors for sick sinus syndrome (sss) treatment in Germany
Leading hospitals
Cost for treatment
Nowadays, cardiologists and therapists often admit patients with sinus node pathology, among which the sick sinus syndrome (SSS) is one of the most widespread. It is necessary to know the tactics of medical care for such patients, and therefore, this problem currently requires a special approach both in diagnostics and treatment.
Content
- Sick sinus syndrome overview
- Why does sick sinus syndrome occur?
- Symptoms of sick sinus syndrome
- Sick sinus syndrome treatment in Germany
- Pacemaker implantation
- Where to undergo treatment in Germany?
- The cost of treatment in Germany
- How to start treatment in Germany?
Sick sinus syndrome overview
The so-called "rhythm drivers", the sinus node and the atrioventricular node, provide impulses that cause the heart contraction and subsequent blood supply.
When all is well, the sinus node generates impulses at a certain frequency that go to the atria; the atrioventricular node receives first the pulses from the sinus node and with a short delay "adds" the same number of pulses per minute from itself to contract the ventricles.
If sinus node functioning is impaired, the atrioventricular node fails to receive signals from its fellow node and takes upon itself its functions. In this case, the atria left without electricity from the impaired sinus node start receiving impulses from the atrioventricular node by the residual principle (retrograde). That is, the poorly functional system continues to work and the person survives, but the pulse will not exceed 30-40 beats per minute, which will need implantation of a cardiac stimulator that is capable of returning the pulse to normal.
Since the sinus node has to function under conditions of different body needs, different mechanisms are used to ensure adequate heart rhythm: from changing the ratio of sympathetic and parasympathetic influences to changing the source of automatism within the sinus node itself. According to modern concepts, there are centers of automatism in the sinus node that are responsible for rhythm guidance with different pulse formation frequencies, so (in a somewhat simplified view) some centers are responsible for the formation of pathology.
Favorable conditions for the occurrence of the pathology are also created by the extremely low speed of impulse propagation through its constituent cells. Moreover, any relatively small impairment of conduction due to autonomic nervous system dysfunction or organic myocardial lesion can cause intra-nodal impulse blockade.
Ischemia due to stenosis of the sinus node artery or more proximal segments of the right coronary artery, inflammation, infiltration, as well as necrosis and hemorrhage, development of interstitial fibrosis, and sclerosis (for example, in surgical trauma) lead to the replacement of sinus node cells by connective tissue.
Why does sick sinus syndrome occur?
The occurrence of sick sinus syndrome (SSS) is linked to some internal or external influencing factors.
Several internal factors cause the disruptions in the sinus node functioning, including:
- Idiopathic (for no apparent reason) replacement of normal cells of the sinus node by connective tissue (body tissue that plays a supporting role in all organs) with calcinosis (deposition of calcium salts) in the area of the sinus node. It mostly occurs in elderly and senile people (over 60 years of age).
- Coronary heart disease (pathology characterized by the impaired blood supply to the heart muscle due to the damage of the heart's own arteries), including myocardial infarction (a severe disease characterized by the death of part of the heart muscle contractile cells) and atherosclerosis (lesion of the vessel wall, which significantly narrows its lumen and reduces the blood supply to the fed organs) of the vessels that feed the sinus node. It is the most common cause of sick sinus syndrome.
- Inflammatory diseases of the heart muscle.
- Heart damage due to autoimmune diseases (pathologies in which the immune system acts against its own organs and tissues): systemic lupus erythematosus, scleroderma (an autoimmune disease with a predominance of small vessels and pronounced skin changes).
- Malignant brain tumors.
- Arterial hypertension.
- Damage to the heart in metabolic disorders such as hypothyroidism (lack of thyroid hormones), hyperthyroidism (excess thyroid hormones), different types of diabetes (insufficiency of the pancreatic hormone, insulin, leading to high blood sugar or insulin resistance).
Several external factors can cause sick sinus syndrome.
- Surgical interventions and cardiac trauma.
- Excessive influence of parasympathetic nervous system (part of the vegetative nervous system, which slows down and weakens the work of organs) on sinus nodes. It may arise due to individual high sensitivity of specific receptors to any impact (mechanical, chemical, etc.), increased intracranial pressure (with a brain tumor), subarachnoid hemorrhage (blood escape between the membranes of the brain due to injury or disruption of brain circulation).
- Disturbance of electrolyte composition (potassium, magnesium, calcium, iron – ions necessary for human life, etc.) that is mainly caused by a diet poor in minerals or incorrect treatment with supplements.
- Effects of high doses of drugs like β-adrenoblockers (drugs that prevent stimulation of receptors to adrenaline and noradrenaline, slow calcium channel blockers (drugs that affect the heart and vascular cells, which cause a decrease in heart rate, thereby reducing vascular tone), cardiac glycosides (drugs that stimulate heart activity), and antiarrhythmic drugs (drugs that prevent the development of rhythm disturbances).
Symptoms of sick sinus syndrome
The main symptoms noticed in patients with sick sinus syndrome are persistent sinus bradycardia (a form of atrial fibrillation) or sinoauricular block combined with arrhythmias.
Patients with the syndrome may complain of weakness, dizziness, heart palpitations, darkening of the eyes, confusion, fainting (may be accompanied by seizures), fatigue and extremely poor performance, "blackouts" in memory, sudden restlessness, and a rare pulse followed by a rapid heartbeat.
The manifestations of the clinical course of sick sinus syndrome are varied. Some patients may not have sick sinus syndrome manifested for a long period, others have marked rhythm disturbances, accompanied in severe cases by headaches, dizziness, or Stokes-Adams seizures. There may be hemodynamic disorders due to decreased stroke and minute output volume, accompanied by, among other things, the development of cardiac asthma, pulmonary edema, or coronary artery disease that manifests as angina pectoris, and less often, myocardial infarction.
In the clinical picture of sick sinus syndrome, there are two main groups of symptoms: cerebral and cardiac.
Cerebral symptomatology in low rhythm disturbances is manifested by fatigue, irritability, forgetfulness, and emotional lability. In elderly patients, intellect and memory impairment may be noticed. With the progression of SSS syndrome and cerebral circulatory insufficiency, cerebral symptoms increase. Syncope develops, preceded by sharp weakness, a feeling of fainting, or cardiac arrest. Fainting of cardiac origin in syndrome occurs without precursors or convulsions (except in cases of prolonged asystole). The skin is pale, cold, covered with cold sweat, with BP (blood pressure) decreasing sharply. Fainting may be provoked by coughing, turning the head sharply, or wearing tight clothes. Fainting usually goes away on its own, but prolonged fainting states may require emergency care. Severe bradycardia (atrial fibrillation) can cause dyscirculatory encephalopathy characterized by increased dizziness, momentary lapses of memory, irritability, insomnia, and memory loss.
Cardiac manifestations of the syndrome begin with the patient's sensation of a slow or irregular pulse, and pain behind the chest (due to the lack of coronary blood flow). Associated arrhythmias are accompanied by heart palpitations, dyspnea, weakness, and the development of chronic heart failure.
With the progression of SSS syndrome, ventricular tachycardia or fibrillation often joins, increasing the likelihood of sudden cardiac death. Among other organic manifestations of sick sinus syndrome are oliguria (insufficient urine production) due to renal hypoperfusion, gastrointestinal disorders, intermittent claudication, muscle weakness due to the lack of oxygenation of internal organs and muscles. Objectively identified are sinus bradycardia (especially nocturnal), persisting with physical activity, sinoauricular block, and ectopic rhythms (atrial fibrillation and flutter, paroxysmal tachycardia, supraventricular, rarely ventricular extrasystole). After a period of ectopic rhythms, and atrial fibrillation specifically, the recovery of a normal sinus rhythm is delayed.
Sick sinus syndrome treatment in Germany
Sick sinus syndrome treatment in Germany is carried out individually, based on the specific pathology present, as well as the peculiarities of the patient's experience with the disease.
If the decrease in heart rhythm is minor and sinus functional dysfunction is moderate, therapy is not required. Other cases involve the transition to the treatment of the disease that provokes sick sinus syndrome. In the transition to the active phase of treatment, the underlying manifestations like atrial fibrillation, ventricular arrhythmia, angina pectoris, and heart failure are highlighted.
If the patient experienced fainting due to the detected sick sinus syndrome, it is necessary to consult with a cardiologist about the need to implant a pacemaker, which plays the role of an artificial amplifier of the heartbeat rhythm following the standard physiological frequency. The pacemaker allows all hemodynamic parameters to return to normal. To diagnose sick sinus syndrome, it is necessary to consult not only a cardiologist but also a general medical practitioner.
Pacemaker implantation
In case of a pronounced syndrome manifestation caused by bradycardia, presence of signs of chronic heart failure, implantation of a pacemaker operating in demand mode, i.e., producing impulses when the heart rate falls to critical values, is indicated.
Absolute indications for pacing are:
- At least a single occurrence of a Stokes-Adams attack.
- Presence of bradycardia.
- Dizziness, coronary insufficiency, high arterial hypertension.
- Combination of atrial fibrillation with other types of arrhythmias, requiring prescription of antiarrhythmic drugs, which for some reason is impossible.
The most common indication for pacemaker is still bradycardia when the heart rate is too low for the body's needs. Possible symptoms of bradycardia include dizziness, extreme fatigue, shortness of breath, and fainting.
The heart rhythm usually makes between 60 and 80 beats per minute. A reading below 60 beats per minute is called bradycardia. In many people who are in good physical shape (or who have this rhythm during rest and sleep), this rhythm is normal. A distinctive feature of such bradycardia is that with increased physical activity the heart rhythm begins to speed up, covering the body's need for its frequency. We talk about bradycardia as a disease when the rhythm has a very small frequency, does not respond to an increase in frequency to physical activity, or in the rhythmic contraction, there are long pauses, which can reach and even exceed more than 2 seconds. When sinus bradycardia is diagnostically confirmed and such a rhythm is the only manifestation, such a rhythm is effectively corrected with a pacemaker.
Currently, it is the patients with the SSS syndrome that make up the vast majority of patients with permanent pacemakers. It should be noted that this method, while improving the quality of life, sometimes significantly, usually does not allow increasing its duration, which is determined by the nature and severity of concomitant heart disease, mainly myocardial dysfunction. When choosing the method of cardiac stimulation, one should seek not only to provide an adequate ventricular rhythm rate, but also to preserve atrial systole.
Where to undergo treatment in Germany?
In German hospitals, great attention is paid to increasing life expectancy and quality of life by preventing heart disease. For this purpose, German hospitals are equipped with unique diagnostic devices. Foreign cardiologists help patients with heart disease, including sick sinus syndrome, and return them to an active lifestyle.
The Departments of Cardiology at German hospitals use all modern and unique methods of diagnostics and heart treatment. In addition to helping patients, the Departments of Cardiology are also engaged in scientific work to improve methods of heart diagnosis and treatment.
The best reviewed hospitals for sick sinus syndrome treatment in Germany are:
- University Hospital of Ludwig Maximilian University of Munich.
- University Hospital Frankfurt am Main.
- Catholic Clinic Koblenz-Montabaur.
- Academic Hospital Brothers of Mercy Munich.
- Bundeswehr Academic Hospital Berlin.
If you need assistance in choosing the hospital, please, contact Booking Health.
The cost of treatment in Germany
Cardiac treatment in Germany is a highly specialized area of modern medicine, in which Germany leads the way, developing and implementing new methods for diagnosis and treatment in specialized cardiology hospitals.
The cardiologist develops an examination program and then a treatment scheme depending on the results of diagnostics, which, in turn, may include electrocardiography, echocardiography, computed tomography or magnetic resonance imaging, cardiac catheterization, laboratory tests, and tests of other organs and systems. Depending on the number of diagnostic tests and the extent of treatment, the cost of treatment is calculated.
The prices for sick sinus syndrome diagnostics start at 467 EUR.
The cost of treatment with pacemaker implantation and coronary angiography starts at 6,531 EUR.
The cost of treatment with pacemaker implantation alone starts at 3,914 EUR.
The prices for rehabilitation in German hospitals start at 566 EUR.
Feel free to contact Booking Health for specifying the prices for your clinical case.
How to start treatment in Germany?
You can easily start your treatment in Germany by using the services of Booking Health.
The Booking Health specialists pay great attention to the peculiarities of your diagnosis and your preferences regarding the treatment organization. Therefore, you get all aspects of your treatment in Germany as personalized as possible.
Besides, it is good to have a reliable companion during such a somewhat stressful time, who can provide support when you need it.
If you want to get detailed information on how to proceed with treatment in Germany, fill in the request form on the Booking Health website.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
