Sick Sinus Syndrome Combined with Wallenberg Syndrome: a Case Report

Lee Sang Wan,Lee Hojin,Yoo Jeehyun,Kim Jiyong,임길병 대한뇌신경재활학회 2021 뇌신경재활 Vol.14 No.3

Cardiac arrhythmia is a rare manifestation of the Wallenberg syndrome; lesions are located in the brainstem, especially the lower medulla, which regulates sympathetic and parasympathetic activity. A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome. While he underwent conservative treatment for Wallenberg syndrome, he experienced several events of self-limiting heart pounding, which required an evaluation of cardiac function. The 24-hour Holter monitor showed an increased RR interval with bradycardia and prolonged sinus pause. As a result, the diagnosis of sick sinus syndrome combined with Wallenberg syndrome was made. Sick sinus syndrome is a rare cardiac complication of the Wallenberg syndrome, and clinicians could overlook it when the initial electrocardiography shows a normal sinus rhythm. Sick sinus syndrome can cause sudden death without appropriate medical intervention. Therefore, clinicians should consider further evaluation, including a 24-hour Holter monitor, to check for the potential presence of sick sinus syndrome in the acute phase of Wallenberg syndrome.

Sick Sinus症候群 6例에 關한 考察

曺局泫,鄭鎭珏,吳鉉觀 順天鄕大學校 1979 의대논문집 Vol.4 No.-

Six cases of sick sinus syndrome were presented and relevent literature were reviewed. Their electrocardiographic findings were revealed Tachycardia-Bradycardia syndrome (l patient), chronic persistent atrial fibrillation(2 patients), chronic persistent bradycardia (2 patients), and A-V junctional bradycardia, Above abnormal electrocardiographic findings were no changed after medical provocation test with atropine and isoproterenol. Prominent clinical symptoms were dizziness, syncope and their underlying diseases were hypertension, valvular heart disease, myocardiopathy and chest trau'na. Prognosis of presented cases was favorable in 4 cases with medical therapv but 2 cases were not controlled. 1912年 Cohn等은 發作性 心房細動과 一時 心停止로 因한 Stokes-Adams 症候가 있는 患者에서 Sick sinus 症候群을 처음 報告란 이래 臨未心傳導學, 心導子法 및 His束電圖의 發達로 從來에는 單純한 慢生 徐脈 또는 心房細動等으로 看過하기 쉬웠던 本 疾患이 臨床的으로 重要視되게 되었다. 特히 最近에는 心筋內의 電氣生理學的現象 및 刺戟傳導에 對한 새로운 槪念이 導入되면서는 本症의 原因이 되는 洞房結節의 機能異常에 對한 病因, 病態生理 等이 밝혀짐으로 해서 診斷과 治療 및 患者管理面에서 큰 進展을 가져오게 되었다. 著者等은 最近 本病院 內科 心電圖室에서 Sick Sinus症候群로 思料되는 患者 6例를 經驗하고 各 症例들의 基底疾患 및 臨床經過等을 觀察하였기에 報告하는 바이다.

가족성 동기능 장애 증후군 1례

남인혜,천성희,길홍량,Nam, In-Hye,Cheon, Sung-Hee,Kil, Hong-Ryang 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.2

Sick sinus syndrome(SSS) constitutes a spectrum of cardiac arrhythmia, including sinus bradycardia, sinus pause-arrest, sinoatrial block, slow escape rhythm, bradyarrhythmia and tachyarrhythmia. SSS is relatively uncommon in children but its exact incidence is unknown because diagnostic criteria are not uniform and most children with SSS, in general are asymptomatic. SSS may be primary(organic sinus node disease) or secondary(cardiac surgery comprises much of SSS in children and adolescents), but it can hardly be caused by familial relations as well. We reports an occurrence of familial sick sinus syndrome. Mother was diagnosed as SSS, which was presented by symptoms of dizziness and treated by permanent pacemaker(DDD). Also, two daughters revealed SSS with non-compacted cardiomyopathy on neonatal screening and fetal echocardiography respectively. We concluded that familial SSS may occur, so familial screening should be suggested. 저자들은 비경화성 심근증을 동반한 두 자녀와 기질적 질환이 없이 발생한 동기능 장애 증후군 환자를 경험하였기에 문헌 고찰과 함께 가족성 동기능 장애 증후군 1례를 보고하는 바이다.

동기능부전증후군에 의한 반복성 현훈증

유현정,이구은,강현석,노숙영 대한평형의학회 2011 Research in Vestibular Science Vol.10 No.4

Vertigo due to primary cardiac disease, known as cardiogenic vertigo, has been rarely reported. We report one case showing recurrent vertigo episodes due to sick sinus syndrome. A 77-year-old female presented to our department because of long history of intermittent brief episodes of rotatory vertigo and non-vertiginous dizziness. She had no past medical history. There was no abnormal sign in neurological examination. Cardiac murmur, finally confirmed as grade 4 ejection systolic and grade 3 decrescendo diastolic murmurs, was found on physical examination. Brain magnetic resonance imaging and auditory evoked potential did not show any abnormal findings. She was consulted to a cardiologist for the evaluation of cardiac murmur. After the evaluation using electrocardiogram, echocardiography, and holter monitoring, she was diagnosed as sick sinus syndrome. After then, a ventricle ventricle inhibited (VVI) pacemaker was inserted. She did not complain of vertigo and dizziness for 3 months after the insertion of a VVI pacemaker. This case shows the need of auscultation for patients with recurrent vertigo episodes although there is rare cardiogenic vertigo.

동기능 부전이 동반된 식도 기관지루 수술치험 -1례 보고-

이재필 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.7

Congenital bronchoesophageal fistula is a rare anomaly that can appear in adult uncommonly. Especially sick sinus syndrome with bronchoesophageal fistula is very uncommon.The patient was 53 years old male who admitted for chronic coughing recurrent lobar pneumonia on RLL since few years ago. And he had familial history of sick sinus syndrome.We confirmed the fistula by barium swallow examination and performed ligation of the fistula and pacemaker implantation.

동기능부전증후군으로 발생한 폐고혈압 1예

박제욱 ( Je-wook Park ),엄재선 ( Jae-sun Uhm ),김동준 ( Dong-jun Kim ),박동혁 ( Dong Hyuk Park ),김규 ( Kyu Kim ),조현수 ( Hyun Soo Cho ),장혁재 ( Hyuk-jae Chang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6

A 60-year-old man visited the hospital after experiencing dyspnea after exertion for 2 weeks. An electrocardiogram showed sinus arrest with junctional escape rhythm at 40 beats/min. Transthoracic echocardiography showed that the right ventricular systolic pressure (RVSP) was approximately 71 mmHg and that the left ventricular ejection fraction was preserved. The ratio of peak early diastolic transmitral inflow velocity to early diastolic peak mitral annular velocity (E/E’) was 29. Cardiac catheterization revealed a systolic pulmonary artery pressure (SPAP) of 63 mmHg, a mean pulmonary artery pressure of 27 mmHg, and a pulmonary capillary wedge pressure of 22 mmHg with a rhythm of 40 beats/min. The patient was diagnosed with pulmonary hypertension (group 2) due to sick sinus syndrome. SPAP decreased to 48 mmHg during atrial pacing at 60 beats/min. After permanent pacemaker insertion, RVSP decreased from 71 mmHg to 44 mmHg. In this case, passive group 2 pulmonary hypertension occurred due to sick sinus syndrome. (Korean J Med 2016;90:528-532)

A Case of Chloroquine-Induced Cardiomyopathy That Presented as Sick Sinus Syndrome

이재학,정우백,강주현,김형우,김진진,김지현,황희정,이재범,정종원,김효림,최윤석,박철수,윤호중,이만영 대한심장학회 2010 Korean Circulation Journal Vol.40 No.11

A 52-year-old woman with rheumatoid arthritis who had been treated with prednisone and hydroxychloroquine for >12 years presented with chest discomfort and a seizure. She was diagnosed with restrictive cardiomyopathy combined with sick sinus syndrome. A myocardial muscle biopsy was performed to identify the underlying cardiomyopathy, which showed marked muscle fiber hypertrophy, fiber dropout, slightly increased interstitial fibrous connective tissue, and extensive cytoplasmic vacuolization of the myocytes under light microscopy. Electron microscopy of the myocytes demonstrated dense, myeloid, and curvilinear bodies. The diagnosis of hydroxychloroquine-induced cardiomyopathy was made based on the clinical, hemodynamic, and pathologic findings. This is the first case report describing chloroquine-induced cardiomyopathy involving the heart conduction system. (Korean Circ J 2010;40:604-608)KEY WORDS:

Function and Dysfunction of Human Sinoatrial Node

정보영,Peng-Sheng Chen 대한심장학회 2015 Korean Circulation Journal Vol.45 No.3

Sinoatrial node (SAN) automaticity is jointly regulated by a voltage (cyclic activation and deactivation of membrane ion channels) and Ca2+ clocks (rhythmic spontaneous sarcoplasmic reticulum Ca2+ release). Using optical mapping in Langendorff-perfused canine right atrium, we previously demonstrated that the β-adrenergic stimulation pushes the leading pacemaker to the superior SAN, which has the fastest activation rate and the most robust late diastolic intracellular calcium (Cai) elevation. Dysfunction of the superior SAN is commonly observed in animal models of heart failure and atrial fibrillation (AF), which are known to be associated with abnormal SAN automaticity. Using the 3D electroanatomic mapping techniques, we demonstrated that superior SAN served as the earliest atrial activation site (EAS) during sympathetic stimulation in healthy humans. In contrast, unresponsiveness of superior SAN to sympathetic stimulation was a characteristic finding in patients with AF and SAN dysfunction, and the 3D electroanatomic mapping technique had better diagnostic sensitivity than corrected SAN recovery time testing. However, both tests have significant limitations in detecting patients with symptomatic sick sinus syndrome. Recently, we reported that the location of the EAS can be predicted by the amplitudes of P-wave in the inferior leads. The inferior P-wave amplitudes can also be used to assess the superior SAN responsiveness to sympathetic stimulation. Inverted or isoelectric P-waves at baseline that fail to normalize during isoproterenol infusion suggest SAN dysfunction. P-wave morphology analyses may be helpful in determining the SAN function in patients at risk of symptomatic sick sinus syndrome.

The Role of the Calcium and the Voltage Clocks in Sinoatrial Node Dysfunction

정보영,Shien-Fong Lin,Peng-Sheng Chen 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

Recent evidence indicates that the voltage clock (cyclic activation and deactivation of membrane ion channels) and Ca^(2+) clocks (rhythmic spontaneous sarcoplasmic reticulum Ca^(2+) release) jointly regulate sinoatrial node (SAN) automaticity. However,the relative importance of the voltage clock and Ca^(2+) clock for pacemaking was not revealed in sick sinus syndrome. Previously, we mapped the intracellular calcium (Cai) and membrane potentials of the normal intact SAN simultaneously using optical mapping in Langendorff-perfused canine right atrium. We demonstrated that the sinus rate increased and the leading pacemaker shifted to the superior SAN with robust late diastolic Cai elevation (LDCAE) during β-adrenergic stimulation. We also showed that the LDCAE was caused by spontaneous diastolic sarcoplasmic reticulum (SR) Ca^(2+) release and was closely related to heart rate changes. In contrast, in pacing induced canine atrial fibrillation and SAN dysfunction models, Ca^(2+ )clock of SAN was unresponsiveness to β-adrenergic stimulation and caffeine. Ryanodine receptor 2 (RyR2) in SAN was down-regulated. Using the prolonged low dose isoproterenol together with funny current block, we produced a tachybradycardia model. In this model, chronically elevated sympathetic tone results in abnormal pacemaking hierarchy in the right atrium, including suppression of the superior SAN and enhanced pacemaking from ectopic sites. Finally,if the LDCAE was too small to trigger an action potential, then it induced only delayed afterdepolarization (DAD)-like diastolic depolarization (DD). The failure of DAD-like DD to consistently trigger a sinus beat is a novel mechanism of atrial arrhythmogenesis. We conclude that dysfunction of both the Ca^(2+) clock and the voltage clock are important in sick sinus syndrome.

즐례 : 전신경화증 환자에서 발생한 동기능부전증후군 1예

김동현 ( Dong Hyun Kim ),김성중 ( Sung Jung Kim ),소중해 ( Jung Hae So ),임균섭 ( Gyun Seop Lim ),김형호 ( Hyung Ho Kim ),김현숙 ( Hyun-sook Kim ),김윤성 ( Yun Sung Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.1

Systemic sclerosis (SSc) is characterized by the presence of microvascular disease and various patterns of cutaneous and parenchymal fibrosis. Manifestation of SSc may occur in numerous tissues and organs and can be particularly problematic when present in the lungs, kidneys or heart. Cardiac involvement in SSc includes pericarditis, myocardial disease, conduction abnormalities, and arrhythmia. Sick sinus syndrome is described as a combination of symptoms (dizziness, confusion, fatigue, syncope and congestive heart failure) caused by sinus node dysfunction and manifested by marked sinus bradycardia, sinoatrial block, or sinus arrest. Sinus node dysfunction is most often seen in the elderly but also, rarely, in systemic amyloidosis and connective tissue disease. Sick sinus syndrome is rarely found in patients with SSc, of which there has been only one case report, according to a review of the literature. Therefore, we report a case of sick sinus syndrome in a 71-year-old female with SSc. (Korean J Med 2014;86:110-115)