Patient case: Sick Sinus Syndrome
A 58-year-old female, resident of a rural area in sub-Saharan Africa, presents to the clinic with complaints of dizziness, fatigue, and occasional fainting episodes. She reports that the symptoms have been gradually worsening over the past three months. The dizziness typically occurs when standing up quickly, and she has fainted on two occasions, once while working in the fields and once while traveling. She also feels unusually tired throughout the day, despite adequate rest.
Her medical history is notable for hypertension, which has been poorly controlled due to limited access to healthcare. She denies chest pain, shortness of breath, or palpitations. On examination, she is afebrile and appears slightly pale. Blood pressure is 130/85 mmHg, and heart rate is irregular, varying between 40 and 60 beats per minute.
An electrocardiogram (ECG) reveals sinus bradycardia with episodes of sinus arrest and prolonged pauses between heartbeats. Further investigations show normal electrolytes and thyroid function. Given her symptoms, history of hypertension, and ECG findings, she is diagnosed with sick sinus syndrome.
The patient is advised to seek a referral for further evaluation and possible treatment with a pacemaker, as she lives in a region with limited access to cardiology specialists. The importance of consistent blood pressure control and monitoring is emphasized.
A) Atrial fibrillation
B) Sick sinus syndrome
C) Ventricular tachycardia
D) Complete heart block
A) Sinus bradycardia with prolonged pauses
B) Uncontrolled hypertension
C) Hyperthyroidism
D) Electrolyte imbalance
A) Anticoagulation therapy
B) Referral for pacemaker evaluation
C) Beta-blocker therapy
D) Increased fluid intake and rest
A) Lack of access to cardiology specialists
B) Poor adherence to antihypertensive medication
C) Dietary salt intake
D) Excessive physical activity
