Sick Sinus Syndrome: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Sick Sinus Syndrome?
A cardiologist (a heart doctor) usually treats sick sinus syndrome, often with an electrophysiologist (a doctor who focuses on heart rhythm problems). A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is sick sinus syndrome?
The heartbeat normally starts in a small area in the top chambers of the heart. This area is the heart's natural pacemaker, and it is called the sinus node. Sick sinus syndrome is a group of heart rhythm problems caused by trouble with the sinus node.
The heartbeat can be too slow, which doctors call sinus bradycardia. The heartbeat can also pause or stop. There can also be episodes of a fast heart rate. Slow and fast rhythms can take turns, which is called tachy-brady syndrome.
It is uncommon, but not rare. It is the most common reason people need an artificial pacemaker.
Symptoms
Most of the time, there are no symptoms.
When symptoms do happen, they can include:
- Fainting or near-fainting.
- Dizziness or lightheadedness.
- Tiredness.
- Feeling your heart beat, called palpitations.
- Shortness of breath, sometimes only with activity like walking.
- Chest pain.
- Confusion or other changes in mental status.
These symptoms can look like those of other disorders. The syndrome most often gets worse over time. It can lead to heart failure, less ability to exercise, and falls or injuries from fainting.
Causes and who gets it
The condition most often happens in people older than age 50. It can affect people of all ages. Men and women are affected equally. It is often due to scar-like damage to the heart's electrical pathways. In children, heart surgery on an upper chamber of the heart is a common cause.
Some medicines can make abnormal heart rhythms worse. These include digoxin, calcium channel blockers, beta-blockers, and antiarrhythmics (medicines for abnormal rhythms). Other outside factors include low thyroid function (hypothyroidism), low oxygen, and very low body temperature. Coronary heart disease, high blood pressure, and aortic and mitral valve diseases can occur with sick sinus syndrome. They may have nothing to do with it.
How doctors diagnose it
An electrocardiogram (ECG) records the heart's rhythm. It may show abnormal rhythms related to this syndrome. Holter monitors and other long-term rhythm monitors help find the condition. They may pick up very slow heart rates, long pauses, and fast rhythms.
Doctors diagnose it when symptoms happen only during episodes of abnormal heart rhythm. This link is often hard to prove. A very slow heart rate or a long pause on a test is not enough if you have no symptoms. Sometimes a doctor watches your heart rate while you walk or exercise to see if it rises enough. A hospital test called an electrophysiology study is very specific for this disorder. It is not often needed, and it may not confirm the diagnosis.
Treatment
You may not need treatment if you do not have any symptoms. Your provider will review your medicines to make sure they are not making your condition worse. Do not stop taking any of your medicines unless your provider tells you to do so.
You may need a permanent implanted pacemaker if your symptoms are related to a slow heart rate. A pacemaker guards against periods of slow heart rate. A pacemaker is the only effective treatment for long-lasting symptoms that do not have a fixable cause. The goal of pacemaker treatment is to relieve symptoms and improve overall quality of life. The long-term outlook is excellent for people who have a permanent pacemaker.
A fast heart rate may be treated with medicine. A procedure called radiofrequency ablation is sometimes used for fast heart rates. Atrial fibrillation or flutter that goes along with this syndrome raises the risk of stroke. Blood thinners have been shown to lower the number of strokes.
When to see a doctor
Contact your provider if you have lightheadedness, palpitations, or other symptoms of the condition.
Call 911 or go to the emergency room if you have chest pain or discomfort lasting two minutes or more, severe trouble breathing, fainting or loss of consciousness, a sudden change in mental state, or sudden weakness or a sudden change in vision.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can review the medicines you take, since some medicines can make heart rhythm problems worse.
Common questions
Is sick sinus syndrome serious?
Yes, it can be serious, because it usually gets worse over time. It can cause fainting, and falls or injuries caused by fainting. The long-term outlook is excellent for people who have a permanent pacemaker.
Does everyone with sick sinus syndrome need a pacemaker?
No, not everyone needs a pacemaker. You may need one if your symptoms are related to a slow heart rate.
Can sick sinus syndrome be prevented?
Often it cannot, because many times the condition is not preventable. Eating a well-balanced diet and exercising can prevent many types of heart disease. You may also need to avoid some types of medicines.
Does sick sinus syndrome always cause symptoms?
No, most of the time there are no symptoms. When symptoms do happen, they can include fainting or near-fainting, dizziness, and tiredness.
Sources
- MedlinePlus - Sick sinus syndrome
- American Academy of Family Physicians - Sick Sinus Syndrome: A Review
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
