امرأة عمرها ٧٦ سنة عندها نبض بطيء مزمن ومتقلب بين ٣٨ و٤٥، مع نوبات تسارع أذيني تصل ١٥٠، وأُغمي عليها مرتين هذا الشهر. الهولتر يؤكد متلازمة العقدة الجيبية المريضة. ما العلاج المتوقع غالباً؟

A 76-year-old woman has chronic, variable bradycardia of 38–45 with episodes of atrial tachycardia up to 150, and has fainted twice this month. Holter monitoring confirms sick sinus syndrome. What treatment is usually expected?

1. Adenosine at every fainting episode
2. A high-dose beta-blocker on its own
3. Lifelong daily oral atropine tablets
4. A permanent pacemaker plus rate-control drugs

Answer: D) A permanent pacemaker plus rate-control drugs. This is sick sinus (tachy-brady) syndrome. Rate-controlling drugs can worsen the bradycardia, so a permanent pacemaker protects against slow rates and allows those drugs to be used safely.