Case One: The Sudden Fall

Prognosis & Evidence-Based Info

In two weeks your patient returns feeling unwell, fatigued and experiencing shortness of breath and lightheadedness. Physical examination reveals patient is stable. No fever. BP: 100/70. HR: 70bpm. Prominent V wave in jugular pulsation and mild crackles in lung bases.

What do you see?
X-ray Results
What do YOU think is the problem?
- Pacemaker Malfunction
- Pacemaker Syndrome
  - Yes, interrogation reveals pacing 90% of the time.
  - With pacemaker syndrome, ventricular pacing may compromise the atrial contribution to ventricular output
Pacemaker Hemodynamics
Nuclear Scan
What would you do next?

“Losing atrial ‘kick’ results in reduced ventricular preload and reduced stroke volume, and retrograde VA conduction resulting in increased atrial pressure in systole (large V wave) and dyspnea”.