Question:
86 yo M with a VVI pacemaker presents to ED complaining of intermittent dizziness
1. What diagnosis can be made from this EKG that accounts for his symptoms❓
2. What is the best way to cure these symptoms?
Answer
- Pacemaker Syndrome
- Add an atrial lead to permit DDD pacing
This Quiz #8 EKG shows sinus rhythm at 65/min, right ventricular pacing at 60/min and AV Block, 3⁰. Notice in rhythm strip II that there is a sinus P wave that precedes each of the first 7 paced QRS complexes, but the 8th and 9th paced QRS complexes have a retrograde P wave. This can account for less ventricular filling and a smaller stroke volume for these QRS complexes because atrial contraction after ventricular contraction retrograde propels what venous return reaches the atria back into the neck veins and pulmonary veins. This accounts for the 20-30 mmHg fall in systolic BP when these retrograde P waves occurred. Intermittent dizziness like this with sinus rhythm, 3⁰ AV block and a normally-functioning VVI pacemaker is called Pacemaker syndrome. Maintaining atrioventricular synchrony by converting to DDD pacing cured this problem.
Powered by EKGaction: EKGaction is much more than the usual textbook of EKG and is different from other online programs. It teaches/reinforces EKG interpretation skills using a method that integrates clinical pearls that makes it easier to commit to memory. These pearls accompany every case and are called Learning Points and Collateral Tracings. The multiple indexes make it useful as a reference. It has been perfected over 15 years, teaching at leading cardiology fellowship programs. It has been shown to improve performance on board exams and it’s fun to use!
Learn more at https://www.ekgaction.com/
