His current medications include furosemide, lisinopril, and carvedilol; no allergies to report. He denies past surgical history and his family and social histories are unremarkable.
You see a fatigued overweight man in no acute distress.
T 37.8 HR 60 110/60 RR 20 SpO2 98% RA
His examination is significant for a well healed incision in his left upper chest with a pulse generator pocket that is non-erythematous, non-edematous, and non-tender to palpation. When you enquire about this, he explains that a pacemaker was placed when he had his heart attack. The remainder of his physical examination is unremarkable, except for trace crackles at bilateral pulmonary bases.
His electrocardiogram follows:
Which of the following is the most likely explanation for his presentation:
A. Runaway pacemaker
B. Failure to capture
C. Pacemaker syndrome
D. Failure to sense
In the meantime, a quote –
“Diagnosis is a system of more or less accurate guessing, in which the endpoint achieved is a name.” Lancet I: 619 (1944)
Thomas Lewis (1881-1945)
Physician and clinical scientist