A rhythmic problem

26/11/2013

An 80 year old lady presents one sunny afternoon with a regular twitching movement to her left arm only. It has been going for 2 days and she couldn't sleep the preceeding night as she found it quite annoying. She has a PMH of IHD - had a CABG 10 years ago and a pacemaker inserted 3 months prior. She is otherwise well with a normal blood pressure.
At first glance it appears she may be having a focal seizure with regular twitching of her upper left arm.
An ECG is performed:

Interpret the ECG and CXR.
What is the cause of her symptoms?
What are the causes of pacemaker failure?

Answer

3 Comments

Yan Wang

3/9/2014 11:50:46 pm

from history sounds like pacemaker lead has become dislodged and activating her left arm muscles, confirmed on CXR

Saw this once in a lady in warragul, only it wasn't her arm but her diaphragm being paced instead of her heart :)

san

23/10/2014 04:43:44 pm

pacemaker malfunctoning

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A rhythmic problem

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