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Where Is A Pacemaker Placed In The Heart?
Question: Where exactly should pacemaker (dual chamber) lead wires be placed in the heart. I just admitted a
pt in my Neuro/Science Unit and she's just not pacing......the hospitalist won't answer my page (he's
honestly buried in patients in the ED). Her chest X-ray shows her leadwires lying next to the apex of her
heart?? This is being missed, I think. Thanks Doc..... XXXXXXX XXXX
pt in my Neuro/Science Unit and she's just not pacing......the hospitalist won't answer my page (he's
honestly buried in patients in the ED). Her chest X-ray shows her leadwires lying next to the apex of her
heart?? This is being missed, I think. Thanks Doc..... XXXXXXX XXXX
Brief Answer:
Repeat ECG and bring cardiologist in the loop
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible.
Based on the history you have shared, it might be possible that leads are not in the right location and it may lead to improper contraction and improper blood flow which can increases tendency to make clots and to throw them to the brain to cause strokes.
However this is a chronic cause for his illness though acute event may have been precipitated by cardiac syncope or incomplete brain circulation due to improper heart contraction or may leaf to circulatory shock. Kindly get his ECG done and get an urgent review with a cardiologist. The Xray findings may be showing the ventricular leads which may come along apex of heart pm chest Xray though one lead for dual chamber is supposed to be in right atrium and one in right ventricle but most important diagnosis modality would be ECG and Echo and vitals monitiring to look for BP and pulse. This will indicate any need for emergency intervention.
Hope this has answered your query, if you have any more questions, feel free to ask. Regards.
Repeat ECG and bring cardiologist in the loop
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible.
Based on the history you have shared, it might be possible that leads are not in the right location and it may lead to improper contraction and improper blood flow which can increases tendency to make clots and to throw them to the brain to cause strokes.
However this is a chronic cause for his illness though acute event may have been precipitated by cardiac syncope or incomplete brain circulation due to improper heart contraction or may leaf to circulatory shock. Kindly get his ECG done and get an urgent review with a cardiologist. The Xray findings may be showing the ventricular leads which may come along apex of heart pm chest Xray though one lead for dual chamber is supposed to be in right atrium and one in right ventricle but most important diagnosis modality would be ECG and Echo and vitals monitiring to look for BP and pulse. This will indicate any need for emergency intervention.
Hope this has answered your query, if you have any more questions, feel free to ask. Regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you Dr. Ulabidin for your reply. I did finally get ahold of the Hospitalist. We
did get an echo done (stat) and another chest Xray. In fact the atrium pacing
wire did come loose and the ventricular pacing wire also was too far away for the
heart to capture the signal. The pt is an elderly lady residing in a "nursing home".
As you may guess, the actual medical intervention is rather limited.....the pt was
never followed up after pacemaker placement. Rather sad.
WE decided to ship her to Swedish Medical Center in XXXXXXX for emergency pace
maker reinsertion/lead placement. She is very lucky that I had the time and curiosity to order a chest Xray. To conclude, her symptoms were not of stroke,
rather episodes of syncope from pacemaker failure. Regards XXXXXXX XXXX
did get an echo done (stat) and another chest Xray. In fact the atrium pacing
wire did come loose and the ventricular pacing wire also was too far away for the
heart to capture the signal. The pt is an elderly lady residing in a "nursing home".
As you may guess, the actual medical intervention is rather limited.....the pt was
never followed up after pacemaker placement. Rather sad.
WE decided to ship her to Swedish Medical Center in XXXXXXX for emergency pace
maker reinsertion/lead placement. She is very lucky that I had the time and curiosity to order a chest Xray. To conclude, her symptoms were not of stroke,
rather episodes of syncope from pacemaker failure. Regards XXXXXXX XXXX
Brief Answer:
Closing remarks
Detailed Answer:
Thanks alot for the appreciation and feedback. I am particularly impressed by your interest in the patients and the kind of research you do to come up with best possible medical care. Patients who encounter you, must have been very lucky. You can reach me in future, directly through my profile in direct queries. Good day. Regards.
Closing remarks
Detailed Answer:
Thanks alot for the appreciation and feedback. I am particularly impressed by your interest in the patients and the kind of research you do to come up with best possible medical care. Patients who encounter you, must have been very lucky. You can reach me in future, directly through my profile in direct queries. Good day. Regards.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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