Pacemaker syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2] Raviteja Guddeti, M.B.B.S. [3]

Overview

Patients with pacemaker syndrome present with varied symptoms resulting from dyssynchrony between atria and ventricles. Pacemaker syndrome should be differentiated from the following diseases:Acute coronary syndrome, failed pacemaker, hypothyroidism, cardiogenic pulmonary edema, arrhythmias (especially supraventricular tachycardias), hyperthyroidism, pulmonary embolism, and carotid sinus hypersensitivity.

Differentiating Pacemaker syndrome from other Diseases

Patients with pacemaker syndrome present with varied symptoms resulting from dyssynchrony between atria and ventricles.

Presenting symptoms include:

• Dyspnea
• Edema
• Orthopnea
• Symptoms of low cardiac output like weakness, fatigue, lightheadedness and dyspnea on exertion
• Hypotension
• Shock
• Orthostatic changes
• Syncope
• Dizziness
• Right upper quadrant pain
• Headaches
• Palpitations
• Easy fatigability

Pacemaker syndrome should be differentiated from the following diseases:

• Consider Pacemaker Syndrome as a differential diagnosis in a patient with implanted ventricular pacemaker who develops new neurological or cardiovascular symptoms
• Acute coronary syndrome
• Failed pacemaker
• Hypothyroidism
• Cardiogenic pulmonary edema
• Arrhythmias (especially supraventricular tachycardias)
• Hyperthyroidism
• Pulmonary embolism
• Carotid sinus hypersensitivity

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Additional findings
	Symptoms			Physical examination
							Lab Findings			Imaging			Histopathology
	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3
Differential Diagnosis 1
Differential Diagnosis 2
Differential Diagnosis 3
Diseases	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3	Histopathology	Gold standard	Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

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