Pacemaker syndrome differential diagnosis

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

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:

• If patient had implanted ventricular pacemaker and develops new neurological or cardiovascular symptoms, consider Pacemaker Syndrome as a differential diagnosis.
• Acute coronary syndrome
• Failed pacemaker
• Hypothyroidism
• Cardiogenic pulmonary edema
• Arrhythmias (especially supraventricular tachycardias)
• Hyperthyroidism
• Pulmonary embolism
• Carotid sinus hypersensitivity

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