History
The patient was a nonsmoker and enjoyed good health in the past. He had a history of new-onset dizziness and one episode of syncope. He was admitted to the hospital, and electrocardiogram (ECG) showed complete heart block with ventricular escape rate about 40 bpm. Clinically, he was not in heart failure, and echocardiography demonstrated normal left ventricular systolic function. Because there was no reversible cause, a dual-chamber pacemaker was implanted. The right ventricular lead was fixed at the right ventricular apex, and the right atrial lead was fixed at the right atrial appendage. The procedure was uneventful, and he was discharged.
One month after discharge, the patient reported a decrease in exercise tolerance and dyspnea.
Current Medications
The patient is on no medications.
Current Symptoms
The patient experienced a decrease in exercise tolerance and dyspnea.
Comments
It is likely new-onset heart failure symptoms occurred after device implantation.
Physical Examination
Comments
Physical examination revealed evidence of heart failure.
Laboratory Data
Electrocardiogram
Findings
Atrial sensing and ventricular pacing rhythm, dependent pacing rhythm.
Comments
The ECG showed dependent pacing rhythm.
Chest Radiograph
Comments
It is necessary to rule out pulmonary disease and see any evidence of congestive heart failure.
Echocardiogram
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