Pacemaker Syndrome - Signs and Symptoms

Signs and Symptoms

No specific set of criteria has been developed for diagnosis of pacemaker syndrome. Most of the signs and symptoms of pacemaker syndrome are nonspecific, and many are prevalent in the elderly population at baseline. In the lab, pacemaker interrogation plays a crucial role in determining if the pacemaker mode had any contribution to symptoms.

Symptoms commonly documented in patients history, classified according to etiology:

• Neurological - Dizziness, near syncope, and confusion.
• Heart failure - Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema.
• Hypotension - Seizure, mental status change, diaphoresis, and signs of orthostatic hypotension and shock.
• Low cardiac output - Fatigue, weakness, dyspnea on exertion, lethargy, and lightheadedness.
• Hemodynamic - Pulsation in the neck and abdomen, choking sensation, jaw pain, right upper quadrant (RUQ) pain, chest colds, and headache.
• Heart rate related - Palpitations associated with arrhythmias

In particular, the examiner should look for the following in the physical examination, as these are frequent findings at the time of admission:

• Vital signs may reveal hypotension, tachycardia, tachypnea, or low oxygen saturation.
• Pulse amplitude may vary, and blood pressure may fluctuate.
• Look for neck vein distension and cannon waves in the neck veins.
• Lungs may exhibit crackles.
• Cardiac examination may reveal regurgitant murmurs and variability of heart sounds.
• Liver may be pulsatile, and the RUQ may be tender to palpation. Ascites may be present in severe cases.
• The lower extremities may be edematous.
• Neurologic examination may reveal confusion, dizziness, or altered mental status.