Presentation
Syncope while resting on a chair. Permanent pacemaker for a history of recurrent syncope in the past.
Patient Data
Age: 80 years
Gender: Female
Frontal
- dual-lead cardiac pacemaker noted
- the position of the pacemaker box has changed; it is currently located more medial and inferior when compared to prior study (refer below)
- new intertwining leads identified at the superior lateral part of the pacemaker box
- the cardiac apex lead appears to be slightly withdrawn when compared to the previous study (refer below)
Frontal
- AP film
- dual-lead cardiac pacemaker noted
- intact pacing leads in expected positions
Case Discussion
The patient presented with the witnessed sudden loss of consciousness while resting on a chair, suspicious of cardiac syncope. She has a past medical history of recurrent syncope, which has resolved since the permanent pacemaker insertion five years ago.
Upon arrival at the Emergency Department, the patient was placed on cardiac monitoring, which showed a transient complete heart block. Chest X-ray was performed as part of the initial syncope workup and revealed findings suggestive of Twiddler's syndrome, correlating with clinical suspicion.
She was admitted to the cardiology team for pacemaker interrogation and repositioning of the leads.
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