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EM@3AM: Leadless Cardiac Pacemakers

An 81-year-old male presents with a heart rate of 31 and a blood pressure of 81/47. He reports feeling lightheaded and chest pain. He recently had a pacemaker placed for having a “slow heart rate” but is unsure of information beyond that. On exam, there is no pacemaker noted on the chest. X-ray demonstrates a small radiopaque object overlying the heart.

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    EM@3AM: Leadless Cardiac Pacemakers

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    An 81-year-old male presents with a heart rate of 31 and a blood pressure of 81/47. He reports feeling lightheaded and chest pain. He recently had a pacemaker placed for having a “slow heart rate” but is unsure of information beyond that. On exam, there is no pacemaker noted on
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    Acute heart failure exacerbation disposition

    Not all patients require admission

     

    Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up

     

    Elevated troponin and serum Cr associated with worse outcomes

     

    Don’t use risk tools alone for DC, but Ottawa Heart Failure Risk Scale may assist in admission (ACEP Level B)

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