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Images in medicine
Pacemaker-related reversible right heart failure
  1. Benoy N Shah1,2,3,
  2. Hugh W L Bethell3,
  3. Roxy Senior1,2,3
  1. 1Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
  2. 2National Heart and Lung Institute, Imperial College, London, UK
  3. 3Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, UK
  1. Correspondence to Dr Benoy N Shah, Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; benoy{at}doctors.org.uk

http://dx.doi.org/10.1136/postgradmedj-2013-131916

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    Introduction

    An under-recognised complication of permanent pacemakers is an increase in tricuspid regurgitation (TR) due to interference with the tricuspid valve apparatus, which can cause right ventricular (RV) dysfunction and right heart failure. We use a recent case to illustrate this phenomenon and highlight this as a differential diagnosis in patients with right heart failure and previously implanted pacemaker or defibrillator.

    Clinical case

    A 61 year old lady was referred for transthoracic echocardiography (TTE) after presenting with exertional dyspnoea. Two years previously she had undergone aortic valve replacement and subsequently required a permanent pacemaker for persistent junctional bradycardia. Clinical examination revealed an elevated venous pressure with prominent V waves and peripheral oedema. TTE showed RV dilatation and new severe TR (figure 1A). Trans-oesophageal echocardiography (TOE) was …

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    Footnotes

    • Contributors BNS and RS conceived the idea for the article. BNS wrote the first draft of the manuscript and created the figure. HWLB and RS critically appraised and edited the manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.