Heart Failure and Pulsus Alternans
An Unusual Presentation of First-Degree Heart Block
Pacemaker syndrome is the development of fatigue and dyspnea in patients with ventricular pacing caused by VA conduction and the resultant atrial contraction against a closed AV valve. First-degree AV block with a very prolonged PR interval has also been reported to present with symptoms of pacemaker syndrome and has sometimes been described as pseudopacemaker syndrome or pacemaker-like syndrome.1 We report a case of pacemaker-like syndrome who presented with florid heart failure and alternans that were abolished with AV pacing.
A 65-year-old woman presented with few months history of dyspnoea on exertion gradually progressing to New York Heart Association class IV. She was admitted twice at the emergency department over a period of a …