ECGs in the ED.

摘要

A 14-year-old girl presents to the emergency department for evaluation of dizziness. She has a history of a neuromuscular disease that is associated with sinus node dysfunction. An epicardial ventricular pacemaker was implanted at 8 years of age. The patient had been in her usual state of health until yesterday when she developed intermittent dizziness, but no syncope. She denies chest pain, palpitations, or shortness of breath. There is no history of trauma to the pacemaker site. There have been no recent fevers, intercurrent illnesses, headaches, vision changes, or vomiting. The past medical history is significant for the neuromuscular disease and pacemaker surgery. The pacemaker is known to be programmed at a lower rate limit of 90 ppm. Her last Pacemaker Clinic appointment was 2 months prior and there were no problems noted at that time.