Case study ( 4764 views as of January 16, 2019 )
Shirley is a 75-year-old previously healthy woman who visits her family doctor with a 2-month history of lightheadedness and weakness. She has no significant past medical history and is currently taking no prescription medications other than an occasional sleeping pill.
Her physical examination is essentially normal aside from a slow heart rate of 50 beats per minute. She is sent for an ECG which is interpreted as sinus bradycardia with a right bundle branch block and a first degree AV block. Her family doctor arranges for a holter monitor (heart rhythm monitor), which reveals occasional pauses up to 3.5 seconds in duration, which correlate with her symptoms of lightheadedness. On this basis she is referred for an urgent outpatient pacemaker implantation after discussion over the phone with a cardiologist.
Shirley and her family have a number of questions about what a pacemaker is, what it does, and how it will help her. Shirley is also concerned about the potential danger of the procedure itself as she was told that it would involve a type of surgery.
Shirley would benefit from some monitoring following her procedure, and should be assigned to a cardiologist for follow-up care. She can also speak with a pharmacist regarding her medications to identify any possible interactions.Author: Dr. Graham Wong, VGH