Diferencia entre revisiones de «Twiddler's syndrome»
(Text replacement - "==Diagnosis==" to "==Evaluation==") |
Sin resumen de edición |
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*Implantable devices with attached wires traveling remotely are at risk for this complication. | *Implantable devices with attached wires traveling remotely are at risk for this complication. | ||
*Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole." | *Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole." | ||
*Wires dislodged from appropriate location in myocardium. | *Wires dislodged from appropriate location in myocardium, often by patient 'twiddling' a recently-implanted pacemaker. | ||
==Clinical Features== | ==Clinical Features== | ||
*Pacemaker placed with poor function. | *Pacemaker placed with poor function. | ||
*Can present with syncope from lack of pacemaker function. | *Can present with [[syncope]] from lack of pacemaker function. | ||
*Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position. | *Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Lead separation | *Lead separation | ||
*Lead | *Lead dislodgement | ||
*Lead infection | *Lead infection | ||
*See also [[pacemaker malfunction]] | |||
==Evaluation== | ==Evaluation== | ||
*CXR to evaluate the placement of the leads | [[File:PMC3487215 APC-5-203-g002.png|thumb|Wrapped pacemaker lead showing Twiddler's syndrome.]] | ||
[[File:PMC4286824 JCIS-4-74-g022.png|thumb|Wrapped pacemaker lead showing Twiddler's syndrome.]] | |||
*[[CXR]] to evaluate the placement of the leads | |||
==Management== | ==Management== | ||
Revisión actual - 18:41 26 sep 2019
Background
- Implantable devices with attached wires traveling remotely are at risk for this complication.
- Device moves within subcutaneous pocket acting like fishing rod pulling wires back to the "pole."
- Wires dislodged from appropriate location in myocardium, often by patient 'twiddling' a recently-implanted pacemaker.
Clinical Features
- Pacemaker placed with poor function.
- Can present with syncope from lack of pacemaker function.
- Can present with symptoms related to stimulation of other structures (diaphragm, brachial plexus) as wires migrate from expected position.
Differential Diagnosis
- Lead separation
- Lead dislodgement
- Lead infection
- See also pacemaker malfunction
Evaluation
- CXR to evaluate the placement of the leads
Management
- Cardiologist for device/lead placement
Disposition
- Admit to allow for device intervention as pacemaker does not function in Twiddler's Syndrome