Neck Pain One Week after Pacemaker Generator Replacement.

Area of Science:

• Cardiology
• Vascular Surgery
• Emergency Medicine

Background:

• Cardiac pacemaker implantation incidence has significantly increased over the last 30 years.
• Emergency physicians must be aware of potential postprocedural complications.
• This case highlights a rare complication of pacemaker generator replacement.

Observation:

• A patient presented with headache and neck pain following a routine cardiac pacemaker generator exchange.
• A temporary transvenous pacemaker inserted via the right internal jugular vein was noted.
• Computed tomographic angiography revealed near-complete occlusion of the left internal jugular vein.

Findings:

• The patient was diagnosed with internal jugular deep vein thrombosis (DVT).
• This is the first documented case of IJ DVT following an uncomplicated pacemaker generator replacement.
• The DVT extended along the course of the pacemaker wires.

Implications:

• Emergency providers should consider DVT in patients with head, neck, or upper extremity symptoms post-pacemaker procedures.
• Untreated DVT can lead to serious complications like airway edema, septic thrombophlebitis, and pulmonary embolism.
• Prompt diagnosis and anticoagulation are crucial for managing this complication.