Unilateral neck pulsations in a patient with a permanent pacemaker.

Area of Science:

• Cardiology
• Vascular Medicine
• Medical Devices

Background:

• Permanent pacemakers are common medical devices used to treat bradyarrhythmias.
• Unilateral neck pulsations can indicate various underlying cardiovascular conditions.

Observation:

• An asymptomatic patient with a permanent pacemaker presented with unilateral accentuated neck pulsations.
• Physical examination revealed severe tricuspid insufficiency and unilateral internal jugular vein obstruction.

Findings:

• The patient had a massively dilated right internal jugular vein and complete obstruction of the left internal jugular vein.
• Tricuspid regurgitation in the context of unilateral internal jugular vein occlusion was identified as the most probable cause.

Implications:

• This specific combination of findings should be considered in the differential diagnosis of asymmetrical neck pulsations.
• Awareness of this presentation can aid clinicians in diagnosing rare cardiovascular complications associated with pacemakers.