Exertional dyspnea and orthopnea in a patient with a pacemaker: an easily overlooked diagnosis

Acute dyspnea represents one of the most common presentations to the emergency department. Identifying the cause of this non-specific symptom among patients with complex medical histories can be challenging. This case report describes a patient in their 60s with worsening dyspnea on exertion, fatigue and orthopnea on the background of a single chamber pacemaker. Our case demonstrates an often-missed diagnosis of pacemaker syndrome which can be identified on the bedside electrocardiogram (ECG). This is a disease with high morbidity and yet is easily treated once diagnosed.