Systolic Murmurs Induced by Pacemaker Catheters

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Abstract
Systolic murmurs of diverse etiologies may appear in association with acute myocardial infarction.1,2 Some are transient and of little consequence while others are manifestations of significant complications. Recently we encountered three patients with transient systolic murmurs which appeared after the introduction of a temporary transvenous pacemaker catheter into the right ventricle. Two of these patients had acute myocardial infarction complicated by arrhythmias and one had Adams-Stokes attacks. The clinical characteristics of such iatrogenic murmurs and their differential diagnosis form the basis of this presentation. Patient Summaries Patient 1. —A 47-year-old white woman was admitted to the George Washington University Hospital with an acute anterior myocardial infarction, complicated by complete heart block with several Adams-Stokes episodes. There were no murmurs. A bipolar electrode catheter was postioned in the right ventricle and functioned well, on a demand basis. Several hours later, a scratchy, squeaky, high-pitched grade 2/6 late systolic murmur

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