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| Title | Pacemaker syndrome as a masquerade of carotid-cavernous fistula |
| Number | 313 |
| Author | Clea Southall |
| Principal Unit where research was undertaken | Royal Free Hospital |
| Purpose | A 72-year-old female presented with an 8-year history of bilateral, asymptomatic, prominent episcleral vessels. She reported left-sided facial flushing which had developed at the same time, but denied any visual disturbance, headaches, or pulsatile tinnitus. Past medical history included insertion of a cardiac resynchronization therapy pacemaker (CRT-P) in 2017 following a myocardial infarction. |
| Methods | Aided visual acuity was 6/12 (OD) and 6/9 (OS), with normal intraocular pressure of 14mmHg (OU). Anterior segment examination demonstrated bilateral engorged episcleral vessels infra-temporally, more significant on the left. Prominent iris vessels were also noted in the left eye. There was no conjunctival chemosis or proptosis. Cranial nerves V and VII were both intact. An MRI angiogram was performed demonstrating normal flow and angiographic appearances, with no evidence of a carotid-cavernous fistula, malformations or other pathology. |
| Results | Engorged episcleral vessels may be suggestive of raised venous pressure within the orbit or cranium, especially when found in conjunction with raised intraocular pressure. However, in the absence of an abnormal intracranial venous system, it may be prudent for clinicians to consider possible causes from further downstream in the venous system. Of note, CCF-like findings have been reported secondary to an upper arm dialysis fistula. |
| Conclusion | In this case, the patient’s symptoms of facial flushing and engorged episcleral vessels appeared following the insertion of her CRT-P. Pacemakers can cause increased venous pressure, a phenomenon known as ‘pacemaker syndrome’, which could increase episcleral pressure and lead to engorged anterior segment vessels. |
Additional Authors
| First name | Last name | Hospital / Institution |
|---|---|---|
| Mark | Westcott | |
| Miles | Kiernan |
