Masked non-massive thromboembolism of the pulmonary artery in patients with the implanted electropacemaker

Diagnosis of pulmonary arterial embolism (PATE) in patients with implanted electrocardiostimulator (ECS) remains challenging due to polymorphism of clinical presentations, especially in non-massive and recurrent forms. Masked PATE and its recurrences can present with repeated pneumonias of unclear etiology, collapses, unidentified fever, drug-resistant manifestation or progression of heart failure and ischemic heart disease, and occurrence or progression of symptoms of subacute or chronic cor pulmonale in the absence of chronic lung disease in the past medical history. Even in the presence of a verified diagnosis explaining respiratory or cardiac symptoms in patients with implanted ECS, one must always take into account chance of PATE co-existing with the primary diagnosis.