A 70 year old man presented with neck pain which aggravated by movement. Which of coz is your typical 'atok tua dengan sakit tengkuk' scenario. A young doc at the A&E however noted something is amiss. His pulse rate only register at 26 per minute!
An ECG revealed a second degree heart block - Mobitz type II which could progress rapidly to 3rd degree or complete heart block which is your Grim Reaper's recipe for dinner.
The heart is likened to a pumping machine which in a normal mortal pumps out about 5 litre / minute of blood into the circulation. It however needs an electrical supply to coordinate its pumping activity. Right now his heart's electrical wiring is fucked up big time.
The A&E doc paged the cardiology unit MO on call aka 'me in sleepy mode' to further manage this case. On further questioning he admitted to been having giddiness for the past 2 days. After consultation with the registrar & cardiologist on call, we decided to perform an urgent transvenous temporary pacemaker (TPM).
Under local anaesthesia we pierced the right internal jugular vein (a big vein at the neck) and push the pacing wire into the heart.
One hour later with the TPM on board we set the heart rate at 60 beats/minute. This should buy some time until the 'fellowship of the heart' reconvene on Monday morning to decide the next best course of action.
My only concern that night was what if the old man suddenly 'mengigau' at 2am in the morning and pulled out the pacing wire that hanging down from his neck !
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