A 65-year-old man with a history of coronary artery disease visits his doctor with complaints of exertional shortness of breath, weariness, and lower limb edema. His medical history is notable for a myocardial infarction 5 years ago and the placement of an electronic pacemaker 2 years ago. The x-ray of his chest is seen below. One of the leaders' segments is highlighted (arrow). The highlighted segment most likely lies within which of the following structures?

Question

A 65-year-old man with a history of coronary artery disease visits his doctor with complaints of exertional shortness of breath, weariness, and lower limb edema. His medical history is notable for a myocardial infarction 5 years ago and the placement of an electronic pacemaker 2 years ago. The x-ray of his chest is seen below. One of the leaders' segments is highlighted (arrow).  The highlighted segment most likely lies within which of the following structures?

Quizplus · Accepted Answer

Eductional Objective: This patient has a biventricular pacemaker, which requires 2 or 3 leads. If three leads are utilized, the first two are inserted in the right atrium and right ventricle. The third lead is utilized to pace the left ventricle. Right atrial and ventricular leads are simple to insert since they simply need to pass via the left subclavian vein and superior vena cava to reach these heart chambers. In comparison, the lead that paces the left ventricle is more difficult to locate. The preferred transvenous technique entails inserting the left ventricular pacing lead from the right atrium into the coronary sinus, which is located in the atrioventricular groove on the posterior portion of the heart. It is then advanced into one of the lateral venous systems.

A 65-Year-Old Man with a History of Coronary Artery Disease