Diaphragmatic Pacing Diagnosed with Point-of-Care Ultrasound

A 59-year-old woman with a history of non-ischemic cardiomyopathy (ejection fraction of 30%) and obesity was admitted to internal medicine with palpitations. She had undergone uncomplicated cardiac resynchronization therapy with defibrillator (CRT-D) placement five days previously. At a skilled nursing facility, she experienced an intermittent pulsating feeling in her left chest several times per day. She described the feeling as the sensation of “somebody doing CPR from the inside.” She was referred to the emergency department for further evaluation.