IMPRESSION:
There is a new right-sided dual lead pacemaker with distal lead tips in the
 right atrium and right ventricle.  Leads appear intact.  There are no
 pneumothoraces.  Heart size is within normal limits.  There is coarsening of
 the bronchovascular markings without overt pulmonary edema.  Suture anchors
 are seen within the right humerus from prior surgery.