BackgroundMultiple gated acquisition (MUGA) studies are commonly used for calculation of ejection fraction (EF). Many observations are commonly drawn from studies in addition to the main objective. We noted splenomegaly on multiple occasions in patients undergoing MUGA in our cardiac laboratory. We did this study to see whether this observation was related to any cardiac dysfunction.MethodsWe retrospectively analyzed MUGA scans done over a period of 4 months for EF, wall motion abnormalities, and splenomegaly.ResultsOf the 98 patients in this study, 53 (54%) were male and 45 (46%) female. Splenomegaly was present in 32 patients (33%). Sixteen patients (16%) had akinetic segments, 9 (9%) dyskinetic segments, and 64 (65%) hypokinetic segments. Mean EF for the 98 patients was 49 (median 44, SD 59, range 11 to 490). Mean EF was not significantly different in those with splenomegaly (mean 58.8, SD 63.1) than in those without splenomegaly (mean 44.3, SD 57.5) (p = .26). The percentage of those with splenomegaly and akinetic or dyskinetic or hypokinetic segments (7, 22%) was not significantly different from the percentage of those without splenomegaly and similar wall motion abnormalities. Twenty-three patients (24%) did not have any akinetic, dyskinetic, or hypokinetic segments; 61 patients (62%) had 1 abnormal segment; and 14 patients (14%) had 2 abnormal segments. The percentage of patients with and without splenomegaly did not vary with number of abnormal segments. The percentage of patients with and without splenomegaly did not vary with wall motion abnormality in any particular segment.ConclusionSplenomegaly on MUGA studies is a purely incidental finding and is not related to results of MUGA scan. Splenomegaly if discovered on MUGA should be evaluated clinically and with further testing if necessary.
ObjectiveThe objective of the project is to study the spectrum of indications for permanent pacemaker (PPM) implantation in a community hospital. The study also analyzed the type of pacemaker implanted, median age, and the indication for the procedure and whether a Holter exam diagnosed the indication for the pacemaker. In addition, we collected data to analyze how many patients had a temporary pacemaker placed before implantation of a permanent pacemaker.MethodsA retrospective study of all patients who had a permanent pacemaker placement in Coney Island Hospital in Brooklyn, New York from January 2000 to January 2004. Data were collected regarding the indication for the permanent pacemaker placement, age and sex of the patient, clinical presentation, and diagnostic utility of Holter.Results214 patients (111 males and 103 females) underwent PPM implantation at the Coney Island hospital in the period of 2002-2004. The age of patients ranged from 43 to 94 years with a median age of 78 years. The indication for PPM implantation was sick sinus syndrome for 103 patients (48%), third-degree AV block or high second-degree AV block for 99 patients (46%), and trifascicular block for 12 patients (5%). Presenting symptom was fall in 40% patients, syncope in 12%, dizziness in 10%, chest pain in 13%, and cardiac arrest in 2 patients; the remaining 23% patients presented with various other noncardiac illnesses like pneumonia, respiratory arrest, altered mental status, and diabetic ketoacidosis. Thirty-four percent of patients received a single-chamber PPM while 66% received a dual-chamber PPM. The diagnosis was established in only 4% of patients with the help of Holter exam. Fifty-four percent of patients had a temporary pacemaker wire inserted before a PPM. Acute myocardial infarction was diagnosed on 10% of patients.ConclusionsSick sinus syndrome and high-grade AV block appear to be major indications for permanent pacing in the elderly. Fall is an important symptom and warrants an electrocardiogram in the elderly. Utility of Holter monitoring in diagnosis to aid permanent pacing was low.
BackgroundWe sought to study the indications, complications and course of patients admitted to a community hospital and needed temporary pacemaker.MethodWe studied 181 consecutive patients who needed a temporary pacemaker between 04/2001 and 04/2003.ResultsA total of 181 patients were studied. The average age was 76.1 ± 12.3, 100 males, 81 females. The commonest site of insertion was right subclavian (45%) followed by right femoral vein (27%), right internal jugular vein in 18%, left femoral vein in 9%. The commonest indication for temporary pacemaker was sick sinus syndrome and symptomatic bradycardia (56%) as a bridge for permanent pacemaker. 47 (25.9%) needing temporary pacemaker had an acute coronary syndrome as their cause, 14 (29%) of which died of cardiac complications, 9 had persistent conduction defect needing permanent pacemaker. 25 of these patients had infarction involving the inferior wall. Non essential medications causing symptomatic bradycardia needing temporary pacemaker was found in 29 (16%) of patients. 20 (11%) patients had hyperkalemia (medication induced or renal failure) and 3 patients had digoxin toxicity as the cause of conduction disturbance. 6 patients needed temporary pacemaker as their permanent pacemaker generator had reached end of life.ConclusionTemporary support of conduction system prior to placement of permanent pacemaker was the commonest cause of temporary pacemaker in our study. Myocardial infarction needing temporary pacemaker is a high risk group patient with a high mortality. Iatrogenic cause of conduction disturbance is a frequent cause for need of temporary pacemaker.
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