[Psycho-social experiences and quality of life of pacemaker patients in Cotonou]. / Vécu psycho-social et qualité de vie des patients porteurs de pacemaker à Cotonou.

PURPOSE OF THE STUDY: The aim was to study the psycho-social experiences and quality of life (QOL) of pacemaker patients at the National Teaching Hospital Hubert Koutoukou Maga in Cotonou. PATIENTS AND METHOD: A descriptive cross-sectional observational study was performed in 2017 and included over a three-month period all pacemaker patients admitted on an ambulatory basis. The psychological impact of wearing a pacemaker was studied, as well as the limits and constraints of daily life and the quality of life appreciated by the SF-36 score. RESULTS: Fifty-five (55) patients were included with an average age of 67 ± 11.3 years. In terms of psychological impact, 98.2% (n=54) had a good overall perception of their health status. However, 60.6% (n=33) perceived pacemaker use as a handicap and 52.5% (n=29) wanted psychological support in post-implantation. Limitations and constraints mainly concerned lateral decubitus on the side of the pacemaker (54.5%, n=30), travel (27.3%, n=15) and sexual relations (21.8%, n=12). The average quality of life was rated good in 6 out of 8 dimensions. The level of quality of life was independent of gender. CONCLUSION: This study has highlighted misperceptions of daily life that may hinder the expected improvement in post-implantation patient performance. Psychological support and enhanced communication with these patients are needed.

Detection of a Left Superior Vena Cava during a Pacemaker Implantation in Cotonou.

Persistent left superior vena cava (LSVC) is a rare congenital anomaly. Its prevalence in the general population is 0.1 to 0.5%. LSVC is 5 times rarer when accompanied by an absence of the right superior vena cava (RSVC). We present the case of a 54-year-old man who carries a persistent LSVC without RSVC. Clinically, this patient presented a regular bradycardia at 40 per minute associated with a heart failure syndrome. The electrocardiogram diagnosed a complete atrioventricular block and transthoracic echocardiography showed dilated left heart cavities and a left ventricular ejection fraction of 50%. During the procedure of pacemaker implantation, the probe followed an unusual LSVC-coronary sinus-right atrium path and it was not easy to pass through the tricuspid orifice. We propose a review of the literature on this subject, focusing on the clinical implications of this malformation in cardiac stimulation and in other areas of cardiology.

[Loss of capture by myocardial ischemia: A case report]. / Perte de capture par ischémie myocardique : à propos d'un cas.

We report the case of a patient with pacemaker who presented chest pain during exercise followed by fainting. He has a history of arterial hypertension and diabetes. The initial examination was normal; the ventricular stimulation threshold was 1.125 volts (V) and cardiac enzymes were normal. Stress test has reproduced chest pain followed by loss of pacemaker capture and asystole. Coronary angiography showed a tight stenosis of the proximal anterior interventricular artery dilated by a drug-eluting stent. The control of stress test was normal. A stent thrombosis eight days later led to an acute coronary syndrome with recurrent syncope due to the loss of ventricular capture. The ventricular pacing threshold was then 2.25V. After revascularization and stabilization of the patient's clinical status, this threshold returned to 1.125V. This clinic case has confirmed that coronary artery disease could increase pacing threshold. It also highlights the usefulness of automatic capture algorithms in coronary patients. The stress test cannot only help to detect coronary artery disease but also allows the optimization of programming the pacemaker.

Dyslipidémie athérogène chez le diabétique de type 2 à Cotonou

Introduction : Les anomalies lipidiques sont fréquentes chez les diabétiques, en particulier les diabétiques de type 2.Objectif : Cette étude avait pour objectif de déterminer la prévalence et les facteurs associés à la dyslipidémie athérogène (DA) chez les diabétiques de type 2 à la Banque d'insuline de Cotonou Méthodes : Il s'agit d'une étude rétrospective descriptive et analytique qui s'est déroulée sur 5 mois (de Mai à Octobre 2014). Résultats : L'effectif total des patients diabétiques de type 2 retenus était de 156 (56% femmes). L'âge moyen était de 54,14 ± 10,5 ans avec des extrêmes de 31 ans et 80 ans. La prévalence d'obésité (37%), d'excès pondéral (36%), d'hypertension artérielle (69%) étaient importantes. Celle du tabagisme était faible (2%). La prévalence de la dyslipidémie athérogène était de 5,1%. Mais séparément, les prévalences de l'hypocholestérolémie HDL et de l'hypertriglycéridémie étaient respectivement de 39% et 12%. C'est la prévalence de l'hypercholestérolémie LDL qui est la plus élevée (71%). Parmi les facteurs associés recherchés dans notre étude, seule l'obésité a été retrouvée comme favorisant la survenue de la DA (p=0,02).Conclusion : Les anomalies lipidiques étaient fréquentes chez les diabétiques de type 2, mais la prévalence de la DA dans notre étude paraissait moins élevée