Blind extrathoracic subclavian venipuncture for temporary pacing lead insertion: a 4 year experience in 760 patients

Seven hundred and sixty patients admitted in Cardiology Dept. Mayo Hospital, Lahore from Feb.1994 to Jan 1998 were inserted temporary pacing lead for different indications. Modification of the percutaneous technique for extrathoracic subclavian venipuncture proposed by Magney and colleagues for permanent pacing lead placement was used. Before puncturing bony landmarks were marked on the skin according to Magney's description to identify the needle entry point. Then the venipuncture was accomplished by inserting the needle through a standard infraclavicular land mark. 760 patients were approached with this technique with in a span period of four years. This technique was successful in 684 [90%] cases with first puncture, additional 35 [5%] with second attempt, while additional 14 [2%] patients required multiple attempts or the change of the site. In rest 3% the procedure was completed using other routes. Patients were followed till the removal of temporary pacing wire or implantation with permanent pacing system. In the present study the blind approach to the extrathoracic portion of the subclavian vein proved to be safe and effective for pacing lead insertion. Further observations are required to establish whether this method decreases the complication rate

Experience with permanent pacemaker implantation at Mayo Hospital, Lahore

Permanent pacemaker implantation procedure was started at Mayo Hospital, Lahore in March, 1978. Till December 31st 1998 nine hundred and sixty six permanent pacemakers had been implanted in this institution. 53% patients were males and 47% patients were females. 55% patients were between 50-70 years old. The youngest patient was only six months old while maximum age of the patients implanted with permanent pacemaker was ninety nine years old. 92% patients had fist implant while 6% patient had second implant and 2% patient had third implant. 84% patients had complete heart block, 5.5% patients had sick sinus syndrome, 2.7% patients had symptomatic second degree heart block, 2.6% patients had congenital heart block

Sustained release verpamil in hypertensive patients

Thirty patients [22 females and 8 males] were put on Verapamil SR, a slow release calcium channel blocker, for three weeks on out door basis. Mean age was 44.3 +/- 2.5 years, mean weight before treatment was 67.1 +/- 24 Kg, after treatment it was 64.7 +/- 3.5 Kg, mean height was 156 +/- 3 Cm and mean duration of hypertension was 3.89 +/- 1.5 Years. Mean supine systolic pressure decreased from 164 +/- 2.33 mmHg to 140 +/- 6.5 mmHg [P<0.01] while supine standing pressure decreased from 163.6 +/- 4.1 mmHg to 147.5 +/- 04 mmHg [p<0.01]. Fall in mean supine diastolic pressure was from 107.33 +/- 1.14 mmHg to 91 +/- 4.2 mmHg [P<0.01] while fall in standing diastolic pressure was from 110 +/- l.7 mmHg to 97.3 +/- 2.1 mmHg [p<0.001]. Mean supine arterial pressure decreased from 126 mmHg to 107.3 mmHg while standing mean arterial pressure decreased from 127.9 mmHg to 114 mmHg. No statistically significant fall in heart rate both in supine and standing position was observed. laboratory results did not show any variation. In 72% of the patients supine systolic pressure was

Analysis of cardiac arrhythmias in patients with ischaemic heart disease admitted to coronary care unit

Three hundred and fifty patients were admitted to Coronary Care Unit Mayo Hospital, Lahore between June 1986 to May 1987. 218[62.8%] patients developed arrhythmias. 158[72.4%] were males and 60[27.6%] were females. Tachyarrhythmia's were mostly ventricular in origin [18%]. Out of 218 patients 47[21.5%] died 126[58%] patients were haemodynamically stable while 92[42%] patients developed left ventricular failure 64.5% of the total females and 61 7% of the total males developed arrhythmias. Arrhythmias and deaths occurred more frequently with anterior Q wave infarction. 18.9% of the male patients and 28.3% of the female patients with arrhythmias died. 78% of patients who died had one or more risk factors. 14% of the patients below 50 years old died while 29% of L the patients above 50 years old with arrhythmias died. We conclude that female gender, presence of one or more risk factors and anterior Q wave infarction is associated with increased mortality in patients who developed arrhythmias in coronary care unit

Efficacy of felodipine in hypertensive patients

Thirty two patients were put on calcium channel blocker felodipine, a dihydopyridine derivative, for twelve weeks, after two weeks on placebo treatment, either alone or in combination with other antihypertensive drugs. Mean sitting systolic pressure decreased from 168 +/- 3.1 mmHg to 138.5 +/- 2.18 mmHg while sitting diastolic pressure decreased from 105 +/- 0.8 mmHg to 89 +/- 1.06 mmHg. Mean standing systolic pressure decreased from 162 +/- 3.2 mmHg to 141 +/- 3.4 mmHg and mean standing diastolic pressure decreased from 107 +/- 0.9 mmHg to 92 +/- 1.4 mmHg. Mean arterial pressure decreased from 125 mmHg to 108 mmHg. Mean pulse rate in sitting position decreased from 94/min to 89/min while drop in mean sanding pulse rate was from 103/min to 98/min. There was not much change in pulse rate. Laboratory results remained almost the same before and after treatment. Felodipine was found effective in decreasing blood pressure either alone or combination with other drugs

Antihypertensive effect of urapidil

Urapidil, an antihypertensive alpha receptor blocking drug, was given to 12 out-door patients for six weeks. Mean systolic pressure decreased from 180.8 +/- 6.7 mmHg to 139.5 +/- 4.9 mmHg [P=<0.001]. Mean diastolic pressure fell from 111.2 +/- 3.9 mmHg to 85.5 +/- 1.8 mmHg [P=<0.001]. Mean pulse rate dropped from 96.2 +/- 3.8/min to 88.5 +/- 30/min [P=<0.05]. No serious side effects were observed. No significant differences in laboratory tests were observed at the end of treatment

profile of patients with ischaemic heart disease

It is generally believed that the lschaemic Heart Disease is a disease of the affluent people. The findings of this study, however, suggest that less well to do sections of the society are equally prone to coronary heart disease rather with a higher mortality. Sixty patients [76.92%] had at least one risk factor, while only 33.33% patients had multiple risk factors. Hypertension was the most common risk factor, present in 39.74% of the patients, diabetes mellitus in 35.89% and cigarette smoking in 30.75% cases. The percentage of patients, who smoked was higher among patients below 50 years of age [43.7%] as compared to those aged over 50 years [27.41%]. The distribution of risk factors was, however, almost equal among both groups