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Pallangyo P, Mgopa L, Millinga J, Bhalia S, Hemed NR, Mkojera Z, Swai HJ, Seraphine P, Mulashani R, Ndelwa B, Shemu T, Janabi M. Suicide Attempt Following Pacemaker Implantation in an Eighty-Three-Year-Old Male: A Case Report. J Med Cases 2019; 10:345-347. [PMID: 34434306 PMCID: PMC8383566 DOI: 10.14740/jmc3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022] Open
Abstract
As the global population ages, cardiac pacing procedures are rising exponentially to keep pace with the increasing incidence of bradyarrhythmias. The efficacy of pacemakers is well established, but recipients may have poor psychosocial adaptation leading to development or exacerbation of mental disorders, that may manifest with anxiety, depressive symptoms or rarely suicidal tendencies. An 83-year-old male of African descent was referred to us for evaluation and expert management. He came with chief complaints of general body malaise, light-headedness, chest pain and fainting spells for about 6 months. He was diagnosed with hypertension 4 years prior, and there was no history of mental illness in the patient or his family. Echocardiography (ECHO) revealed features of hypertensive heart disease while electrocardiogram (ECG) showed features of third-degree heart block. He underwent successful pacing with a resultant ventricular paced rhythm. The patient was stable and symptom free post pacing, but on the fourth day he jumped off the window of the ward in the hospital’s second floor. Post suicide attempt examination revealed epistaxis, right periorbital hematoma with a temporal lacerated wound and deformed ankles bilaterally. ECG showed a ventricular paced rhythm and the chest radiograph showed an intact pacemaker. Ophthalmological review was evident for right sided blepharospasm with massive chemosis and bilateral constricted reactive pupils. Radiological investigations showed right orbital fracture, stable C5 and C6 fractures, and bilateral bimalleolar fractures with ankle dislocation. Neurosurgical review was unremarkable and psychiatric review could not be performed. The patient died 18 h after the suicide attempt incidence. Emotional disturbances post pacing impairs the quality of life and in the worst case scenario could lead to unanticipated cessation of life. In view of this, thorough evaluation and monitoring of the patient’s psychological well-being both pre and post pacing is paramount.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania.,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Lucy Mgopa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Naairah R Hemed
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Polycarp Seraphine
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Rydiness Mulashani
- Department of Nursing, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Baraka Ndelwa
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Tulizo Shemu
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
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