Although pacemaker implants are generally safe, they can pose unique challenges, especially in patients with complex medical history. A recent case study attracted its rarity and multidisciplinary significance, highlighting the abnormal interaction between cardiac surgery and inflammatory disease. This case involves patients with gout arthritis, which causes special complications after pacemaker implantation. This, while rare, emphasizes the potential for unexpected outcomes in high-risk patients, especially those with conditions such as coagulation and heart failure, and the need for a link between inflammatory diseases and pacemaker complications.
In the strange field of medicine, there has been a recent case of interweaving cardiology and rheumatism in unexpected ways. Dr. Surachat Jaroonpipatkul, Dr. Thipsukhon Sathapanasiri, Dr. Sungchai Aungthararak, Dr. Apichai Pokawattana of Rangsit University and Dr. Leenhapong Navaravong of Utah University Health encountered a case in a unique pacemaker pocket. Heart rhythm case report. This case highlights the complexity and multidisciplinary nature of certain medical conditions.
The patient is a 64-year-old Thai man with a confusing medical condition. He has a history of various chronic diseases, including gout arthritis, and received pacemaker implantation in April 2020. Two years later, he showed symptoms of cardiomyopathy caused by pacemakers and planned to undergo synchronous cardiac treatment upgrades. However, the process was not successful due to the limitations of anatomy.
One month after the failure escalation, the patient returned swelling at the pacemaker wound site, but no fever or pain. The examination showed painless swelling on the spot and painful lower limbs. Investigations including ultrasound and chest X-rays revealed a fluid collection in the pacemaker pocket. Despite antibiotic treatment, the swelling continued, leading to a decision to revise the wound.
The operation found bloody content with chalk-like material in the pacemaker pocket, which was later analyzed and found to contain coagulated blood and uric acid crystals, confirming the diagnosis of gout-related complications. Dr. Jaroonpipatkul explained: “In our patients, serum uric acid levels are elevated, bilateral topsi on the lower limbs and bloody fluid with chalk-like content and monosodium uric acid bisulfate crystals pointing to the diagnosis of pacemakers. Urea and cystic gout of hematoma in the bag. The abnormal position of MSU crystals forming in the pacemaker pocket is a unique aspect of this condition.
After intensive serum uric acid control and wound care, the patient’s condition improved, highlighting an abnormal condition in which the gout manifests itself in the position outside the joint – especially in the creation of pacemakers rather than typical joints In the space. Dr. Jaroonpipatkul noted: “The surprising connection between gout and cardiac equipment was discovered, and this study “Beyond arthritis”. It encourages all physicians to work together to see the bigger picture of patient care. By combining efforts , We can prevent potential health problems and provide better overall support. This study links cardiology and rheumatism, highlighting the importance of teamwork to patient well-being.”
This case underscores the importance of considering comorbidities in patient care, especially in patient care with a complex medical history. It also highlights the need for holistic and multidisciplinary approaches in medical practice. The interaction between the patient’s gout and his heart disease presents unique challenges and requires the expertise of cardiologists and rheumatologists to manage effectively.
In conclusion, this extraordinary case adds to the medical literature by illustrating the rare manifestations of gout and the need to be alert in the care of patients with multiple medical conditions.
Journal Reference:
Jaroonpipatkul S., Sathapanasiri T., Aungthararak S., Pokawattana A., Navaravong L. 2023. Heart rhythm case report. doi: https://doi.org/10.1016/j.hrcr.2023.07.008.
About the Author
Dr. Surachat JaroonpipatkulA renowned cardiologist based in Bangkok, Thailand, received her PhD in Medicine from Lansit University. As a lecturer and consultant in Cardiology at Rajavithi Hospital and Rangsit University, he specializes in clinical cardiology with a focus on pacemakers, defibrillators and cardiac electrophysiology. Driven by his passion for medical education, he mentors and mentors students, residents and researchers, making a significant contribution to their academic growth. His dedication extends to the administrative role of Rajaveti Hospital. Dr. Jaroonpipatkul has a strong research background and has written publications on a variety of cardiology topics. Dedicated to global knowledge sharing, he actively participates in seminars and lectures, reflecting outstanding performance in cardiology practice and medical education.
