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Fulltext Emotional Stress Induced Broken Heart Syndrome: A Case Report

Wei Juan L, Kaisbain N

Cureus, 2022 Dec;14(12):e32384.

PMID: 36632256 DOI: 10.7759/cureus.32384

Takotsubo syndrome (TTS) is a medical condition mostly due to emotional or physical stress which frequently leads to misdiagnosis or late diagnosis. Patients tend to present initially with acute heart failure or acute coronary syndrome to our emergency department. Here we describe a patient with no history of cardiovascular disease, who developed TTS due to emotional stress from the death of her husband and then fully recovered during follow-up.

Fulltext Verapamil-Induced Hypotension in End-Stage Renal Disease: The Role of Calcium Gluconate

Kaisbain N, Lim WJ, Kaisbain V

Cureus, 2023 Jan;15(1):e33341.

PMID: 36741660 DOI: 10.7759/cureus.33341

Verapamil is a useful drug in supraventricular tachycardias, atrial flutters, and fibrillations. However, its usage is accompanied by an undesirable side effect of hypotension. This limits its usage in patients where even the slightest reduction of blood pressure for a brief period may prove detrimental, e.g., in patients with critical coronary artery disease. Intravenous calcium given as pretreatment to verapamil prevented verapamil-induced hypotension. Its usage after hypotension restored the blood pressure to its baseline level. All these occur without the loss of the antiarrhythmic effect of verapamil. Furthermore, the pharmacokinetics of verapamil is unaltered in patients with chronic kidney disease. Thus, no dosage adjustment is required in this population. Here we describe a case of verapamil-induced hypotension in a patient with end-stage renal failure, which was reverted with intravenous calcium administration without altering the atrioventricular blockade effect of verapamil.

Fulltext Atrial septal defect with Crochetage sign presenting with pulmonary artery thrombosis

Kaisbain N, Lim WJ, Kim HS

BMJ Case Rep, 2021 Jul 27;14(7).

PMID: 34315750 DOI: 10.1136/bcr-2021-244180

Atrial septal defect (ASD) is the most common congenital heart disease observed in adult. Several ECG findings are considered sensitive for the diagnosis of ASD. We describe a 50 years old man who displayed Crochetage sign, incomplete right bundle branch block (IRBBB) and right ventricular strain pattern on ECG. Crochetage sign is highly specific for ASD and it correlates with shunt severity. The diagnostic specificity for ASD increases if the R waves have both Crochetage patterns and IRBBB. It is important not to confuse Crochetage signs with IRBBB abnormalities on ECG. Our patient was ultimately diagnosed with a large ASD measuring 3 cm with bidirectional shunt and concomitant pulmonary thrombosis. This illustrates that high suspicion of the ASD with the use of good-old ECG signs remains relevant in this modern era. This also reminds us that patients with Eisenmenger syndrome are at higher risk for pulmonary thrombosis.

A Rare Combination: Dengue Fever Complicated With Guillain-Barre Syndrome

Lim CS, Kaisbain N, Lim WJ

Cureus, 2023 Jun;15(6):e40957.

PMID: 37503499 DOI: 10.7759/cureus.40957

Guillain-Barre syndrome (GBS) is an uncommon neurological complication of dengue viral infection. It is more commonly reported with Campylobacter jejuni, Epstein-Barr virus, and Cytomegalovirus infection. We report an uncommon case of a 49-year-old man with dengue fever, who developed bilateral lower limb weakness and areflexia on day two of dengue illness. He was diagnosed with GBS as a sequel of dengue infection with the nerve conduction study showing evidence of demyelinating neuropathy. He recovered gradually without immunotherapy and was discharged after a week of hospitalization.

ECG lead misplacement in the frontal and horizontal plane mimicking A myocardial infarction

Kaisbain N, Khoo KKL, Lim WJ

Am J Emerg Med, 2023 Dec;74:196.e1-196.e4.

PMID: 37863804 DOI: 10.1016/j.ajem.2023.10.009

BACKGROUND/AIMS: Electrocardiogram (ECG) is an inexpensive, fundamental screening tool used in daily clinical practice. It is essential in the diagnosis of life-threatening conditions, such as acute myocardial infarctions, ventricular arrhythmias etc. However, ECG lead misplacement is a common technical error, which may translate into wrong interpretations, unnecessary investigations, and improper treatments.

METHODS/RESULTS: We report a case of a multiple ECG lead misplacement made across two different planes of the heart, resulting in a bizarre series of ECG, mimicking an acute high lateral myocardial infarction. Multiple ECGs were done as there were abrupt changes compared to previous ECGS. Patient was pain free and administration of potentially harmful procedures and treatments were prevented.

CONCLUSION: Our case demonstrated the importance of high clinical suspicion in diagnosing ECG lead misplacement. It is the responsibility of both the healthcare workers who are performing and interpreting the ECG to be alert of a possible lead malposition, to prevent untoward consequences to the patient.

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