MyMedR

Posterolateral Premature Ventricular Complex Manifest as Posteroseptal Premature Ventricular Complex: A Case Report

Othman MK, Krishinan S, Yusof Z, W Isa WYH

Cureus, 2023 Nov;15(11):e48405.

PMID: 37942125 DOI: 10.7759/cureus.48405

Premature ventricular complex (PVC) is one of the most common arrhythmias detected in young patients. We report a case of a young patient with symptomatic high-burden PVC suspected to originate from the posterior right ventricular outflow tract (RVOT) who underwent an electrophysiology study (EPS) and was subsequently successfully ablated with markedly reduced PVC burden. The following day, it was noted that there was a change in PVC morphology. A repeat 3D electroanatomical mapping localized the second PVC morphology to posterolateral RVOT and abolished it with radiofrequency ablation (RFA).

Fulltext Diagnostic Performance of Automated Blood Pressure Monitor for Detection of Atrial Fibrillation

Othman R, Suliman A, Yusof Z, W Isa WYH

Cureus, 2024 Jan;16(1):e53093.

PMID: 38414682 DOI: 10.7759/cureus.53093

Background Atrial fibrillation (AF) is a type of heart disease characterized by an irregular cardiac rhythm. The complications of AF are associated with significant morbidity, mortality, and medical expenses. This emphasizes the significance of detecting AF early using a feasible device. Methods A total of 123 patients who attended cardiology and INR clinics were enrolled, with 51 of them having AF. The blood pressure of all patients was measured three times using the Rossmax X5, while a single-lead electrocardiogram (ECG) was monitored simultaneously. Following that, a 12-lead ECG was performed on all patients. A cardiologist confirmed the irregular rhythm. Results Compared to the 12-lead ECG method, Rossmax X5 has an accuracy of 99.3%, a sensitivity of 100%, and a specificity of 98.6%. The positive and negative predictive values were also significant, which were 98.1% and 100%, respectively. Conclusion The Rossmax X5 automated blood pressure monitor has a high detection accuracy for AF. Therefore, Rossmax X5 can be recommended for use in the clinical setting as a screening tool for early AF detection.

Potential of Phage Display Antibody Technology for Cardiovascular Disease Immunotherapy

Yeoh SG, Sum JS, Lai JY, W Isa WYH, Lim TS

J Cardiovasc Transl Res, 2021 Aug 31.

PMID: 34467463 DOI: 10.1007/s12265-021-10169-x

Cardiovascular disease (CVD) is one of the leading causes of death worldwide. CVD includes coronary artery diseases such as angina, myocardial infarction, and stroke. "Lipid hypothesis" which is also known as the cholesterol hypothesis proposes the linkage of plasma cholesterol level with the risk of developing CVD. Conventional management involves the use of statins to reduce the serum cholesterol levels as means for CVD prevention or treatment. The regulation of serum cholesterol levels can potentially be regulated with biological interventions like monoclonal antibodies. Phage display is a powerful tool for the development of therapeutic antibodies with successes over the recent decade. Although mainly for oncology, the application of monoclonal antibodies as immunotherapeutic agents could potentially be expanded to CVD. This review focuses on the concept of phage display for antibody development and discusses the potential target antigens that could potentially be beneficial for serum cholesterol management.

Impaired peripheral microvascular reactivity in patients with nonobstructive coronary artery disease

Sanip Z, Pahimi N, Bokti NA, Yusof Z, Mohamed MS, W Isa WYH, et al.

Microcirculation, 2023 Apr 20.

PMID: 37080549 DOI: 10.1111/micc.12807

OBJECTIVE: This study aimed to determine whether peripheral microvascular reactivity is impaired in patients with nonobstructive coronary artery disease (NOCAD).

METHODS: Stable patients presenting with angina were recruited and, based on results from coronary angiography, were categorized into OCAD (coronary stenosis of ≥50%) and NOCAD (stenosis <50%) groups. A control group with no history of angina was also recruited. Forearm skin microvascular reactivity was measured using the laser Doppler blood perfusion monitor and the process of postocclusive skin reactive hyperemia (PORH).

RESULTS: Patients were categorized into OCAD (n = 42), NOCAD (n = 40), and control (n = 39) groups. Compared with the control group, the PORH perfusion percent change (PORH% change) was significantly lower in the OCAD and NOCAD groups. No significant differences were noted between the OCAD and NOCAD groups. Additionally, the NOCAD group without any coronary obstruction takes a longer time to reach peak perfusion and had lower PORH% change compared with the nonangina control group.

CONCLUSION: Angina patients with NOCAD have microvascular dysfunction as demonstrated by reduced magnitude of reperfusion with an ischemic stimulus. NOCAD patients without coronary obstruction also displayed a slower response to reperfusion.

Managing a Pseudo-Mobitz Type II Atrioventricular (AV) Block Intrapartum: A Case Report

Othman MK, Konok MZ, Engku Ismail EH, Yusof Z, W Isa WYH

Cureus, 2023 Dec;15(12):e50221.

PMID: 38084258 DOI: 10.7759/cureus.50221

Atrioventricular (AV) block in pregnancy is rare, but it is a serious arrhythmia that needs to be carefully managed in pregnancy. However, as of now, there are no clear guidelines or consensus for intrapartum management. Most of the time, an intrapartum AV block is secondary to hypervagatonic sinus node dysfunction and is treated conservatively. Hypervagatonic sinus node dysfunction has a heterogeneous presentation of AV block, and pseudo-Mobitz type II in labor is rarely reported. We report a case of pseudo-Mobitz type II AV block during pregnancy due to labor pain, which is successfully managed conservatively.

The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

Othman MK, Yusof Z, Ismail ZKA, Sayuti KA, W Isa WYH

Cureus, 2024 Jan;16(1):e52889.

PMID: 38274596 DOI: 10.7759/cureus.52889

Acute pulmonary embolism is an important differential diagnosis in patients presenting with acute shortness of breath. However, the overlapping clinical presentation between acute coronary syndrome, aortic dissection, pneumonia, and heart failure made the diagnosis of pulmonary embolism very challenging in a limited resources center. We present a case of acute pulmonary embolism with an uncommon ECG pattern that was initially misdiagnosed as acute coronary syndrome. The authors made the appropriate diagnosis using the Zurkurnai ECG pattern in acute pulmonary embolism, which is defined as the presence of right axis deviation, deep symmetrical T wave inversion in V1 to V5, II, III, and AVF with the maximum at V3-V4 and poor R wave progression, which indicates the high-risk features of acute pulmonary embolism.

Fulltext The Unusual Cause of Cardiac Tamponade

Othman MK, Yusof Z, Hussin SA, Samsudin N, Muhd Besari AB, W Isa WYH

JACC Case Rep, 2022 Oct 05;4(19):1288-1291.

PMID: 36406916 DOI: 10.1016/j.jaccas.2022.07.016

We present a previously healthy young man with cardiac tamponade. He underwent emergency pericardiocentesis. The pericardial fluid was exudative, and Salmonella sp. was grown on both pericardial and blood cultures. Further investigations revealed that this patient had classical Hodgkin lymphoma, which explains his immunocompromised state predisposing him to this infection. (Level of Difficulty: Advanced.).

Dizzy spells in pregnancy: successful antenatal removal of a huge left atrial myxoma with mitral valve obstruction

Shahbuddin HMA, Hussin SA, W Isa WYH, Mamat AZ, Marzuki A, Yusof Z

BMJ Case Rep, 2024 Mar 07;17(3).

PMID: 38453227 DOI: 10.1136/bcr-2024-259675

Diagnosing atrial myxoma in pregnancy is challenging because patients may present with non-specific symptoms that might be overlooked. The timing of non-obstetric operation usually depends on the nature of the disease, after careful consideration of feto-maternal safety, including the use of cardiopulmonary bypass and placental transfer of anaesthetic drug. A woman in her 30s at 18 weeks of pregnancy presented with recurring dizziness. She underwent successful myxoma excision at 20 weeks under general anaesthesia and cardiopulmonary bypass. The 6×5 cm myxoma was histologically confirmed as myxoma. Early detection of atrial myxoma in pregnancy is crucial, and a clinician has to consider the diagnosis of left atrial myxoma with mitral valve obstruction as a cause of severe dizziness. Optimal outcomes require multidisciplinary management. In this case, surgery during the second trimester of pregnancy enabled a full-term pregnancy with the patient's and foetal well-being and normal postprocedural echocardiography.

Fulltext Adverse Cardiovascular Events Associated With Kopi Jantan

Othman MK, Yusof Z, Mohd Rossli NI, Mohd Fauzi MH, W Isa WYH

Cureus, 2024 Jan;16(1):e52344.

PMID: 38361715 DOI: 10.7759/cureus.52344

Energy drinks (EDs) are widely accessible worldwide. In Malaysia, it is common for EDs to be premixed with sexual stimulants. ED consumption has been shown to have an association with cardiac arrest, myocardial infarction, spontaneous coronary artery dissection, and coronary vasospasm. In addition to this, EDs are associated with arrhythmias, which significantly prolong the QTc interval. Myocardial infarction with no obstructive coronary artery disease (MINOCA) is defined as a patient presenting with myocardial infarction with no obstructive coronary artery disease or ≤50% stenosis. It is a challenging and complex pathophysiology compared to obstructive coronary artery disease. MINOCA is more frequently associated with younger patients and women. Here, we report two cases related to a Malaysian local energy drink Kopi Jantan, which presented with atrial flutter and MINOCA.

Displaying all 9 publications