MyMedR

Fulltext Longitudinal stent compression: a not so new percutaneous coronary angioplasty (PCI) complication

Yew KL, Cham YL

Med J Malaysia, 2012 Feb;67(1):123-4.

Fulltext Respiratory clinics: left-sided hydropneumothorax in a young male: importance of clinical and radiological markers in arriving at an aetiological diagnosis

Khajotia R, Kew S, Cham Y

Malays Fam Physician, 2009;4(1):41-3.

PMID: 25606160

Fulltext Evaluation of β-blocker Dose Optimisation Among Patients Attending Heart Failure Clinic at Sarawak Heart Centre, Malaysia

Wong YC, Ong TK, Cham YL

Eur Cardiol, 2021 Feb;16:e71.

PMID: 35106087 DOI: 10.15420/ecr.2021.16.PO15

Fulltext Pseudo-infarction electrocardiographic changes in delayed onset hypoparathyroidism: A case report

Chow HB, Lim CT, Ho YH, Cham YL, Fong AYY, Said A, et al.

Clin Case Rep, 2023 Jun;11(6):e7580.

PMID: 37351358 DOI: 10.1002/ccr3.7580

KEY CLINICAL MESSAGE: The high-risk "Shark Fin" electrocardiogram (ECG) pattern has been associated with transmural ischemia but can also result from electrolyte anomalies. Therefore, the decision for invasive coronary catheterization requires a detailed history and dedicated biochemical tests.

ABSTRACT: Pseudo-infarction ECG pattern resembling "Shark Fin" was demonstrated in a 76-year-old lady with a previous total thyroidectomy who presented with unspecific symptoms. An incidental finding of hypokalemia and hypocalcemia was thought to be related to delayed onset hypoparathyroidism. Potential etiologies like coronary vasospasm and catecholamine-associated myocardial injury were suggested.

Fulltext Carotid intima media thickness and high sensitivity C-reactive protein as markers of cardiovascular risk in a Malaysian population

Chua SK, Kilung A, Ong TK, Fong AY, Yew KL, Khiew NZ, et al.

Med J Malaysia, 2014 Aug;69(4):166-74.

PMID: 25500844 MyJurnal

INTRODUCTION: Carotid intima media thickness (CIMT) being a cost effective and easily performed technique is useful in the detection of subclinical atherosclerosis and has been shown to be a prognosticator of cardiovascular events. The primary objective of this study was to obtain the distribution of CIMT measurements, highly sensitive C reactive protein (hs-CRP) and assessing health awareness and attitudes of the Malaysian population at cardiovascular disease (CVD) risk and not receiving lipid lowering agents. Secondarily the study sought to assess the significance of the relationship between these measurements against various patient characteristics.

METHODS: Measurements of CIMT are obtained by ultrasonography of 12 sites within the common carotid artery was recorded for 123 subjects from a single centre tertiary hospital of Malaysia who had two or more CVD risk factors but were not receiving lipid lowering therapy. CVD risk factors and lipid and glucose profiles were analyzed with respect to distribution of CIMT and high-sensitivity Creactive protein (hs-CRP) values.

RESULTS: The mean-max CIMT was 0.916±0.129mm (minimum 0.630mm, maximum 1.28mm) and the mean-mean CIMT was 0.743±0.110mm (minimum 0.482mm, maximum 1.050mm) and mean hs-CRP was 0.191mg/dL (minimum 0.030mg/dL, maximum 5.440mg/dL). Multivariate analyses confirmed a significant association between increasing CIMT and increasing age, total and low density lipoprotein cholesterol while log-transformed hs-CRP levels showed significant association with increasing body mass index, waist circumference, high blood glucose and triglyceride levels. Our patients had good health awareness on CVD.

CONCLUSION: Newly defined CIMT measurements and hs-CRP levels may be useful adjunctive tools to screen for atherosclerosis in the Malaysian population. It may help in refining risk stratification on top of traditional clinical assessment.

Association of CYP2C19*2 polymorphism with clopidogrel response and 1-year major adverse cardiovascular events in a multiethnic population with drug-eluting stents

Tan SSN, Fong AYY, Mejin M, Gerunsin J, Kong KL, Chin FYY, et al.

Pharmacogenomics, 2017 08;18(13):1225-1239.

PMID: 28745576 DOI: 10.2217/pgs-2017-0078

BACKGROUND: Patients undergoing elective percutaneous coronary intervention (PCI) with drug-eluting stents (DES) who have impaired clopidogrel response, have a higher risk of subsequent major adverse cardiovascular events (MACE).

AIM OF THE STUDY: To establish the relationship between CYP2C19 genotype, clopidogrel responsiveness and 1-year MACE.

MATERIALS & METHODS: Aspirin/clopidogrel responses were assessed with Multiplate Analyzer and CYP2C19*2 allele by SpartanRx.

RESULTS: A total of 42.0% carried ≥1 CYP2C19*2 allele. Prevalences of aspirin and clopidogrel high on-treatment platelet reactivity (HPR; local cutoffs: 300 AU*min for aspirin and 600 AU*min for clopidogrel) were 11.5% and 19.8% respectively. In multivariate ana-lysis, clopidogrel HPR was found to be an independent predictor for 1-year MACE (adj HR: 3.48, p = 0.022 ).

CONCLUSION: Having clopidogrel HPR could be a potentially modifiable risk factor guided by phenotyping.

Fulltext From Primary to Tertiary Care: Expert Position Statements to Guide Heart Failure with Preserved Ejection Fraction Diagnosis

Wan Ahmad WA, Mohd Ghazi A, Abdul Ghapar AK, Muthusamy TS, Liew HB, Zainal Abidin I, et al.

Malays J Med Sci, 2023 Feb;30(1):49-66.

PMID: 36875198 DOI: 10.21315/mjms2023.30.1.5

Globally, heart failure with preserved ejection fraction (HFpEF) is quickly becoming the dominant form of heart failure (HF) in ageing populations. However, there are still multiple gaps and challenges in making a firm diagnosis of HFpEF in many low-to-middle income Asian countries. In response to this unmet need, the Malaysian HFpEF Working Group (MY-HPWG) gathered and reviewed evidence surrounding the use of different diagnostic modalities indicated for patients with HFpEF to identify diagnostic tools that could be conveniently accessed across different healthcare settings. As a result, five recommendation statements were proposed and an accompanying algorithm was developed, with the aim of improving the diagnostic rate of HFpEF. The MY-HPWG recommends using more easily accessible and non-invasive tools, such as natriuretic peptide (NP) biomarkers and basic echocardiogram (ECHO), to ensure timely HFpEF diagnosis in the primary and secondary care settings, and prompt referral to a tertiary care centre for more comprehensive assessments in uncertain cases.

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