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).

Severely calcified pericardium as post tuberculosis sequale

Othman MK, Bang LH, Yusof Z, Isa WYHW

Oxf Med Case Reports, 2024 Jul;2024(7):omae077.

PMID: 39087088 DOI: 10.1093/omcr/omae077

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.).

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.

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.

Evaluating the Impact of Intensifying Treatment from Human to Analogue Insulin on Glycaemic Control and Insulin Expenditure in Patients with Type 2 Diabetes: A Retrospective Cohort Study

Hussin SA, Mohamad NA, Othman MK, Wan Mohamed WMI

Malays J Med Sci, 2024 Apr;31(2):159-169.

PMID: 38694591 DOI: 10.21315/mjms2024.31.2.14

BACKGROUND: Achieving good glycaemic control is essential to reducing the risk of diabetes complications. Insulin is the most effective therapy for achieving good glycaemic control; however, it is associated with a higher risk of hypoglycaemia, especially with human insulin. This study aimed to evaluate the efficacy of intensification from human to analogue insulin and its added cost.

METHODS: This retrospective study was conducted at the Hospital Universiti Sains Malaysia (HUSM). Patients with type 2 diabetes mellitus (T2DM) who underwent intensification for at least 3 months from human to analogue insulin were included in this study. The patients' medical records, haemoglobin A1c (Hba1c) and fasting blood sugar (FBS) were retrieved. The total cost pre- and post-intensification of insulin was obtained from the pharmacy database. Differences in HbA1c, FBS and total insulin cost pre- and post-intensification were analysed.

RESULTS: A total of 163 patients with T2DM who had intensification from human to analogue insulin were included in this study. HbA1c and FBS levels were significantly lower in analogue insulin. However, the differences were not clinically significant, as the mean reduction in HbA1c was less than 0.5%. Meanwhile, the total costs of analogue insulin for 3 months were higher.

CONCLUSION: There were no clinically significant improvements in patients' HbA1c and FBS after the intensification of insulin, despite the extra costs spent. Hence, it is vital to choose the right group of patients to receive an insulin analogue to maximise its benefit but at the most optimal cost.

Fulltext A rare case of dual left anterior descending artery type 4 in inferior myocardial infarction patient: a case report

Isa WYHW, Yusof Z, Aziz MFA, Othman MK, Suliman A

Eur Heart J Case Rep, 2025 Feb;9(2):ytaf032.

PMID: 39963306 DOI: 10.1093/ehjcr/ytaf032

BACKGROUND: This case highlights a type 4 dual left anterior descending coronary artery anomaly, identified incidentally during coronary angiography.

CASE SUMMARY: A 51-year-old male patient presented with acute myocardial infarction, which was successfully treated with thrombolysis and percutaneous coronary intervention. Angiography revealed an anomalous origin of the left anterior descending artery (LAD) from the right coronary artery. Stenting was performed on the right coronary artery and the right posterior descending artery branch.

DISCUSSION: Type 4 dual LAD is a rare coronary anomaly with potential clinical risks, including sudden cardiac death due to its course between major arteries. Variations in the structure of coronary arteries can present challenges for interventional cardiologists when conducting percutaneous coronary interventions. Accurate coronary anatomy assessment via angiography and computed tomography coronary angiography is crucial for successful percutaneous coronary intervention and surgical planning. Although uncommon, the dual LAD type 4 anomaly is a significant coronary artery variation that interventional cardiologists must consider due to its impact on prognosis and long-term treatment strategies.

Fulltext Recurrent Cardiac Tamponade as a Complication of Prolonged Left Bundle Branch Area Pacing

Kamarulzaman N, Wan Abdullah WNA, Othman MK, Isa WYHW, Yusof Z, Mohamad Jamali AA, et al.

Eur J Case Rep Intern Med, 2025;12(2):005144.

PMID: 39926563 DOI: 10.12890/2025_005144

Post-cardiac injury syndrome (PCIS) is one of the complications of cardiac interventional procedures. This condition has been postulated to be due to an immune reaction, especially with pacemaker lead implantation. Patients with PCIS can have uncomplicated pericardial effusion until they develop cardiac tamponade. The management of PCIS, which can be conservative management or require pericardiocentesis or surgery depends on the patient's clinical symptoms. As the left bundle branch area pacing (LBBAP) implantation technique and technology are still new, it is associated with longer procedural time than conventional pacemaker implantation. Herein, we report a case of PCIS in a patient who had a prolonged LBBAP procedure due to difficult anatomy and presented with recurrent cardiac tamponade.

LEARNING POINTS: Prolonged fluoroscopy in cardiac procedures can potentially lead to post-cardiac injury syndrome.Active pacemaker lead fixation is one of the risk factors for post-cardiac injury syndrome due to immune reaction.Left bundle branch area pacing in adults with congenital heart disease is challenging because of anatomical differences.

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