1.Cardiac arrhythmia triggered by diureticinduced hyponatremia
Hou Tee Lu ; Hou Chan Loo ; Kian Seng Ng ; Yin Onn Wong ; Rusli Bin Nordin
Malaysian Family Physician 2019;14(2):39-43
Diuretics have a long and distinguished history in the treatment of hypertension and heart failure.
Clinical practice guidelines recommend that diuretics should be considered to be as suitable as
other antihypertensive agents for the initiation and maintenance of antihypertensive treatment.
However, diuretics may potentially cause electrolyte disturbances and metabolic side effects.
Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We
present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by
cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case
serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing
diuretics.
2.Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians
Kai Ping Ang ; Chu Zhen Quek ; Chuey Yan Lee ; Hou Tee Lu
The Medical Journal of Malaysia 2019;74(6):561-563
The clinical presentation of acute myocarditis is highly
variable ranging from no symptoms to cardiogenic shock.
Despite considerable progress, it remains a challenge for
frontline physicians to discriminate between acute
myocarditis and myocardial infarction, especially in the
early phase. Our case serves as a reminder that acute
presentation of myocarditis could resemble ST elevation
myocardial infarction potentially misdirecting the
therapeutic decision. The clinical presentation,
electrocardiographic and laboratory findings of the patient
are not specific enough to distinguish acute myocarditis
from myocardial infarction. The gold standard tests such
coronary angiography and cardiovascular magnetic
resonance (CMR) can reliably differentiate the two entities.
3.Diagnostic value of electrocardiogram in cardiac tamponade
Kai Ping Ang ; Rusli Bin Nordin ; Stanley Chin Yu Lim ; Chuey Yan Lee ; Hou Tee Lu
The Medical Journal of Malaysia 2019;74(1):51-56
We aim to study the diagnostic value of
electrocardiogram (ECG) in cardiac tamponade.