We are seeing more implantation of cardiac device such as pacemakers and defibrillators and also cardiac implantable electronic device infection. The infection may affect just the pocket site or progress to deeper infection and bacteraemia. Inadequately treated infection may lead to right sided endocarditis, cardiotomy for pacemaker explantation and increased cost and length of stay in the hospital. We report a Staphylococcal infection of a pacemaker system, its successful medical and surgical management.

No available abstract

No available abstract

Myocardial Infarction

Warfarin has its origin as a rat poison and has become one of the widely used anticoagulant drugs to prevent thrombosis and embolism. Many medications, foods and vegetables can interact with warfarin and affect its blood thinning effect in the body. The antibiotic, moxifloxacin official product monograph indicated no interaction with concomitant warfarin treatment as this fourth generation synthetic fluoroquinolone antibiotic does not share the same cytochrome P450 system metabolism pathway with warfarin. However, we report a case of increased anticoagulant activity in a patient treated with moxifloxacin and warfarin causing prolonged hospital stay.

There is increasing consumption of exotic food in Malaysia. Animals such as insects, worms and wild life animals also form part of the staple food of the local population. This practice may lead to more incidence of food allergy and anaphylaxis. We report a non-indigenous man who developed food anaphylaxis after consuming fried sago worms and consequently Takotsubo cardiomyopathy. We postulate that certain food allergy and anaphylaxis could be another causative trigger for Takotsubo cardiomyopathy.

Coronary artery anomalies are often discovered incidentally during cardiac catheterization or computed tomography coronary angiography and may involve the affected coronary artery origin and its course. Coronary artery anomalies are associated with congenital heart disease. The affected coronary arteries may have an unusual high take off origin, origin from contralateral or non-coronary sinus, origin from the pulmonary artery, single coronary system or coronary artery fistula.
Bland White Garland Syndrome

Sudden occlusion of the coronary artery results in ischemia, myocardial cell death and myocardial infarction(MI). The most common cause is atherosclerotic plaque rupture. MI can be complicated by arrhythmia such as ventricular tachycardia, heart block, heart failure, ventricular wall rupture and death.