A disulfiram-like reaction (DLR) associated with ornidazole is a rare but important adverse drug-alcohol interaction. We report a 44-year-old female with no known comorbidities or drug allergies who presented to the emergency department with palpitations, nausea, vomiting, facial flushing, and acral hyperemia. Her symptoms began approximately 30 min after consuming two glasses of raki while receiving ornidazole for a pilonidal cyst. On examination, she was found to be hypotensive and tachycardic. Laboratory results were within normal limits. Her symptoms improved significantly with supportive care over 16 h. A Naranjo Adverse Drug Reaction Probability Scale score of 7 indicated a probable relationship with ornidazole. This case represents a rare instance of a DLR due to ornidazole monotherapy in a patient without chronic alcohol use. Clinicians should be aware of this potential interaction and advise patients to avoid alcohol consumption during ornidazole therapy to prevent DLRs.

Left posterior fascicular ventricular tachycardia (LPF-VT) is considered the most common type of fascicular ventricular tachycardia. False tendons (FTs) are reported to be common in patients with LPF-VT and may contribute to the pathogenesis of this condition. However, LPF-VT cases with congenital septal structural abnormalities have not been reported.

Objective: To explore the correlation between anxiety and the vasovagal syncope (VVS) in children and the impact of anxiety on the autonomic nervous function in pediatric VVS patients. Methods: A cross-sectional study was conducted. From January 2022 to October 2024, a total of 81 children diagnosed with VVS by head-up tilt test (HUTT) from the Department of Pediatric Cardiology, Capital Center for Children's Health, Capital Medical University were retrospectively enrolled. The VVS symptoms were quantified. The emotional state was evaluated using the screen for child anxiety related emotional disorders (SCARED). Autonomic nervous function was evaluated by the heart rate variability (HRV). According to the HUTT results, VVS children were categorized into vasoinhibitory type (VVS-VI), cardioinhibitory type (VVS-CI) and mixed type (VVS-M). The anxiety scores of VVS children were evaluated and the differences in anxiety scores among different subtypes were analyzed. According to the SCARED results, VVS children were divided into anxiety group and non-anxiety group. General characteristics, VVS symptoms scores, and HRV indicators were compared between the two groups. The comparison between groups was performed using independent sample t test, Mann-Whitney U test, Kruskal-Wallis H test, and chi-square test. Correlation analysis was completed using Spearman correlation analysis. Results: Among 81 VVS children, there were 31 males and 50 females, with the age of (11.6±2.0) years. The scores of somatization or panic, generalized anxiety disorder, separation anxiety disorder, social phobia, school phobia and the total score of anxiety in VVS children were 5.0 (2.0, 10.0), 5.0 (2.0, 9.0), 4.0 (2.0, 7.0), 5.0 (3.0, 8.0), 1.0 (0, 3.0) and 22.0 (13.0, 38.0). There were 40 cases of anxiety, accounting for 49% and 41 cases without anxiety, accounting for 51%. There was a significant difference in separation anxiety between VVS subgroups (P<0.05). Compared with the non-anxiety group, the anxiety group had a lower score of syncope symptom and a higher score of palpitation symptom (both P<0.05). Anxiety was positively correlated with palpitation score (r=0.25, P=0.011). Anxiety score was negatively correlated with syncope symptom score (r=-0.26, P=0.008), and positively correlated with chest tightness and palpitation symptom score (r=0.23, 0.26, both P<0.05). For HRV indices, the anxiety group showed significantly higher values in standard deviation of all normal-to-normal intervals, standard deviation of the average sequential 5 min normal-to-normal interval means and low-frequency power compared with the non-anxiety group (all P<0.05). Conclusions: The prevalence of anxiety in children with VVS is high and its manifestations are diverse. Those with VVS and comorbid anxiety have fewer syncope episodes but more palpitations. Children with VVS and comorbid anxiety exhibit an overall enhanced autonomic nerve tension, mainly sympathetic nerve activation.

To examine the clinical characteristics of sintilimab-induced myocarditis and to provide evidence for its diagnosis and management. Retrospective analysis was conducted on clinical case reports of sintilimab-induced myocarditis documented before July 31, 2025. A total of 34 patients were included, with a median age of 64 years (range: 33-85), including 23 (67.6%) male cases. The onset of myocarditis ranged from 1 to 120 days post-treatment, with a median onset of 21 days. The primary clinical presentations included dyspnea (41.2%), chest tightness (35.3%), palpitations (17.6%), and shortness of breath (14.7%), with some cases remaining asymptomatic (8.8%). Comorbid immune-related adverse events included myasthenia gravis (44.1%), myositis (17.6%), and hepatitis (17.6%). Laboratory findings often revealed elevated cardiac troponin I, N-terminal probrain natriuretic peptide, creatine kinase MB, and lactate dehydrogenase. The electrocardiogram mainly showed atrioventricular block (41.2%), ST-T segment changes (44.1%), and atrial or ventricular arrhythmias (50.0%). Echocardiography examination can show normal (34.5%), left ventricular diastolic dysfunction (31.0%), left atrial enlargement (13.8%), and pericardial effusion (13.8%). Cardiac magnetic resonance imaging may show normal (42.9%), myocardial edema (28.6%), and delayed myocardial enhancement (28.6%). Coronary angiography showed normal (73.3%) and coronary artery stenosis of the lumen (26.7%). All patients discontinued sintilimab and received steroid and intravenous immunoglobulin treatment. Outcomes indicated that 79.4% recovered from myocarditis, while 20.6% succumbed. Sintilimab-induced myocarditis has nonspecific manifestations and a high mortality rate. Myasthenia gravis and myositis can occur simultaneously with myocarditis. During simtimab treatment, it is necessary to closely monitor cardiac parameters and symptoms.

We describe the case of a 69-year-old female patient who presented with a sensation of her heart pounding and an electrocardiogram showing tachycardia with unusual grouped beating. She was recently diagnosed with heart failure with reduced ejection fraction presumed to be secondary to atrial fibrillation which did not improve with beta-blocker therapy. She underwent an electrophysiology study which demonstrated Dual AV nodal non-reentrant tachycardia status post slow pathway ablation. She had significant improvement in her ejection fraction and palpitations thereafter. This case highlights the significance of correctly identifying the rhythm for management of tachyarrythmia-induced cardiomyopathy.

Background/Objectives: Palpitations are among the most common reasons for cardiology referrals. Despite widespread use of ambulatory cardiac monitoring, contemporary data from the Middle East are scarce. Extended Holter monitoring provides detailed evaluation of arrhythmia burden, autonomic regulation, and symptom-rhythm correlation in routine clinical practice. Methods: We conducted a prospective observational study of consecutive patients presenting with palpitations who underwent 24-96 h ambulatory Holter monitoring at a cardiology outpatient clinic in Saudi Arabia in 2025. Demographic and clinical characteristics, comorbidities, medication use, echocardiographic parameters, heart rate variability (HRV), ventricular and supraventricular ectopy, tachyarrhythmias, and symptom diary activations were systematically evaluated. Results: Among 251 patients (mean age 41.9 ± 16.4 years; 35.5% male), Holter monitoring showed excellent recording quality (mean analyzable time 98.7 ± 9.5%). Premature ventricular contractions (PVCs) were detected in 53.4% of patients, but burden was low (median 0.0%, IQR 0-0.1%), with only 4.4% exceeding 10%. Atrial premature contractions (APCs) were common (92.0%), though usually low-burden (median burden 0.0%, IQR 0-0.1%); atrial fibrillation and supraventricular tachycardia were rare (0.8% each). Symptom diary activation occurred in 116 patients (46.2%), with 996 events; most (87.9%) correlated with sinus tachycardia, while only 8.6% correlated with PVCs and 2.6% with APCs. In the remaining 53.8% of patients, no symptom-rhythm correlation was documented during monitoring. Heart rate variability showed expected age-related changes. Conclusions: In this predominantly young cohort, Holter monitoring revealed frequent low-burden atrial and ventricular ectopy, whereas clinically significant tachyarrhythmias were uncommon. Holter monitoring up to 96 h provided a diagnostic yield in approximately 50% of patients and should be considered a first-line screening tool. Patients without diagnostic findings may require prolonged monitoring using external or implantable devices.

Background/Objectives: Work stress (WS), occupational fatigue (OF), and Burnout syndrome (BS) among administrative workers are associated with negative psychosocial and metabolic effects. Although antioxidant-rich nutritional strategies have been proposed to help manage stress, evidence from real-world occupational settings is still limited. This study evaluated the total antioxidant capacity (TAC) of a multi-antioxidant dietary supplement 2.0 (DS2.0; apple polyphenols, [APP], astaxanthin [AXT], and fucoxanthin [FXT]; 387:12:1 ratio) and explored its association with metabolic parameters, OF, psychosocial outcomes, and hair cortisol concentration (HCC) in administrative workers with and without obesity. Methods: A quasi-experimental pilot study was conducted among 22 workers, who received DS2.0 (52.13 mg/day, n = 17) or a placebo (n = 5) for 30 days. TAC was analytically assessed using standardized assays. Metabolic outcomes (lipid profile, fasting plasma glucose), psychosocial variables (SOFI-SM, CESQT/SBI, and IMSS tests), and HCC (competitive immunoassay) were evaluated before and after supplementation. Statistical analyses included within-group pre-post comparisons, independent-sample tests, and effect size estimation. Results: DS2.0 demonstrated high TAC. Supplementation was associated with reductions in total lipids, total cholesterol, and non-HDL cholesterol, as well as decreases in OF, BS, and WS scores. HCC decreased in the overall sample (217.19 vs. 31.64 pg/mg; p = 0.000) and among workers with obesity (276.80 vs. 34.13 pg/mg; p = 0.002). Stress-related symptoms, including sleep deprivation, exhaustion, appetite changes, difficulty waking, and palpitations, also improved (p ≤ 0.05). Conclusions: An antioxidant-rich DS2.0 supplement may be associated with psychosocial and stress-related biomarkers; however, these exploratory findings require confirmation in larger randomized controlled trials. Trial registration: ISRCTN 12762846.

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that secrete catecholamines. While classic symptoms such as palpitations, sweating, and headaches may occur, many patients exhibit nonspecific or mild signs due to intermittent or low-level catecholamine secretion. This variability complicates diagnosis and increases the risk of missed or delayed detection. In this case series, we describe four patients with PPGLs demonstrating variable catecholamine secretion from overt secretion to low levels of secretion, where a clinician might incorrectly exclude the diagnosis of PPGL based on a biochemical test within the normal range. Key elements to improve detection of PPGLs from patients with minimal catecholamine secretion include a careful history on clinical symptoms of catecholamine excess, serial biochemical testing over time, utilizing nuclear medicine studies, Hounsfield units >10 from computed tomography (CT), and family history of PPGLs. Our findings from this case series help the clinician to appreciate the broad biochemical spectrum of PPGLs from no detectable or minimal catecholamine secretion to overt secretion, and how to navigate such an evaluation.