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Brugada syndrome is an inherited cardiac arrhythmia condition characterized by coved-type ST elevation and J point elevation of at least 2 mm in at least 2 of the right precordial electrocardiogram (ECG) leads (V1–3). An increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce a characteristic Brugada ECG pattern, predisposing the patient to fatal ventricular arrhythmias. However, there are scarce data regarding the clinical significance. In this case series, a typical Brugada pattern was unmasked by lithium, valproic acid, and thiocolchicoside; however, the clinical scenario was different in all 3 cases, ranging from an asymptomatic patient to sudden cardiac arrest.

Summary– Diuretics have been used for years to treat hypertension as both a monotherapy and in combination. Hydrochlorothiazide, indapamide, and chlorthalidone have frequently been considered in the same category as thiazide diuretics, but there is no evidence that their activities are similar. Studies have shown that chlorthalidone and indapamide reduce cardiovascular morbidity and mortality; however, there is no study indicating that hydrochlorothiazide has beneficial effects on cardiovascular outcomes such as myocardial infarction, renal failure, stroke, or death. Hydrochlorothiazide has less effect on blood pressure, a high risk of metabolic side effects, and may not have pleiotropic effects. As a result, it is not accurate to evaluate chlorthalidone and indapamide as similar to thiazide diuretics. Indapamide or chlorthalidone is a better choice of diuretic for use in the treatment of hypertension.

Objective: The aim of this study was to examine the relationship between vitamin D levels in patients with heart failure (HF) and response to cardiac resynchronization therapy (CRT). Methods: We studied 57 patients (mean age: 60.47+-13.09 years) with New York Heart Association Class II or III heart failure, QRS duration ≥120 milliseconds, and ejection fraction 15% decrease in left ventricular end-systolic volume at 6 months compared with baseline measurements. Vitamin D levels were evaluated before CRT implantation with ELISA. Results: Of the 57 patients, 34 patients (59.6%) were classified as responders and 23 patients (40.4%) were classified as non-responders. Baseline features, laboratory findings, and echocardiographic characteristics were nearly the same in both groups. High vitamin D level was detected in responder group compared to non-responder group (26.17+-7.5 vs 21.15+-5.9; p=0.009). Age, hypertension, diabetes mellitus, ischemic cardiomyopathy, QRS morphology and duration, and levels of B-type natriuretic peptide (BNP) and vitamin D were associated with CRT response in our study population. In multivariate regression analysis, preimplantation QRS duration, and BNP and vitamin D levels remained independent predictors (QRS duration Odds ratio [OR]: 1.047, CI: 1.019–1.417, p=0.006; BNP OR: 0.997, 95% CI: 0.994–0.999, p=0.029; vitamin D OR: 1.121, 95% CI: 1.011–1.242, p=0.030). Conclusion: In the present study, preimplantation level of vitamin D was found to be predictor of response to CRT, independent of BNP.