Antiarrhythmic drugs are commonly prescribed cardiac drugs. Due to their receptor mimicry with several of the gastrointestinal tract receptors, they can frequently lead to gastrointestinal side effects. These side effects are the most common reasons for discontinuation of these drugs by the patients. Knowledge of these side effects is important for clinicians that manage antiarrhythmic drugs. This review focuses on the gastrointestinal side effects of these drugs and provides a detailed up-to-date literature review of the side effects of these drugs. The review provides case reports reported in the literature as well as possible mechanisms that lead to gastrointestinal side effects.

Patients with systemic lupus erythematosus (SLE) can present with multiple cardiovascular pathologies, including pulmonary hypertension, valvular disease, pericarditis, myocarditis, and premature atherosclerosis. SLE medications can also cause cardiovascular side effects. We present a patient who developed a severe cardiomyopathy secondary to the hydroxychloroquine prescribed to treat her SLE. ( Level of Difficulty: Beginner. )

Klinefelter syndrome (KS) is associated with increased incidence of thrombotic events. Hypofibrinolysis is associated with increased risk of thromboembolism. Although testosterone replacement therapy (TRT) inhibits the hypofibrinolysis, it can still cause thrombosis paradoxically due to increased dose and duration of use. Herein, we present a case of a young male diagnosed with KS who was taking testosterone. The dose was increased to boost the energy levels, and the patient presented with abdominal pain. Computed tomography (CT) of the abdomen showed extensive portal vein thrombosis. He was started on enoxaparin followed by apixaban. Studies need to be done regarding the need for thromboembolism prophylaxis in patients on TRT.

Myocardial infarction (MI) is associated with complications in spite of appropriate management. The incidence of mechanical complications declined over time secondary to reperfusion therapies, improved control of blood pressure, the use of beta blockers and angiotensin-converting enzyme inhibitors, and aspirin. A high degree of suspicion is required, especially in elderly patients with complications post-PCI (percutaneous coronary intervention). Herein, we present a case of elderly male diagnosed with an inferior wall MI who had a PCI. He was found to have a post-infarction ventricular septal rupture (VSR) and basal inferior wall aneurysm that progressed over three weeks to a myocardial free wall rupture with hemopericardium. This case emphasizes the need for close monitoring of complications.