Iatrogenic uneasiness and fast forward ventricular ectopics

A 23-year-old female novice, with no previous history of heart disease was prescribed 1. Cap. amoxycillin 250 mg, 1 cap thrice a day 2. A fixed dose combination tablet for cold, 1 tab twice a day, containing: Pseudoephedrine 60 mg Chlorpheniramine 2 mg Bromhexine HCl 8 mg 3. Cough syrup 1 teaspoon thrice a day, each 5 ml containing: Ammonium chloride 100 mg Chlorpheniramine 2 mg Menthol 0.5 mg for 7 days, for cold and cough at a private hospital. On Day 2 the patient returned with complaints of uneasiness, dizziness and weakness. The patient was sent to the author for an opinion. On examination: the pulse rate 50/ min and highly irregular; temperature normal; BP 128/80 mm of Hg; RR 18/min; not anemic and no pedal edema. Her menstrual history was normal with no missed periods. No member of her family has any known cardiac problem. A detailed history and clinical examination revealed no evidence of any systemic abnormality except the abnormal pulse. An immediate ECG revealed that there were runs of ventricular premature complexes (VPCs). The patient was reassured and advised to stop all medications. She was also instructed to have a cardiology consultation upon worsening of symptoms or any new adverse development. When the patient returned a week later she felt perfectly well. A repeat ECG revealed a marked reduction in the frequency of VPCs. The patient was however advised to have a specialist opinion for the VPCs. The patient could not be seen later but enquiries revealed she was doing fine.