Biomedical subjects
Publications and source records attributed to B L Chia.
The simultaneous occurrence of left bundle branch block and right axis deviation is very rare and occurs mainly in patients with cardiomyopathy. This paper describes a 61-year-old man with end stage ischaemic heart disease who presented with this unique electrocardiographic abnormality.
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Right-sided chest lead ECGs (V3R to V6R) were recorded in 110 normal male subjects who were between the ages of 17 and 22 years old (mean, 17.9 years). The prevalence of the rS pattern decreased from V3R (89 percent) to V6R (37 percent). However, the opposite was the case for the rSr pattern (10 percent in V3R and 36 percent in V6R). The amplitudes of the r wave, S wave and secondary r wave all progressively decreased from V3R to V6R. The prevalence of the qr and qS patterns was 0 and 1 percent, respectively in V3R and 14 and 2 percent, respectively in V6R. A positive ST segment deviation of 0.5 to 1 mm was present in 13 percent of subjects in V3R and 5 percent in V4R. T wave inversion was common and the prevalence increased from V3R (60 percent) to V6R (79 percent).
Between December 1980 and December 1987, approximately 6,000 two-dimensional echocardiographic examinations were performed in our noninvasive cardiac laboratory. During this period, five cases of intra-atrial smoke-like echoes were diagnosed. The four patients with dense smoke-like echoes in the left atria all had echocardiographic evidence of severe mitral stenosis and thrombi in the left atrial cavity, both of which were confirmed at open-heart surgery. One patient with right-sided cardiomyopathy had echocardiographic evidence of dense smoke-like echoes and thrombus in the right atrial cavity. One of our five patients was receiving anticoagulant therapy, and none had a history of thromboembolism. We conclude that using conventional two-dimensional echocardiographic techniques, smoke-like echoes in the atria are a very infrequent finding and are very commonly associated with formation of thrombi.
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Electrocardiograms from 204 subjects aged 60 and above, residing in homes for the aged, were analysed. 13% had evidence of cardiovascular disease. 55% of the electrocardiograms showed at least one abnormality. At least 10% of electrocardiograms showed left atrial hypertrophy, first degree atrioventricular block, right bundle branch block, pathologic Q waves, ST-T abnormalities, or prolonged QT interval. Findings predictive of cardiovascular disease were left ventricular hypertrophy patterns and ST-T abnormalities, or prolonged QT interval. Findings predictive of cardiovascular disease were left ventricular hypertrophy patterns and ST-T abnormalities. Increase of age from 60 to 100 years was associated with prolongation of PR and QT intervals, but shortening of the RR interval.
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Postectopic normalization of inverted U waves, a previously undescribed phenomenon, provides another parallel to T wave behavior.
We report a case of adrenal phaeochromocytoma with the stigmata of neurofibromatosis, who presented with acute hypotension. The patient later had episodes of hypertension alternating with hypotension, associated with electrocardiographic changes simulating myocardial infarction, and finally a completed stroke. The circumstances illustrate the problem of early recognition of the protean clinical effects of an excess of circulating adrenal medullary hormones. They also emphasise the need to consider phaeochromocytoma as a differential diagnosis of apparent clinical shock.
57 patients with chest pain, had tomographic thallium-201 stress scintigraphy (TTSS), and coronary angiography within three months of the TTSS. The exercise images were compared with delayed images obtained at 3 hours post-exercise. The sensitivity and specificity of locating individual coronary artery disease was 88% and 100% for disease of left anterior descending artery (LAD), 89% and 83% for right coronary artery disease (RCA), and 24% and 96% for left circumflex artery (LCX) disease. Other than for LCX disease, our results compare favourably with other reports. The overall accuracies are 91%, 86% and 60% for LAD, RCA and LCX disease respectively.
We describe two patients suffering from hepatoma who presented with right atrial metastatic tumors as a result of invasion of the inferior vena cava and extension into the right atrium. Two-dimensional echocardiographic studies detected the right atrial tumor during life in both patients and the invasion of the inferior vena cava in one patient.