Defective T wave combined with incomplete right bundle branch block: a new electrocardiographic index for diagnosing atrial septal defect / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Incomplete right bundle branch block (ICRBBB) is commonly associated with atrial septal defect (ASD), but lacks sufficient diagnostic test characteristics. An abnormal T wave is also often observed in ASD, with horizontal or inverted displacement of the proximal T wave limb in the right precordial leads, termed "defective T wave" (DTW).</p><p><b>METHODS</b>We examined the diagnostic test characteristics of combining ICRBBB with DTW as a new index to diagnose ASD. A total of 132 consecutive patients with ASD and 132 cases of age/gender-matched controls without ASD were enrolled.</p><p><b>RESULTS</b>Sensitivities of DTW, ICRBBB, and both were 87.1% - 87.9%. Specificities were 97.0%, 96.2%, and 100%, respectively. Positive predictive values were 1.3%, 1.1%, and 100.0% respectively, while negative predictive values were 99.9% for each.</p><p><b>CONCLUSION</b>Combining ICRBBB with DTW in electrocardiogram (ECG) as a new index significantly increased the specificity and positive predictive values while maintaining a high sensitivity in diagnosing ASD.</p>

Significance of the Intima-media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population

Ultrasound detected intima-media thickness [IMT] of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease [CAD] in asymptomatic individuals. Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population. A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test. At plaque-free regions, the carotid IMT was evaluated by B-mode ultrasonography and thoracic aorta IMT was evaluated by trans-esophageal echocardiography [TEE]. The significance of difference in means between two groups was analyzed using one-way ANOVA F-test and the significance of difference in proportions by Chi-square test. Multiple comparisons were done by Bonferroni t test. The correlation between IMT and severity of CAD was assessed by Spearman's method. There were 38 males and 2 females among cases with age 51.7 +/- 8.3 years, and 28 males and 2 females among control subjects with age 52.2 +/- 7.1 years. Increased carotid IMT was noted among 24 cases and 2 control subjects, and the association was significant for CAD [P<0.001, Chi-square=20.89, odds ratio [OR]=21.00, and 95% confidence interval [CI]=4.78-89.59]. Similarly, 19 cases and one control subject had abnormal IMT with positive correlation for CAD [P<0.001, Chi-square=16.39, OR=28.24, and 95% CI=4.06-163.21]. There was no association between IMT and diabetes, hypertension, or smoking; however, IMT was significantly associated with age and dyslipidemia. Also, there was no correlation between extent of IMT and severity of CAD. IMT of the carotid and thoracic aorta is strongly associated with risk of CAD in a South Indian population, and may be used as a non-invasive screening tool for coronary atherosclerosis in resource-limited settings. The presence of dyslipidemia influenced IMT and may be used as a tool to follow patients on hypolipidemic drugs

Cardiovascular complications in ciguatera fish poisoning: a wake-up call

Ciguatera fish poisoning occurs with ingestion of fish containing ciguatoxin. It causes a clinical syndrome that comprises classic gastrointestinal, neurological and cardiovascular symptoms. Ciguatoxin is a sodium channel agonist with cholinergic and adrenergic activity. Although cardiovascular symptoms are rare with ciguatoxin, we report two cases with bradycardia and hypotension. Fatality and long-term sequelae are not uncommon with ciguatoxin poisoning and educating the general population is essential