V.E. Dhandapani’s research while affiliated with Madras Medical College and other places

Objective: The present study was designed to derive the normal limits of a new ECG lead system aimed at enhancing the amplitude of atrial potentials through the use of bipolar chest leads. Methods: Sixty healthy male subjects, mean age 38.85±8.76 years (range 25 to 58 years) were included in this study. In addition to a standard 12-lead ECG, a modified limb lead (MLL) ECG was recorded for 60 sec with the RA electrode placed in the 3rd right intercostal space slightly to the left of the mid-clavicular line, the LA electrode placed in the 5th right intercostal space slightly to the right of the mid-clavicular line and the LL electrode placed in the 5th right intercostal space on the mid- clavicular line. Results: In the frontal plane, the modification of limb electrode positions produced significant changes compared to standard limb lead I and II. The mean P wave amplitude was 111±17μV in MLL I and 64±16μV in standard limb lead (SLL) I (p<0.001). Similarly it was 118±22μV in MLL II and 100±27μV in SLL II. No statistically significant changes were seen in V1-V6 due to modification of the Wilson central terminal electrode positions. Conclusion: The modification of limb electrode placement leads to changes in the amplitude of the P waves in the MLL leads I and II compared to SLL leads I and II in healthy subjects. These changes may be of importance in the detection of atrial electrical activity.

Congenital mitral stenosis (MS) is a rare congenital cardiac malformation and the obstruction to the flow across the mitral valve can be caused by supramitral ring, commissural fusion, short chordae, anomalous mitral arcade, anomalous position of the papillary muscles and the so-called'parachute mitral valve'. We describe here the case of a 47 year old male diagnosed to have a double outlet right ventricle (DORV), subaortic ventricular septal defect (VSD) with no pulmonary stenosis, severe pulmonary hypertension and congenital MS due to parachute mitral valve.

Hypothermia is an uncommon condition in a tropical country like India. It can present with various characteristic features on electrocardiogram (ECG). This is a case report of a 50-year-old male with hypothermia who presented with an abnormal ECG. Based on the clinical and ECG features, hypothermia was diagnosed and treated successfully.

The close relationship between pleural space and pericardial space and the dependence of their pressure kinetics are well known. This study evaluates the effects of increased intra pleural pressure due to pleural effusion on cardiovascular system. Forty patients above the age of 12 who had massive unilateral/bilateral pleural effusion due to non-cardiac etiology were included in the study. Therapeutic thoracocentesis was done for massive pleural effusion. The echocardiographic parameters measured before and after thoracocentesis were compared. Mean age of the patients 46.6 years. Out of 40 patients 8 were females (20%). 7 patients had right atrial collapse on echo. 85% of patients had significant flow velocity changes across both tricuspid valve and mitral valve during phases of respiration.11 patients (47.82%) had IVC compressibility of <50% during inspiration. Mean flow velocity respiratory variations across tricuspid valve before thoracocentesis and after thoracocentesis E 45.04 ± 10.3,32 ± 11.3% (p value <0.001), A 53.71 ± 28%, 32.08 ± 12.5% (p < 0.001) across mitral valve E 32.30 ± 12%, 19.78 ± 7.8% (p < 0.001), A 26 ± 11.2%, 21 ± 9.3% (p 0.006) across pulmonary artery 42.63 ± 31.3%, 17.70 ± 6.2% (p < 0.001), across aorta 21.57 ± 11.4%, 14.08 ± 7.6% (p < 0.001). Large pleural effusion has a potential to cause adverse impact on the cardiovascular hemodynamics, which could manifest as tamponade physiology. Altered cardiac hemodynamics could be an important contributor in the mechanism of dyspnea in patients with large pleural effusion.

Background: The underlying mechanism of cardiac failure in high output states has not been clearly understood. It is well known that left ventricular systolic functional indices are usually preserved. So, what causes the symptoms of cardiac failure?. We analysed the LV diastolic parameters in some of the common high output states Aim: The aim of this study was to evaluate Left Ventricular (LV) diastolic function in various high output states. Study population: Comprising 185 patients, mean age -25 (20-30) years, of various high output states such as pregnancy 2nd trimester (24-28 wks), 3rd trimester (32-36 wks), Chronic kidney disease patients with patent arterio-venous fistula, Hyperthyroidism, Anemia with hemoglobin levels of 6-8 gm%, patients with normal left ventricular systolic function (EF 58-65%),functional class II or III were included in our study.Patients with co-morbid states fused trans-mitral inflow E/A velocities and arrhythmias were excluded. Methods: Echocardiographic evaluation of all patients was done using Philips HD7XE machine in our Echo lab. Diastolic function was assessed using conventional trans-mitral inflow pattern, Pulmonary venous flow, and mitral annular tissue Doppler imaging. Results: Results are shown in Table 1. View this table:Enlarge table

Introduction: The observation of atrial activity is critical in the case of atrial arrhythmias. Since the ventricular QRS potential may obscure that of the P wave, much information about the atrial phase is not well determined in the standard 12 lead ECG. A novel Modified Limb Lead (MLL) system is proposed to enhance the atrial P and Ta waves in healthy subjects and patients with AV block. Methods: Sixty healthy male subjects (mean age 38 ± 8.76 years) and fifteen male patients with AV block (mean age 68 ± 5.43 years) were studied. In addition to a standard 12-lead ECG, an MLL ECG was recorded with the RA electrode placed at the 3rd right intercostal space a little to the right of the parasternal line, the LA electrode placed in the 5th right intercostal space slightly to the right of the mid clavicular line, and the LL electrode placed in the 5th right intercostal space on the mid clavicular line. ECGs were recorded for 60 s each with an EDAN SE-1010 PC ECG system. Results: The average R wave amplitude and duration in standard leads I–aVF were 0.44 ± 0.25 mV and 89.61 ± 17.07 ms respectively. The average P wave amplitude and duration were 0.04 ± 0.05 mV and 91.83 ± 7.12 ms respectively. Corresponding MLL R and P wave amplitude and duration measurements were 0.13 ± 0.09 mV, 89.64 ± 11.45 ms and 0.07 ± 0.09 mV, 86.84 ± 5.41 ms. A negative wave was observed after the P wave in the PR segment of the MLL trace. This was regarded as the atrial Ta wave. The polarity of the Ta wave was opposite to that of the P wave and the duration was longer. A significant correlation was found between P and Ta wave amplitudes (r = 0.30, p = 0.01). In all cases of AV block, the Ta wave was observed more clearly in the MLL ECG than in the standard ECG. Conclusion: The MLL system allows easier recognition of the atrial Ta wave than the standard 12 lead ECG

The intra myocardial hematoma we report is a rare form of cardiac rupture occuring after acute anterior wall myocardial infarction.