Publications by authors named "Rochelle Anne Chua"

2 Publications

  • Page 1 of 1

New Precordial T wave Inversions in Hospitalized Patients.

Am J Med 2021 Nov 20. Epub 2021 Nov 20.

Division of Cardiovascular Medicine, University of California San Francisco, Fresno, California.

Background: The incidence of precordial T changes has been described in athletes and in specific populations, while the etiology in a large patient population admitted to the hospital has not previously been reported.

Methods: All ECGs read by the same physician with new (compared to prior ECGs) or presumed new (no prior ECGs) precordial T wave inversions of >1 mm (0.1 mV) in multiple precordial leads were retrospectively reviewed and various ECG, patient-related and imaging parameters assessed. 226 patients and their ECGs were initially selected for analysis. Of these, 35 were eliminated leaving 191 for the final analysis.

Results: Patients and their ECGs were divided into 5 groups based on diagnosis and incidence including Wellens' syndrome, takotsubo, type 2 myocardial infarction, other (including multiple diagnoses) and unknown. While subtle differences including number of T inversion leads, depth of T waves, QTc intervals and other variables were present between some groups, diagnosis in individual cases required appropriate clinical, laboratory and/or imaging studies. For example, although Wellens' syndrome was identified in <20% of cases, a presenting history of chest discomfort with precordial T changes either on the admission or next day ECG was highly sensitive and specific for this diagnosis. In some cases, Type 2 myocardial infarction can also have a Wellens' like ECG phenotype without significant left anterior descending disease.

Conclusions: Precordial T wave changes in hospitalized patients have various etiologies and, in individual cases, the changes on the ECG alone cannot easily distinguish the presumptive diagnosis and additional data are required.
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November 2021

Technique to Avoid Hemodialysis Catheter in Patients with Failing Aneurysmal Arteriovenous Fistula by Creating a Concomitant New Arteriovenous Fistula.

Ann Vasc Surg 2018 May 24;49:304-308. Epub 2018 Feb 24.

Department of General/Vascular Surgery, Kaiser Permanente Fontana, Fontana, CA. Electronic address:

Autogenous arteriovenous fistula (AVF) is the primary recommended access for hemodialysis. Long-term use will not uncommonly result in AVF aneurysmal degeneration. Aneurysm-associated complications encompass pain, skin ulceration, infection, thrombosis, cannulation difficulties, and life-threatening bleeding. Various methods to repair aneurysmal AVFs have been described. However, there may be circumstances when this is not possible and require insertion of a temporary hemodialysis catheter (HDC) until a new arteriovenous access is created. We describe a case series of creating a new simultaneous AVF while continuing to use the primary failing aneurysmal AVF to avoid placement of an HDC. Once the new AVF becomes operational, the primary aneurysmal AVF can be abandoned. Six patients underwent simultaneous new AVF creation, 4 ipsilateral, and 2 contralateral. None of the patients developed symptomatic steal syndrome or congestive heart failure. Five of 6 patients had successful usage of the new AVF, and subsequently underwent ligation and excision of the aneurysmal AVF, thus avoiding a temporary HDC. Close monitoring for skin compromise and bleeding in the aneurysmal AVF is recommended while the new AVF matures.
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May 2018