An Illustration of Aorta-PA relation in Normal, D-TGV & L-TGV
The relationship between Aorta & PA is the key to diagnose many complex congenital heart diseases. Here is a simplified illustration for gross understanding. Please refer to other sources for complete review.   Further reading CONGENITAL HEART DISEASE| VOLUME 118, ISSUE 9, P1390-1398, What Determines Whether the Great Arteries Are Normally or Abnormally Related?  Richard Van Praagh, MD  https://doi.org/10.1016/j.amjcard.2016.07.050   (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 12, 2021 Category: Cardiology Authors: dr s venkatesan Tags: congenital heart disease Embryology : Heart valve development embryology of heart Uncategorized accessorry av node Aorta pulmonary artery relationship atrial septostomy double switch surgery dtgv ltgv ctgv left av valve regurgitation l Source Type: blogs

3-D printing of heart : Moving from the labs to bed side
3D printing technology is growing at a rapid pace. Both cardiologists and cardiac surgeons are expected to benefit a lot.It helps us in understanding deformed anatomy in complex congenital heart disease as well as planning for synthetic cardiac implants.  Currently, the technology is limited only by the chemical material used to print the heart and its components. The American chemical society is working at it to create more realistic heart models. Once we master this,  biological printing with synthetic tissue equivalents is the ultimate aim.  Major Indications Planning cardiac reconstructive s...
Source: Dr.S.Venkatesan MD - June 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 3D printing in cardiology 3d prototyping evolute r core valve future of cardiology sapien valve edwards tavr mavr Source Type: blogs

Who is going to save medical science from “ peer reviewed ” madness ?
This 90-second video clip is a “perfect provocation” .Allan Savory  is a renowned ecologist from Africa. He is a global leader in environment and eco protection. He is making this famous comment, during one of his interviews from within the deep forests of Zimbabwe, after years of ground-level work in the field of desertification and climate change. I can understand his feelings, as we also encounter similar situations at ground zero of the health care delivery system. (I wonder if there is anything called peer-reviewed bedside caring) We realize wide gaps between academia, patient care, an...
Source: Dr.S.Venkatesan MD - May 30, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized art of healing best book in medicine cost effectiveness in medicine definition of medical care ethics in medicine evidence based medicine harrison principles davidson medical education medical science is an art or true scie Source Type: blogs

Coronary physiology update : Why did the “ French FLOWER ” failed to blossom ?
The concept of Fractional flow reserve ( FFR) has dominated the coronary interventional field for over a decade. It gave us a (false) sense of security and pride that we have been advocating physiology-based appropriate stenting. The much-expected FlOWER-MI trial was presented in ACC & NEJM a week ago. (May 16th  Issue 2021) FFR, though physiologically an attractive concept, has many well-known confounders right from the technical factors, lesion-related errors in physics, mirage of true hyperemia induction with Adenosine, finally & most importantly microvascular dynamism. The value of FFR in the ACS setti...
Source: Dr.S.Venkatesan MD - May 20, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized FFR FLOWER trial FFR IFR QFR CT FFR FLOWER MI Source Type: blogs

Defining Hypertension : Why we remain in “ Status confusious ” despite 50 years of clinical trials ?
Next to the atmospheric pressure, the most curious pressure to understand is stored within human blood. Yes, it is the “blood pressure”, fondly referred to as BP by both physicians and patients. (When worried men & women visit us and say, that they are suffering from BP, please make it a point to clarify, BP is a sign of existence of life, rather than a dreaded pathology )  Why should blood have pressure? BP is lateral pressure exerted by flowing blood on the vessel wall (or is it the propelling pressure head ? It is to be noted, cuff pressure doesn’t measure this !) BP is generated by the hear...
Source: Dr.S.Venkatesan MD - May 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Hypertension 2013 STEMI AHA ACC Guidelines blood pressure lowering treatment trialist collaboration hypertension and dyslipidemia Hypertension current guidelines jnc 6 7 8 hypertesnion Lancet BP LTT trial LDL vs diastolic BP vs fasting blood Source Type: blogs

Cerebral hemodynamics in AF : ” Irregularly irregular ” brain perfusion and risk of “ dementia cordis ”
No doubt, the heart is a biological wonder with its non-stop pump function. Still, it cannot function as a continuous rotary pump like the electrical motors do. It has no other option but to contract in a pulsatile manner. However, the mean pressure in circulation is fairly constant, flow is kept continuous, and fairly laminar. This is made possible by the built-in elastic pressure in the aorta and the poorly understood but vitally important parameter vascular tone. Aging widens the pulse pressure due to dissipation of vascular tone. Atrial fibrillation adds new bizarre dynamism to this pulsatility and challenges the aorti...
Source: Dr.S.Venkatesan MD - May 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized affirm race trial atrial fibrialltion rate vs rhythm control atrial fibrillation cerebral bllod flow in atrial fibrillation nir spectroscopy in atrial fibrillation Source Type: blogs

Troponin positivity in AVNRT: A panic reaction and its mechanism.
Here is an uncommon story of a patient with palpitation,SVT , Troponin +ve, and suspected ACS. Palpitation in ER ⇒ {Tachycardia +Troponin positive ≠ ACS} Mechanism of troponin elevation following any SVT At high heart rates (>200) myocardium is subjected to non-Ischemic mechanical strain & squeeze. Minute amounts of Troponin is let out like a myocardial juice into the circulation (Like atrial natriuretic peptide release which causes polyuria during AVNRT) Tropinin releases have been shown to correlate with both heart rate and duration of ST depression (Subendocardial strain /AVRT left lateral pathways) Sho...
Source: Dr.S.Venkatesan MD - May 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized avnrt avrt af biomarkers in tachycardia cpk troponin in avrt false positive troponin in avnrt svt troponin t troponin 1 Source Type: blogs

What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !) What is an intermediate coronary lesion? (ICL)  Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any  revascularisation debate). Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet ...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs

Z va score in Aortic stenosis : No more a theoretical concept
It was the final case on weekend Echocardiogram review day, I asked my fellow for a brief summary of the patient. A 3 minute conversation“Yes, sir, he is a 62-year-old male retired govt officer. He has a severely stenosed aortic valve, with a peak gradient of 90 mmHg and a mean gradient that comes to almost 50 mmHg. LV  EF is 58%, GLS is 18, LVH is obvious. LA is not dilated (Didn’t measure volume though), but DT is short. Valve orifice is hovering around 1cm, mild calcium noted in LCC  I am not sure whether it’s bi or tricuspid still. The annulus is 22mm. The mitral valve is perfect, no ca...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: aortic stenosis Aortic valve replacement asymptomatic severe aortic stenosis tavr vs savr for aortic stenosis zva score in aortic stenosis Source Type: blogs

Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(25/year) shall prevail over surgery in most patients with ASD.  Reference 1López-Fernández T1, Gómez de Diego JJ, Monedero MC . Aortic wall erosion after percutaneous closure of atrial septal defect.Am Soc Echocardiogr. 2011 Feb;24(2):227.e5-8     2.Amin Z Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement.atheter Cardiovasc Interv. 2014 Jan 1;83(1):84-92.    3.Catheter Cardiovasc Interv. 2012 Aug 1;80(Percutaneous atrial septal oc...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs

Heart disease in pregnancy: Overview & management
Some of the questions  addressed  in this presentation 1.What happens to fetal blood pressure during maternal hypotension how good is fetal autoregulation? 2.Why is LSCS increasingly preferred mode of delivery in heart disease complicating pregnancy challenging the traditional scientific concept? 3.What is likely hood of patients with moderate mitral stenosis developing pulmonary edema during prolonged 2nd stage of labor? 3.What is the missing link between PIH and PPCM? How prepartum cardiomyopathy differs from postpartum? 4.Is Eisenemneger really an absolute contraindication for pregnancy? 5. How can we continue...
Source: Dr.S.Venkatesan MD - April 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Pregnancy and heart pregnancy and heart disease cardiac disease in pregnancy esc aha pregnancy heart disease fetal aortic blood Source Type: blogs

Sailing the Osler ’ s ship of medicine in the third millennium
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - March 31, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Patient page cardiology -Therapeutics Clinical cardiology general medicine Medical education Medical ethics medical quotes Two line sermons in cardiology clinical acumen dr venkat quotes ethics in medicine ev Source Type: blogs

Rheumatic fever : Dr Jones would smile if we get rid of the “ supportive criteria ”
Dr. Duckett Jones, the famed American physician, from Good Samaritan hospital, Boston would be a proud man in heaven, to find his criteria still being celebrated all over the globe. He will also be pleased to know his home country USA  is painted green on the world RHD map due to his untiring efforts that began in 1944. Of course, what the rest of the world has done in the last century has left us wanting (including the WHO).   Global RHD map. Note the red and brown shading in south Asia and Africa. It is obvious, RHD is more about economics, equality, and poverty, rather than aggression from an otherwise innoc...
Source: Dr.S.Venkatesan MD - March 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: rheumatic heart disease acute rheumatic fever aso titer chronic rheumatic fever dr duckket jones jones criteria primary vs secondory prevention rtpcr for rheumatic fever supportive criteria for acute rheumatic fever essential Source Type: blogs

D-dimer levels in normal pregnancy : Learnt something Important recently !
Have we ever wondered how six liters of blood in our body flows like a live stream, maintaining the fluidity life long, in spite of an active coagulation system in situ, ready to freeze at the slightest provocation (Invisible vascular wear & tear!) This housekeeping job, within the vast network of the human vascular tree, is silently accomplished by a less apparent system called fibrinolytic system. D-dimer is a physiological breakdown product of this system . D-dimer comes from fibrin monomer. The D in D-dimer stands for the domain. (See below) The ability to detect the D-dimer in the bedside has given us a good oppor...
Source: Dr.S.Venkatesan MD - March 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease fdp vs d dimer pulmonary embolism dvt in pregnancy what is the normal d dimer in pregnancy Source Type: blogs

Coronary collateral circulation : Why many scientific cardiologists Ignore it ?
A consult with a 62-year-old patient in my office  Hi, welcome?  What is your problem? Nothing doctor. I am good.  What brings you here then? I used to have angina before. Now, I am fine doctor but confused after undergoing this angiogram. I need an opinion. How is your exercise capacity? I do walk, work, and able to do almost all regular activities. Why did you do this angiogram then?  Had to undergo this after a doubtful stress test, Now, I am told by at least 2 eminent cardiologists, that I am having just one functional coronary artery, and it is dangerous for the all-important LAD to ...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chronic total occlusion collateral circualtion in cto coronary collateral circulation interventions in cto Source Type: blogs

Mobile right heart thrombus : Capture by Flowtriever device is possible
What shall we do when encountering a mobile right heart thrombi waiting to get dislodged at any time? A series of question comes as the answer to this query  Feeling helpless?  What will be the consequence?Massive pulmonary embolism?  Can we thrombolyse and dissolve it ? Logistics of emergency open-heart surgery are too many. What about capturing the thrombus?   A dream thought, now seemingly possible.Inari Flowtriever though made originally for pulmonary embolism can come in handy in any foreign body removal. I think It is approved by FDA. Here is a case report from Dr Gautam reddy....
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: New hardware pulmonary embolism Inari flow triever mobile ra rv clot Source Type: blogs

Why evidence-based medicine continue to have a turbulent course?
Because . . . its current course is not always in the right direction &  not everyone is ready for course correction as well! Reference 1.Hasnain-Wynia R. Is evidence-based medicine patient-centered and is patient-centered care evidence-based? Health Serv Res. 2006;41(1):1-  2. Wyer PC, Silver SA. Where is the wisdom? I—a conceptual history of evidence-based medicine. J Eval Clin Pract. 2009;15(6):891-898.   3.Tonelli MR. The philosophical limits of evidence-based medicine. Acad Med. 1998;73(12):1234-1240.     (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - February 13, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology quotes cardiology-ethics best medical quotes dr venkatesan quotes ethics in medicine evidence based medicine evidence vs experience based medicine hippocrates ethics limitations of ebm medical education medical ethics quote Source Type: blogs

How to follow up Hypertrophic cardiomyopathy ? : Too much reliance on LVOT gradient is problematic
Hypertrophic cardiomyopathy (HCM)  is the most common primary disorder of cardiac muscle. The incidence is about 1 in 500, which would mean 1.5 crore HCM patients will be living on our planet at any moment. The root cause of pathology is located in 20 odd genes that define cardiac muscle protein integrity. (Myosin, Troponin, Titin, etc) This leads to the bizarre architecture of cardiac muscle, prone to progressive fibrosis.(Paradoxically, 90% of HCM have normal or supernormal contractility till very late stages, proving that the much-dreaded term myocardial disarray has little effect on contractility. It is all the mo...
Source: Dr.S.Venkatesan MD - February 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: hypertrophic cardiomyopathy criley concept hocm hcm lobster claw hcm lobster claw is pulsus bisferiens mavacamten explorer trial what is the mechanism of hocm gradient lvot Source Type: blogs

Why didn ’ t you try ECMO for my dad , doctor ? I feel really guilty !
It is just past midnight: This is a gloomy conversation between a patient’s son and a cardiologist in the silent waiting room, just outside the dim-lit ICU of a popular 4-star hospital in Chennai. “I am sorry to say, Mr. B., your father didn’t make it. Has succumbed to the heart attack. We have been trying to resuscitate him for the past one hour. We have done everything. We have managed to open up IRA, and 2 more critical blocks still it couldn’t help. It was a massive one. Sorry again. “Doctor, I feel very bad. What went wrong, I want to know. Doc, did you try ECMO ?,” the ...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Technology ecmo IABP impella tandem heart ecmo Source Type: blogs

History of cardiology : Robert F Rushmer, a cardiac scientist par excellence .
Few individual’s works mattered more than others in the field of cardiology. Here was a man born in Utah, studied at Rush university trained in Mayo, settled in Seattle as a pediatrician. But his passion drove him to become a specialist cardiac physiologist with an urge to find the answers to all those lingering queries that arise as a practicing clinical cardiologist.  He built an exclusive animal lab to study the mechanics and physics of circulation and cardiac pumps.   He can be called new age, Harvey. He seemed to always bother, how is it that the 6 liters of blood traverse fro...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Basic sciecne Basic science -Physiology Best books in cardiology bio ethics great cardiologists best books in cardiac physiology best cardiology books cardiovascular physiology famous Seattle doctors Great Men in cardiology history of Source Type: blogs

Dynamic Auscultation: A presentation
Heart is a dynamic organ, so any auscultation by default becomes dynamic. Still, what we mean by dynamic auscultation is, to look(hear) carefully at what happens to the sounds and murmurs during different phases of respiration*, posture and induced hemodynamic stress by altering preload, and afterload, etc. (* Some of us may not consider respiratory changes as part of dynamic auscultation, But, it is to be noted even spontaneous respiration is subtle dynamism and is reflected in JVP as well as second sound mobility. While forceful breath-holding or exhalation can dramatically shut down & release venous return from ente...
Source: Dr.S.Venkatesan MD - January 19, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized delman and stein dynamic auscultation hocm vs mvps Isometric handgrip mullers manuver squatting in hocm valsalva manuver Source Type: blogs

Wrong-way catheter during radial angiogram : An Illustration
The commonest cause* for repeated entry of right radial catheter to descending aorta is not due to any anomaly. Most times,it is just a skewed angle between right brachio-cephalic artery with Aortic arch, that deflects the catheter to the descending aorta . Just make sure, aortic root is entered with a deeply held inspiration. *Anomalies of the aortic arch, aberrant right subclavian, Kommerell’s diverticulum, vascular ring must be kept in mind.   Postamble: A true abnormal course Though, It might appear prudent to avoid the radial route when encountering anomalous subclavian ...
Source: Dr.S.Venkatesan MD - January 19, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart aberrant right sub clavian artery aortic arch anomalies arteria lusoria ptca brachio cephalic artery aortic arch angle radial angiogram tips radial pci Source Type: blogs

Principles of practice of medicine: 2020 version
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Medical education Medical ethics medical quotes Venkat quotes best medical quote drsvenkatesan drsvenkatesan.com ethical quote in medicine ethics of medical practice Hippocratic oath hippocratic quotes madras medical colllege primu Source Type: blogs

How important is CAD in HFpEF ?
One of the topics rarely discussed in heart failure is  CAD as a contributory factor in HFpEF. This is a copy of the presentation done at the ECHO India Annual scientific meet  2019 at Kolkatta. India.   Will try to find out the recorded version with audio. Here is a GIF run through. PDF version Download here (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 7, 2021 Category: Cardiology Authors: dr s venkatesan Tags: CAD in HFpEF Heart failure with preserved LV EF HFrEF vs HFpEF diastolic dysfunction dr venkatesan ppt prsentation presentation on HFpEF and cad Source Type: blogs

Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology Sinus venosus ASD (also referred to as SVC ASD)  is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between S...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs

Mitra clip for Rheumatic mitral regurgitation: A break through Indication
Mitra clip is a small metal device that is delivered percutaneously, to clip the incompletely coapting (closing) mitral valve. It was first introduced to treat degenerative mitral regurgitation. It is an interventional imitation of the famous edge to edge Alfieri stitch repair.This procedure in fact converts the single mitral valve orifice into two. In the process, curtails the regurgitation jet orifice significantly. Though the technique looks nice and simple to hear, lots of per and post-procedure issues need refinement. Conceptually it is ideal in primary disorders of the mitral valve. (Read EVEREST 2 criteria for optim...
Source: Dr.S.Venkatesan MD - January 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: MVPS valvular heart disease alfieri repair mitral valve coapt mitra-fr everest trials mitra clip mitra clip for rheumatic mitral regurgitation Source Type: blogs

Principles of medical education : Do we have problems with our priorities ?
Two queries that linger in the medical profession for a long. I am afraid they aren’t addressed specifically by the stakeholders. Question 1  Foe a moment, let us assume there is no option to answer all three are equally important. Medical colleges are supposedly Godly places where high-quality noble professionals would germinate, let into the community thereupon, to heal the ill and suffering. The teaching faculty has a huge responsibility. They must ensure that students are transformed into responsible caregivers in the first place. They should be made to understand that the knowledge they acquire ha...
Source: Dr.S.Venkatesan MD - January 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized best quotes in medicine dr venkatesan quotes ethics in medicine hippocrates medical education principles of medical education quotes in noble profession Source Type: blogs

2021 dawns & let ’ s welcome back happiness …
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Year end quiz : What is the name of this Investigation ?
Just role over the virtual marker along the coronary lesion to get the underlying flow ratio. Blue is an absolute normal segment. Green is ok, orange and red slow-moving coronary traffic jam zones. it’s just like drawing a google map showing life traffic. No wire, no adenosine FFR comes inbuilt in every angio shot. Looks great Isn’t it? This is called QFR. Quantitative flow ratio derived from routine coronary angiograms. It can also guide us to find the optimal sites of both proximal and distal stent landing zone in the best physiological manner. Which company makes this ? Any studies done with QFR ? FAVOR 2 st...
Source: Dr.S.Venkatesan MD - December 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome Tips and tricks in cath lab coronary doppler coronary flow physiology ffr vs ifr vs ct ffr vs qfr ISCHEMIA trial non invasive ffr oct ivus when to intervene a stable cad Source Type: blogs

TEE Bicaval view : An anatomical orientation
Bicaval view is an Important TEE view to visualize, the LA, IAS, and right atrium. I used to have some trouble getting oriented to this view. Hence this post. It is obtained in the 90-120 degree view at the mid esophageal position. Imagine the patient is lying on his left side and the probe comes from above down between the spine and heart to the LA from within the esophagus. This is the best view to see IAS in the profile.(Subcostal TTE can also do it) Note how the LA hugs the right atrium which is actually an ill-defined (In TEE I mean) common meeting point of both IVC and SVC. Also important is the relationship of RUPV ...
Source: Dr.S.Venkatesan MD - December 17, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd rims bicaval view svc asd tee bicaval view Source Type: blogs

LA myxoma surgery : Preventing recurrence should be an important goal.
Cardiac myxoma is the most common primary tumor of the heart that presents as mitral inflow obstruction/ regurgitation often with a systemic presentation. It can be either familial, syndromic, or sporadic. Excellent imaging is possible and diagnosis has become straightforward. Surgery is the specific treatment, What information do the Surgeons need?  Size, attachment to surrounding structures is the key. The myxoma origins most often in IAS and defining its attachment is crucial. Mitral leaflet distortion, Injury ( and even attachment) is possible. It is helpful for the surgeons if we let them know the mechanis...
Source: Dr.S.Venkatesan MD - December 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiac myxoma IAS patch closure for myxoma LA myxoma surgery mesenchymal cell tumor myxoma myxoma benign or malignant Source Type: blogs

Will PCI reverse LV dysfunction in Ischemic cardiomyopathy ?
PCI is effective in relieving angina,  what does it do to LV dysfunction? This is a fundamental query in the principles of revascularisation of CAD . The term LV dysfunction can convey a bizarre meaning.It can constitute any of the combinations of the following.Cell death, necrosis, scarring, fully dead, partially dead, partially viable, apoptotic cells that are clustered across various myocardial segments. These cells are interwoven with fibrotic interstitium. Microvascular integrity is also altered. Cells stretch, slip and slide with one another. Contractile architecture is lost. This is referred to as remodeling.In...
Source: Dr.S.Venkatesan MD - December 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: CABG for Ischemic DCM Dilated cardiomyopathy Uncategorized How effective is pci in reversing lv dysfunction ? REHEAT STICH CABG PCI MEDICAL THERAPY revascularisation in ischemic dcm Source Type: blogs

Why AF is often well tolerated in Hypertrophic cardiomyopathy ?
Up to 25 % of LV filling is done by atrial contraction. Atrial booster function is important in LV outflow lesions. This can be critical in patients who have diastolic deformities of LV. ( an audible or even palpable S4 confirms the atrial kick in these situations )  This is how we were taught for decades right. Still, it may hold good in many left-sided condtions, but in HCM it definitely seems to be not true.  A succinct review of this topic makes a good read. Incidence if AF in HCM is about 20% (Mostly paroxysmal 70 % , Persistent /Permanent 30 %) Mechanism of AF IN ...
Source: Dr.S.Venkatesan MD - November 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation af in hocm affirm study atrial fibrillation in hypertrophic cardiomyopathy current guidelines in hcm hcm hocm mechansim of af in hcm pathophysiologyof hcm Source Type: blogs

ASD device closure: “ Mind the gap ” to avoid SA nodal artery compression.
The branching pattern of the human cardio-vascular tree is as unique as one’s fingerprint. One such hugely variable anatomy is the SA nodal blood supply. Certain salient features Variation can be seen in origin, course, and termination. Now it is estimated to arise from RCA in 70% (Moved up from 55% in old studies ) From LCX (25%) Dual SA node supply(5%) Direct from Aorta It is heartening to find this good anatomical review on this topic. A) From the Right Coronary Artery; (B) From the Left Circumflex Artery (proximal); (C) From the Left Circumflex Artery (distal); (D) From the Left Coronary Artery; (E) From the Ao...
Source: Dr.S.Venkatesan MD - November 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology research topics cardiology research topics for fellows Uncategorized ASD device closure cardaic lymphatics cardiology reserach topic sa nodal compression during asd device closure Source Type: blogs

Corona second wave might bring some good news !
This article never intends to undermine the importance of preventive measures and vaccine for this worst pandemic in recent human history         (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - November 17, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized corona second third wave corona second wave corona vaccine what is the case fatality rate in corona Source Type: blogs

Arrhythmia basics: How often we need to know the mechanism of arrhythmia ?
How many times you have treated cardiac arrhythmia in both emergency & non-emergency situations? Infinite times. How many times did you really bother to know the mechanism of a given arrhythmia before ordering medication or shocking? Hmm,.. let me think. (Except for AVNRT/ AVRT, and few VTs, very rarely I have worried about the mechanism  !) Why is it so? because treatment takes priority and we are able to tame the arrhythmia even without knowing the real mechanism. The following slide is a gross summary of the cardiac arrhythmia mechanism Understanding cardiac a...
Source: Dr.S.Venkatesan MD - November 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Basic science -Physiology Brugada syndrome cardiac electrophysiology cardiology -Therapeutics Cardiology-Arrhythmias brady dependent vt eads dads early and late after depolarisation enhanced automaticity vs triggerred activity vs reentry Source Type: blogs

Acute Aortic syndrome : Please mind the length of “ Ascending Aorta ” as well.
 Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes.  Meanwhile, CT ,  4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and tr...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: aortic aneurysm marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs

Acute Aortic syndrome : Please mind the Length of “ Ascending Aorta ” as well !
 Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes.  Meanwhile, CT ,  4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and tr...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs

All time best quote on “ Principles of learning and education “
Today is one of the most auspicious days in Indian traditional festive time. Saraswathi pooja, a celebration of the Goddess of knowledge and education. I would like to share one of the all-time great quotes on learning from Thiruvalluvar a sage poet who lived in the southern Indian state of (mine), Tamil Nadu in 4th -5th century BC  2500 years ago.  This Thirukural number 391 in the chapter of education goes on like this. (In the Tamil Language) In English Karka, Kasadara, Karpavai , Katrapin, Nirka , Atharkku Thaga ! It says Karka : Learn Kasadara...
Source: Dr.S.Venkatesan MD - October 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics medical quotes bioethics medical education principles of practice of medicine princniples of learning quotes on education Thirukuraal Source Type: blogs

DAPT blues in ACS : Does Prasugrel really bother to know about the coronary anatomy before it acts ?
It appears,antiplatelet agents are waging a turf war on the CAD battlefield. It is no secret either, the fight often goes beyond academic reasons. Though NSTEMI connotes a true cardiac emergency, it consists of a highly heterogeneous population. A patient with UA can be treated even at home (Low-grade angina with little ECG changes, when it’s due to Increase demand situation). While, in the other extreme of NSTEMI, a patient with a GRACE score>200, in Ischemic  LVF, might need an emergency multivessel angioplasty along with Mitra clip ±  ECMO support.  Antiplatelet agents along wit...
Source: Dr.S.Venkatesan MD - October 19, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome oral anticoagulants warfarin acitrom prasugrel 2b3a vs prasugrel coronary anatomy in nsteacs dapt mapt NSTEMI guidelines esc acc 2020 prasugrel vs aspirin vs ticagrelor reopro vs prasugrel themis twilight study Source Type: blogs

“ Dialysable LV dysfunction In CKD ” : Myocardial edema clearance plays a role.
In CKD, LVH is a near-constant feature with echo showing thick, bright echoes from IVS. The LV mass increases, partly due to physiological hypertrophy ,also contributed by deposits of uremic middle molecules and fluid collection in the interstitium as myocardial edema.This, is recognised as T 2 weighted MRI signals. Chronic fluid stasis may progress to myocardial fibrosis. (Kidney Blood Press Res 2018;43:134–142 )   Effect of Frusemide on myocardial edema  We know, loop diuretics cause aggressive depletion of ECF volume and to a lesser extent Interstitial fluid. The effect of diuretic on myo...
Source: Dr.S.Venkatesan MD - October 11, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology research topics for fellows cardiology thesis topics Uncategorized myocardial edema in ckd myocardial edema mri Source Type: blogs

Amiodarone in Ischemic VT : Doesn ’ t work always,.. IRA patency could be the missing link.
Curiously, the management of VT is simple if the patient is unstable. Just, we need to shock. Cardiologists are troubled only with a hemodynamically stable patient with VT. Some of us still think Amiodarone is a universal antidote for any VT. Though It is effective in both ischemic and non -Ischemic VT, the success rate is not uniform. The mechanism of action of the Initial IV bolus is not a class 3 K + blocking action, instead, it is thought to be its beta-blocking action. If amiodarone fails, we may try Lignocaine,  magnesium, Flecainide. .Many times it is the cumulative dose of amiodarone that reverts the VT. In so...
Source: Dr.S.Venkatesan MD - October 10, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized brugada criteria for vt efficacy of amiodarone localisation of vt magnesiusm for vt research ideas in cardiology research papers in cardiology Source Type: blogs

Newer frontiers in cardiac pacing : Wireless dual-chamber pacing
The field of cardiology is always at the forefront of any technological breakthrough. Cardiac pacing stands tall among all Innovations. While remote monitoring and pacemaker telemetry are well-known concepts. One would have wondered why Intracardiac leads couldn’t communicate with each other wirelessly. Yes, It was just a matter of time, for that to happen.  The leadless pacemaker Micra/Nanostim was Introduced recently but lacked the much needed physiological pacing as they were single chamber based pacing. Though mechanical sensing of atrial activity was possible with Micra TPS software patch  (A&nb...
Source: Dr.S.Venkatesan MD - October 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized av micra tps ddd vs dddr pacemaker dual chamber wirless lead less pacemaker micra nanostim paceaker naspe cardiac rhythm society Source Type: blogs

Medical distillery : How to eliminate evidence based falsehoods in medical literature ?
If science is considered as a journey towards truth,.. knowledge, data, and statistics are the key companions in this infinite voyage to the dreamy destination. While hundreds & thousands of scientists do travel in this turbulent road daily, pursuing their mundane work, there are very few researchers worried about the true purpose of their journey, the quality of the road they travel, the dangerous fault lines they create. It has become a taboo topic to criticize medical science even after realizing the fact that we are compelled to follow and glorify some of the best nonsense. Dr. Jhon Loannidhis Pr...
Source: Dr.S.Venkatesan MD - October 5, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized audit of medical science bioethics cleansing of medical literature Dr. Jhon Loannidhis ethics in medicine medical science distillery Source Type: blogs

Role of RT-PCR in the diagnosis of Rheumatic fever/RHD
RT-PCR: Real-time polymerase chain reaction, a sophisticated gene sequence-based biochemical test. Thanks to corona, this complex medical investigation has become a household name. Jones proposed his criteria to diagnose acute rheumatic fever  in 1944, we still use it to diagnose with many modifications . Currently, AHA position statement – 2015 by Gewitz et all is  being followed. (Circulation 2015) From Braunwald textbook of cardiology. Apart from this, there is one catch . Even if the child fulfills Jone criteria, there needs to be evidence for preceding streptococcal sore throat, either by culture or an...
Source: Dr.S.Venkatesan MD - October 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acute rheumatic fever aha rhd 2015 rhuematic fever anti dnase streptococcus group a beta hemolytic streptococci rtpcr mirna rtpcr rhd qpcr in rheumatic fever revised jonec criteria 2015 RHD jones criteria role of rtpcr fro Source Type: blogs

If EF% is a most flawed LV functional parameter,.. why we Insist HF to be classified based on it ?
Heart failure has been classified in many ways, with prevailing levels of our knowledge and ignorance. It is based on a variety of factors like rapidity of onset, etiology, chambers involved, hemodynamics, etc.  Forward vs backward failure Acute vs chronic failure RV/LV or Biventicular failure  Systolic vs diastolic heart failure High output vs low out failure Ischemic vs non-ischemic failure  Reversible vs Refractory HF  None of them have really helped at the bedside though it helped us understand the condition. Now, in the last decade, we have crash-landed on our favorite obsession to clas...
Source: Dr.S.Venkatesan MD - September 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ase esc acc csi echo cariteria definition of heart failure diastolic heart failure ejection fraction limitation forward vs backward failure hf with normal GLS HFpEF HFrEF rv vs lv failure systolic vs diastolic heart failu Source Type: blogs

“ Meta physical ” effect of “ Physical exertion ” on coronary plaque
Is sudden, unaccustomed, physical exertion a trigger for plaque rupture and an ACS ? Yes, it is, but don’t get apprehensive. The underlying risk factors, plaque burden, and its morphology matter much to result in a coronary event. What is the mechanism? Plaque morphology,  the lipid core, the shoulder region’s eccentricity, the crystallization of cholesterol lay the foundation. The Isometric component of stress surges Intra-coronary pressures and facilitate vascular injury.  Endothelial dysfunction leading to erosion and subsequent acute total thrombotic occlusion is a well-known response to stress. C...
Source: Dr.S.Venkatesan MD - September 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: atherosclerosis vulnerable plaque physical and mental stress and vulnerable plaque physical exertion and plaque fissure Source Type: blogs

History of cardiology : A soulful story of “ Dr.Thomas ” and his BT shunt
History is rarely kind to the original heroes in the scientific world.The classical Blalock-Taussig shunt,(BT shunt) the term we heard for the first time in the early clinical years of MBBS .We know, it as a dramatic cure (Palliative  though)  for the commonest congenital cyanotic heart disease -Tetralogy of Fallot. Now, half a century later, came to know, there is a gripping  story of an oppressed black hero behind this famous cardiac surgery. This post is  all about the  fascinating life of  Vivien Thomas,  a humble carpenter’s son from Nashville. While he dreamed to become a doct...
Source: Dr.S.Venkatesan MD - September 17, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized baltimore john hopkins BT shunt dr blalock dr helen b taussig history of cardiology modified bt shunt something lord made vivien thomas Source Type: blogs

NSTEMI : Is it the baby of STEMI or a Neo NSTEMI ?
It was April 15th 1912, Titanic, the Invincible, had just sunk into the dark waters of Atlantic coast off Newfoundland. Exactly same time around, Dr. James Herrick, In Chicago,Illinois was busy documenting the first diagnosed case of acute coronary thrombosis. A new disease was born ie Myocardial Infarction. This was also the era of the Noble Prize-winning  Invention of the ECG machine by Waller, Einthoven, and Thomas Lewis & co that sow the seeds for the speciality of electro-cardiology. Though much was studied about MI with pathological specimens in the subsequent decades, there was a lull in the efforts to defi...
Source: Dr.S.Venkatesan MD - September 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome herrick james stemi nomenclature issues of acs non q mi NSTEACS nstemi NSTEMI new definition 2020 Source Type: blogs

Peer reviewed perils: Medical science is still far away from true democracy !
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - September 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidelines clinical cardiology drsvenkatesan venkat quotes medical editors medical ethics nstemi peer reviewed journal Source Type: blogs