Still, trying to get rid of these “ Seven sins in medicine ” !
Dr.Richard Asher,  a British physician from Sussex addressed a group of young passing out medical students way back in 1948 in London. The lecture was titled seven sins of medicine! We should thank the Lancet for having published this brief speech the subsequent year in its journal making it immortal medical teaching! Though he was listing these sins among medical students, it is very relevant to every health professional. 1. Obscurity Asher endorses the use of clear communication and plain language whether writing or speaking. Obscurity may be used to cloak one’s own ignorance, or due to an inability to com...
Source: Dr.S.Venkatesan MD - September 15, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology-Land mark studies Great men in Medicine Hippocratic oath medical quotes Two line sermons in cardiology Wintage cardiology Source Type: blogs

Which is most important component in any medical research paper ?
There are about 30000 scientific journals and two million papers every year. Of which 5000 are in medicine (Ref : World university news)  Now, take a deep breath and answer this query. What do you think is the most important aspect of any scientific or medical research in the current era ? Final message With due respect to all researchers, What do you think is the most important aspect of any scientific or medical research?  This query is very much relevant today. All components are equally important is an easy way out. But, that’s not the pathway that will take us to the truth. ...
Source: Dr.S.Venkatesan MD - September 11, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Ethics in Medicine evidence based cardiology Medcal research duplicate medical research ebm evidence based medicine finger criteria how to do medical research how to right a scientific paper junk research medical education medical re Source Type: blogs

D-Cube syndrome : DES-Dengue-DAPT
Background A 52-year-old diabetic woman who had undergone recent PCI with a DES developed a febrile illness which was diagnosed as Dengue fever. She has been taking DAPT (Dual antiplatelet) meticulously to maintain her stent. Now, her platelet count has dropped from 1.5 and subsequently to 1 lakh. She is asking now, whether to stop DAPT or not? What is the risk of stent occlusion if she stops?  The D³ cube syndrome  Infectious diseases rarely bother a cardiologist (maybe a few IE,  myocarditis, etc). Now, a unique situation is emerging. *Dengue affects 50-100 million people worldwide every year and ...
Source: Dr.S.Venkatesan MD - September 9, 2021 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug antiplatelet drugs in dengue clopidogrel prasugrel ticagrelol in dengue fever dapt in dengue fever therapeutic issues in dengue and cad warfarin heparin in dengue Source Type: blogs

How did all those calcium entered my father ’ s coronary artery doctor ?
“It was severe double vessel disease &  turned out to be a complex angioplasty in LAD ”  Why doctor? what happened? It was a hard lesion, there was plenty of calcium deposits. It was not clearly visible in the angiogram. I had to do IVUS. Curiously, the calcium was clustered in all the three planes of the vessel ( intima the media and adventitia) and they projected into the lumen blocking the path. Image collage representation purpose Thank you, doctor,  how did you manage to remove it,? It was a real struggle. I had to break the calcium shell before deploying the stent. (What we...
Source: Dr.S.Venkatesan MD - September 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions calcium supplementation coronary calcification intimal medial adventitial calcium ivl wolverine angiosculpt opn balloon orbitel atherectomy osteoporosis plaque calcium rotoablator serum calcium vs coron Source Type: blogs

Pregnancy in Hypertrophic cardiomyopathy : LSCS or vaginal delivery ?
Hypertrophic cardiomyopathy is a specific genetic disorder of myocyte (myosin and others) within the sarcomere. Though uncommon in pregnancy it raises considerable anxiety to the patient, family, and the obstetrician.  Hemodynamics Though we tend to worry more about dynamic LVOT obstruction, it is actually the restrictive physiology of LV myocardium that might cause more concern. Three key variables operate in this entity namely preload, afterload, and contractility that determine the cardiac hemodynamics and possibly the symptoms. We know the classical consequence of pregnancy is a fall in systemic vascular resista...
Source: Dr.S.Venkatesan MD - August 27, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease Uncategorized esc ropac zahara pregnancy heart disease complicating pregnancy indication for lscs in hcm hocm lscs or normal delivery in hocm hcm pregnancy in hocm pregnancy in hypertrophic c Source Type: blogs

This RCA is trying to teach some basic lessons in ACS
Inferior STEMI, and see the first shot in RCA below. The patient was pain-free and hemodynamically stable at the time of the angiogram. (Don’t wonder how this is possible, defying the fundamental rules learned from  animal experiments after acute ligation of the coronary artery)                  What needs to be done ? Go ahead and do a primary PCI as we do in any other  IRA. Be watchful, just pass on the wire, feel the lesion, and decide thereupon. Consider intracoronary lysis. How about a long stent from proximal to distal RCA? Kissing the lesion w...
Source: Dr.S.Venkatesan MD - August 22, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ectatatic coronary rca guidewire angioplasty oac noac for coronary ectasia plain balloon angioplasty primary pci Source Type: blogs

How to find which lesion is causing angina in multivessel CAD ?
Yes, it is a triple vessel disease, with one tight lesion and at least two other significant lesions. One of them appears diffuse as well.  Representative Image: Source courtesy DOI: 10.14740/cr548w LicenseCC BY-NC 4.0 “What to do next?. Is he symptomatic?  Yes. Definitely has significant angina” but LV function is normal. “Ok then. If you are daring enough, ask this question”. Which lesion is causing angina? No easy answer at all. Try looking for some clues right from history, ECG, stress ECHO, meticulous assessment of individual lesions. Realize, even sophisticated i...
Source: Dr.S.Venkatesan MD - August 20, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Cardiology -Definitions cardiology- coronary care Ethics in Medicine Uncategorized ACC AHA ESC Guidelines for multivessel cad angina related artery ara vs ira approach to tvd cabg vs pci vs medical maangement ov cad Source Type: blogs

How good is late PCI ? in STEMI : A presentation
Late PCI: This is a tricky topic to discuss on any day. A tight walk on the evidence base and a narrow risk-benefit ratio. The problem starts right from the genesis point of the true-time window, to the host-dependent myocyte response to hypoxia. Finally, we have the ubiquitous open artery hypothesis, that can taunt even the best brain in cardiology.           Late-PCI-Download (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - August 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Primary -PCI Primary PCI Source Type: blogs

Ignored concepts in ICU : Protecting RV from ventilator stress
We know the right ventricle is a weak pump compared to LV. This is evident from the triangular pressure-volume loop of RV. RV not only generates less pressure, its thin wall and its direct connectivity to the extrathoracic compartment make it vulnerable to hemodynamic fluctuations whenever Intrathoracic pressure swings. Note the lowly lying pressure-volume loop of the right ventricle. RV is a too gentle chamber and needs to be handled with extreme care especially when it is failing acutely. Patients on ventilators are typically exposed to iatrogenic rise and fall in right heart pressure. If continuous airway pressure is ...
Source: Dr.S.Venkatesan MD - August 13, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized impact of mechanical ventilator on rv right ventricle peep settings for rv failure post heart transplant ventilatory settings rv dysfunction in pulmonary rv function dysfunction rv infarction rv pressure volume loop Source Type: blogs

Optimal lipid control & Oligonucleotides
Sharing a presentation on lipid control done in 2020. This talks about newer strategies beyond statins.   PDF version lipid-metabolism Download     (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - August 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: lipids lipid metabolism Uncategorized dyslipdemia inclisiran j curve in ldl j curve in lipid control pcsk blockers ppt on lipid metabolism siRNA pcsk lipid metabolism ssss trial simvastatin statins in primary prevention Source Type: blogs

Cardiology Image watch : Its not a stent for sure … then what ?
A 75-year-old male post CABG with severe LV dysfunction and ICD and dual-chamber pacer in situ presented with NSTEMI. An angiogram revealed something, and he got this form of treatment. ? What is it? Image and case courtesy Patel R, Ghadiam H, Patel P, et al. (April 05, 2020) Angina Leading to Metal in the Heart: An Interesting Case of Saphenous Vein Graft Coiling. Cureus 12(4): e7546. doi:10.7759/cureus.7546 Features of SVG venous graft aneurysm Graft aneurysm what are the risks? Thrombosis Recurrent ACS Rupture  Management  Vascular plug...
Source: Dr.S.Venkatesan MD - July 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coil occlusion of coronary aneurysm post cabg coronary aneurysm SVG graft aneurysm Source Type: blogs

A dramatic TAVR complication : God only could have predicted this !
TAVR is a game-changing structural interventional procedure that delivers an Aortic valve percutaneously. With hardware and expertise constantly Improving, excellent outcomes are common. However, this video clip reminds us, nothing can be taken for granted in any Intervention. (Sharing a Twitter feed Courtesy Raffaele Piccolo) Aortic Rupture resulting in fatal bleeding during TAVR #CardioTwitter @InvasiveCardiol @DLBHATTMD @PCRonline@ACCinTouch @didier_tchetche @dmylotte @drmaisano @ThomPilgrim @alaide_chief @barbanti_marco @Almanfi_Cardio @azeemlatib @nicolasdumonte1 https://t.co/hbaixe3jYj pic.twitter....
Source: Dr.S.Venkatesan MD - July 10, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

“ To be or Not 2B ” : Let us stop fooling around with premature scientific evidence !
Evidence-based medicine (EBM) is being projected as a scientific God’s secret specialty. Physicians who don’t follow EBM are considered unfit non-professionals. Presumably, in pursuit of truth, all those glamorous official bodies in cardiology bring out umpteen number of protocols, guidelines, advisories, and recommendations. The blueprint for EBM We have the famous 3 levels of recommendation backed up by different levels of evidence. Many of us trust these as the jury’s final verdict for most illnesses in cardiology. I would like to bring one particular issue about this hugely popular model of EBM. ...
Source: Dr.S.Venkatesan MD - July 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: evidence based cardiology health economics Public Health Public health issues Social medicine Uncategorized acc aha scai esc guidelines class 2a vs 2b indication Class 2b Indication Comparative efficacy cost effetiveness dr venkatesa Source Type: blogs

Why ISCHEMIA trial conclusions often make us nervous ?
Why ISCHEMIA trial conclusions often make us nervous? Because, we know we can’t follow the lessons from it with true intent, as many of us are near slaves to Invisible Interventional forces in some form or other. I would think, ISCHEMIA trial in one sense was a wasted effort. We always knew OMT is superior to any sort of PCI in stable CAD  (Backed up with COURAGE /BARI 2D/and of course the deadly exposure by ORBITA ) Anyway, we did ISCHEMIA for the sake of deniers, with huge public funding to prove the truth as truth. Still, I am sure ISCHEMIA will be looked down, by most elite Interveni...
Source: Dr.S.Venkatesan MD - July 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Criteria cardiology -Therapeutics Cardiology -unresolved questions Comparative efficacy acc aha esc csa Chronic stable cad courage orbita bari 2d ISCHEMIA ISCHEMIA trial Source Type: blogs

Wish to take a break from covidology … with this birdy !
“Third wave? pardon me, what is that”  (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - July 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Acute pulmonary edema: Come ’ on let us blame it on Right ventricle
Basic science lessons are promptly forgotten by the time we reach the final year of medical school. How about recalling them decades into clinical practice. The mechanism of systemic edema revolves around the interplay between hydrostatic pressure, colloid pressure, interstitial pressure. However, In the pulmonary circuit, it gets a little more complex. Acute pulmonary edema begins to occur at around 18mmhg  PCWP. What is special about this number 18? Nothing great. The lung begins to ooze when the LVEDP/LA mean pressure exceeds the colloid osmotic pressure, (that keeps fluid in situ) within the pulmonary capillaries,...
Source: Dr.S.Venkatesan MD - July 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

How to misunderstand health economics ?
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines Ethics in Medicine Social medicine wisdom in cardiology comparative effectiveness cost effectiveness cost ineffectiveness drsvenkatesan evidence based medicine health budget of a country health care indices hea Source Type: blogs

Postprandial syncope : Incidence, mechanism & hemodynamics.
Syncope is one of the common, yet difficult symptoms to evaluate especially in the elderly. Post-prandial syncope is one condition likely to be missed out.As the name suggests It has a distinct relationship with food intake. Mild fall in postprandial BP is an expected response but if it exceeds a  limit* syncope is triggered. (*Highly variable) Hemodynamics of Postprandial state Normally splanchnic circulation demands up to a 25%  increase in blood volume after a moderately large meal.  When this happens there must be compensatory vasoconstriction elsewhere especially in muscles. Lack of...
Source: Dr.S.Venkatesan MD - June 24, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Clinical signs Cardiology -Definitions Cardiology -Hemodynamics Cardiology -Mechnisms of disease Syncope gastrointestinal cause for syncope orthostatic vs postprandial hypotension post prandial hypotension post-prandial hypoten Source Type: blogs

MDM of mitral stenosis is a “ mid diastolic misnomer ”
Nearly a century ago, Carl Wiggers helped us understand the dynamics of cardiac cycle with a historical diagram depicting systole and diastole. We know diastole has 4 phases. They are  IVRT(nil)  early rapid filling,(70%) diastasis,(0-5%) atrial contraction(25%) (Percentage filling within the brackets) What is mid diastole? The easiest way to define mid diastole is to divide diastole into three parts with reference to time and call the mid-third as mid-diastole. (.5 seconds/ divided by 3). But, Physiologically we can’t do that. Even hemodynamically there is no distinct mid diastole as diasto...
Source: Dr.S.Venkatesan MD - June 23, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Auscultation Cardiology - Clinical Clinical cardiology Mitral stenosis Uncategorized cardiologist vs physiologist diastole diastasis murmur diastolic time intervals edm in mitral stenosis ivrt vs at os interval mdm in mitral stenosis Source Type: blogs

Democrazy in science needs some attention
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 19, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized best quote in science ethics in medicine venkat quotes Source Type: blogs

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

Fighting the pandemic : Real war is not against Corona as such !
Caution: Some language  News It is heartening to note the apex body that is leading the fight against Covid in India, has responded well. It has either recalled or censured many of the Investigations & drugs, procedures that were used in this pandemic. (Not because they are futile, but they also resulted in a meaningless escalation of cost and possibly worsened the outcome) So, what? Beware, “non-scientific mutations” are common in medical research even in ordinary times. It is omnipresent now, and no surprise they end up as a premature evidence base. The consequences of thi...
Source: Dr.S.Venkatesan MD - June 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 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