Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG ?
Can a bedside echocardiogram help rule out STEMI in patients with suspicious ECG?No, it can’t  (Though, it may be tempting to use a rapid echo to look for wall motion defect to rule out ACS ) If your answer was No, probably you don’t need to read any further in this post. Diagnosis of STEMI* is based onClinicalECGBio-Markers *Please note, two of the most popular investigations namely Echo and Coronary angiogram are missing in the list.Middle-aged man with  chest pain.  Can an echocardiogram help you confirm  STEMI here? Most likely not. It may still be a evolving STEMI. But, obser...
Source: Dr.S.Venkatesan MD - July 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diagnostic criteria for stemi gls in stemi role of echocardiography in diagnosis of acs stemi nstemi wall motion defect in stemi by echo Source Type: blogs

Awesome Doctors are not created in medical schools
Who is a doctor?  Where they are made?I haven’t clearly understood the true meaning of customary Dr tag, my name carries for more than 3 decades, till I saw this. Wish, this video is played to all young medical students on their graduation day.              I am realizing with guilt, it requires a Holywood movie buff to remind us the true meaning of the famous WHO – definition of Health, done in the most holistic fashion in the year 1948. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.So, tec...
Source: Dr.S.Venkatesan MD - July 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ethics in medicine hippocrates otth on medical education Iam documentry Tom Shadyac Patch adams Source Type: blogs

Covid times energy booster … with love from China
Halway way through 2020 , still miles to go. Welcome to a non academic break.This 3 minutes video definitley helped, amidst the paronia. Wish, we can retire peacefully and join this family. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 21, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Thrombolysis, is a ” best friend ” of STEMI in non-covid times,.. but, definitely not during this deadly pandemic !
That’s how the title sounded to me, when I happened to read this paper from the reputed Circulation journal. Even in the serene non-covid days, primary PCI rate in most countries is at best 10 % and thrombolysis* is the only savior in STEMI.(*with or without Pharmaco Invasvive ) It’s Covid times you know, can’t take science for a ride. Let us all take a pledge, in this deadly pandemic to increase pPCI rate to atleast 50% and ditch that dedicated, trustworthy , uncomplicated all weather friend ! Reference https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006885     (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Thrombolysis, can be a best friend of STEMI in non-covid times,.. but,definitely not during a deadly pandemic !
That’s how the title sounded to me, when I happened to read this paper from the reputed Circulation journal. Even in the serene non-covid days, primary PCI rate in most countries is at best 10 % and thrombolysis* is the only savior in STEMI.(*with or without Pharmaco Invasvive ) It’s Covid times you know, can’t take science for a ride. Let us all take a pledge, in this deadly pandemic to increase pPCI rate to atleast 50% and ditch that dedicated, trustworthy , uncomplicated all weather friend ! Reference https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006885 (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - June 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Effect of coronary collaterals on FFR measurement
FFR is based on the hemodynamic principle of pressure drop when fluid or blood flows across a narrowed segment (similar to Bernoulli principle). If there is more than 25 % pressure drop across the lesion under maximum hyperemic condition (or steady-state) it is counted as significant.(FFR is .75) Now, if the distal vessel is supported by collaterals, what happens? When a vessel in question, is supplied by well-formed distal collaterals, it will prevent this pressure drop and hence lesion is underestimated. Similarly, if the donor artery has a suspicious intermediatory lesion, the FFR across it shows falsely low...
Source: Dr.S.Venkatesan MD - June 15, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized FFR IFR wave free qfr imr ct ffr ffr in left main bifurcation lesion tandem lesion ffr vs tmt stress test impact of collateral on ffr oor man's ffr stres test equivalent Source Type: blogs

Planned PCI in high bleeding risk patient: Three forbidden options
Though two stents Onyx one (Medtronic) and Biofreedom(Biosensors) appear promising with rapid endothelisation and hence short DAPT. There are three more options. available in this situation. Option 1 Avoid the endothelium unfriendly DES and use BMS* and use MAPT (Mono or minimal antiplatelet therapy). For the sake of the young generation cardiologists, let me expand BMS,ie Bare metal stents. BMS in 2020 ! What nonsense are you talking about? (For those who ask this question, please try to go through the following study with a conscience) (NORSTENT 2016 -One of the most underrated, deliberately concealed landmark paper in...
Source: Dr.S.Venkatesan MD - June 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized biofreedom vs onyxone bms for high bleeding risk BMS VS DES IN 2020 NORSTENT BASKET PROVE NEJM POBA DEB to reduce bleeding risk Source Type: blogs

Why should the three antiplatelet siblings Tica ,Prasu & Clopi fight perennially?
Anti-platelet drugs find a place virtually in every prescription written by a cardiologist for CAD.No doubt, it sits right on top among the highest prescribed medication in the world. They are used in all forms of CAD/ ACS. It becomes  mandatory in  post PCI as a stent maintenance protocol. Cardiologists (at least me) are exhausted with so many studies with these drugs. When we thought we are relaxing for a while, the current issue of circulation release a big meta-analysis with 50,000 patient data.It tries to draw fresh battle lines between the three friendly  P2Y12 inhibitors.  https://doi.org/1...
Source: Dr.S.Venkatesan MD - June 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome anti platelet drug bms vs des isar react 5 themis stents for high bleeding risk biofreedom onyxone ticagrelor vs prasugrel vs clopidogrel Source Type: blogs

History snippet : Madras medical college had a branch in Kerala
I stumbled upon this unique historical info about my college. *According to Prof. Emeritus M.G. Sahadevan., F.R.C.P. (London), the first medical college of Kerala was started at Calicut, in 1942-43, during the Second World War. Due to a shortage of doctors to serve the military, the British Government decided to open a branch of Madras Medical College in Malabar, which was under Madras Presidency then. The Medical School was started close to the then district hospital at Kottaparamba ( now Women and Children’s Hospital).The war was over before the medical students completed their course. After the war, the medical sc...
Source: Dr.S.Venkatesan MD - June 6, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized histroy of madras medical college madras medical college calicut branch Source Type: blogs

Chloroquine is not useful for Corona declares this Important study from Lancet … but
The antiviral properties of hydroxychloroquine are well known. The doubt is whether this property works against the pandemic Coronavirus. Mechanism of HCQ’s antiviral action. HCQ primarily gets concentrated intracellular endosomes, that’s where the virus resides and multiply. The study, all of us were expecting has come out. It concludes,    While, many of us might think, its end of the controversy, but definitely not. Why the top medical journal uses a term “unable to confirm” the benefits of HCQ on covid. Why it hasn’t concluded as “No benefit”  This is bec...
Source: Dr.S.Venkatesan MD - June 5, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized antiviral properties of corona chloroquine for corona hcq for corona Source Type: blogs

Can you believe this? Ticagrelor approved for Primary Prevention of STEMI
It’s all happening. FDA approves Ticagrelor for high-risk cad primary prevention and stroke. I am sure, even Astra Zenica wouldn’t have expected this. At best, the evidence from THEMIS for this Indication, can be called as a statistical extrapolation of comical proportion.  Meanwhile, Ticagrelor thanks Aspirin for its extreme kindness for agreeing to co-live with it.   The twitter reacts. This one is fromDr. Davide Capodanno , current Editor In chief , of  EuroIntervention, the journal with one of the top Impact factor with a huge following. New FDA label for ticagrelor in "h...
Source: Dr.S.Venkatesan MD - June 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized fda approves ticagrelor THEMIS TRIAL ticagrelor for primary prevetnion Source Type: blogs

What does “ Public health ” mean to you ? … I am confused!
After decades into the field of medicine, I am unable to come to terms with one of the most fundamental questions in our profession. What does the term Public health means? Have we erred, by defining health in terms of its delivery rather than a comprehensive biological definition? How do you compare a guy, who gets pride with glittering five-star care in a private hospital , with that of man who humbly accepts the same in a crowded public health facility? “It’s 1 .30 AM past midnight. I am part of the  COVID supervisory team on rounds. I could see a tired-looking corporation worke...
Source: Dr.S.Venkatesan MD - June 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

What exactly is the relationship between Hypertension and Corona ?
The mainstream (& the sidestream) medical media have already named one culprit ie hypertension (HT) as a significant comorbid entity in the current Corona pandemic. But, If we ask one direct question, how Corona and HT are linked ? , the answer is not forthcoming fluently. . Some of the thought process about the Issue. 1. Does Coronavirus relish high blood pressure on its journey to attack lungs ? Funny question you may think. The virus primarily lives and tracts through the respiratory tract to reach lungs. Viral load in bloodstream is nil or  miniscule till late stages. BP is nothing to do with what is...
Source: Dr.S.Venkatesan MD - May 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized what is the link between hypertension and corona outcome Source Type: blogs

Link between LV dysfunction & VPDs … Is it a cause or bcoz ?
We know, LV dysfunction of any etiology can cause VPDs.This must be differentiated from VPDs induced LV dysfunction. Mind you, this is not an easy job at all. When do you suspect excess VPDs are the cause (or might cause) of LV dysfunction?In young, otherwise healthy persons with “VPDs and LV dysfunction”  would suggest chronic abnormal electrical activity is the cause for subsequent LV dysfunction. (An expression of electromechanical remodeling) Monomorphic VPDs more often suggest primary electrical pathology(Like OTVT, Fascicular VT)VPD count more than>10000 in 24 hrs in Holter will pro...
Source: Dr.S.Venkatesan MD - May 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized av desynchrony due to vpd influence of vpd on crt PVC induced cardiomyopathy tachycardic cardiomyopathy what is the relation between LV dysfunction and VPD vpc pvc Source Type: blogs

Corona times: Clinical cardiology wakes up from deep coma, for a while !
Surprised to see many of my colleagues, physicians and fellows are beaming with new pride even in this troubled corona times. Paradoxically, I could see some fresh clinical sense in their approach to problems as well. Each one of them had a story to tell Sir, I could suddenly diagnose heart failure for the first time with my eyes and ears without NT- Pro BNP or E/E’ . I agree with you sir, textbooks seem to be right. There was indeed basal rales and JVP was elevated. I was astonished I could diagnose CHF clinically! I feel proud, that I have acquired the rare expertise of giving fitness to an emergency appendectomy...
Source: Dr.S.Venkatesan MD - May 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Corona times: Clinical cardiology gets up from graveyard, for a while !
Surprised to see many of my colleagues, physicians and fellows are beaming with a new pride even in this troubled corona times. Paradoxically, I could see some fresh clinical sense in their approach to problems as well. Each one of them had a story to tell. Sir, I could suddenly diagnose heart failure for the first time with my eyes and ears without NT- Pro BNP or E/E’ . I agree with you sir, textbooks seem to be right. There was indeed basal rales and JVP was elevated. I was astonished I could diagnose CHF clinically! Suddenly, I found, I have acquired the rare expertise of giving fitness to an emergency appendect...
Source: Dr.S.Venkatesan MD - May 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Issues in thrombolysis: There may not be anything called “ Absolute contraindication ”
This post was originally written in 2013. A middle-aged man with STEMI  came to our CCU.  It is just another case of STEMI and asked my fellow to lyse. But it was not the case . He, told me, Sir, the patient had a syncope following chest pain and he has injured his face and Jaw. He was actively bleeding. When I saw this face, it was indeed  frightening. What shall we do ? When a patient  with STEMI presents with bleeding facial Injury Rush for Immediate PCI (Which was  of course not possible in our place as it happened out of office hours! ) Take that ultimate risk and thrombolysis Give only hepa...
Source: Dr.S.Venkatesan MD - May 16, 2020 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology Risk assesment cardiology- coronary care Cardiology-Coronary artery disese Primary PCI Thrombolysis relative and absolute con Source Type: blogs

Is there an entity called “ Isolated ” systolic pulmonary arterial hypertension ?
What is the incidence of Isolated systolic pulmonary arterial hypertension (ISPAH) and its Implication? We attempted to answer this question and found some interesting answers. It was published in the Indian heart journal  December 2007 Abstract issue. More than a decade gone. I think this issue is still largely misunderstood. Fellows may pursue this. One more parameter that can be explored is pulmonary artery pulse pressure and effect on progressive pulmonary vascular disease and PVR. Mean while  PAH definition and classification has changed many times, ISPAH definitely requires a place in the new scheme of thin...
Source: Dr.S.Venkatesan MD - May 15, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Pulmonary arterial hypertension Pulmonary circulation Pulmonary vascular resistance Thesis/Research topics for cardiology fellows isolated pulmonary arterial hypertension ispah normal pulmoanry arterial pressure pulmonary hypertension syst Source Type: blogs

Can we mix philosophy with science in medical teaching ?
Take Our PollI think it is an Invalid question. Whether you like it or medical science and philosophy are always bonded together and its relationship is eternal. It doesn’t make sense to separate them. I think we have misunderstood the meaning of philosophy. While science is presumed truths, philosophy is trying to believe in unknown truths. Philosophical truths are built-into every decision a medical professional takes.                                                         ...
Source: Dr.S.Venkatesan MD - May 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ethics in medicine Source Type: blogs

Difficult calls in cardiology : Be ready for DC cardioversion during pregnancy !
This report from Taiwan  reassures there is no adverse effect by measuring umbilical artery flow (Yu-Chi Wang European Journal of Obstetrics & Gynecology and Reproductive Biology 126 (2006) 268–274)While we consider DC shock during pregnancy is safe for the fetus, still, shock pads close to the abdomen, amniotic fluid being a good conductor of electricity at least one mother showed a sustained contraction of the uterus and fetal distress. This was possibly attributable to DC shock  Eleanor J. Barnes BJOG 2003 https://doi.org/10.1046/j.1471-0528.2002.02113. Final message Most cardiac arrhy...
Source: Dr.S.Venkatesan MD - May 11, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology women Pregnancy and heart Uncategorized amiodarone verapamil in pregnancy avnrt avrt during pregnancy cardioversion during pregnancy dc shock during pregnancy fetal distress during dc shock peripartum cardiomyopathy vt vpd managem Source Type: blogs

Do I add “ real value ” to my medical profession ?
  A throbbing query …for so long Got into this amazing lecture, that Infuses knowledge and wisdom about values in life, in just 14 minutes .Probably, It has more treaures than what we may get, in our entire life time as we search for truths. I wonder, such thoughts can come only from God’s special messengers.Devdutt Pattanaik seems to be one.    (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - May 10, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Why we ignore LA appendage when measuring LA volume?
This study suggests we have to be careful about the hidden potential of LAA to expand and if ignored the device is likely to get dislodged with volume overloading. These observations make it clear we can’t isolate LAA volume when calculating LA volume.  Final message There is a strong case for measuring  LAA size & volume separately and preferably be added in the net LA volume Index. We can’t simply Ignore this vital and inherent part of LA , just because its called as an appendage. Of course, even a novice will rank LAA first,  as the pathological hot spot within the entire LA. Refe...
Source: Dr.S.Venkatesan MD - May 7, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Anatomical paradox: When ventricular outflows crisscross , left main becomes closer to RVOT , than even the LVOT !
If you think coronary artery ostia are exclusively related to LVOT, and they nowhere come closer to RVOT, we are seriously wrong for some hidden anatomical reasons. Though, Its a well recognised anatomical reality , we had to learn it from EP labs during the ablation of RVOT VT. The left main ostium is at equal (If not more ) at risk as we ablate across RVOT.The reason being the complex twist God conferred on the outflow tracts of heart.The LVOT goes beneath and posteriorly travels from left to right, while the opposite happens for RVOT. This results in the net anatomical conundrum of RVOT and LVOT sharing common wall at s...
Source: Dr.S.Venkatesan MD - April 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Aortic valve anatomy : A complete exploration
Found a wonderful anatomy teaching resource. A succinct yet comprehensive lecture on Aortic valve .A must-read for anyone who deals with valvular Interventions. For the cardiology fellows , I can tell you can’t find anything better than this. Thanks to Prof Gregory M Scalia and the structural heart disease Australia. It starts with this one master diagram of Aorta in the center with all surrounding structures and goes on to ensure we watch this 25-minute lecture nonstop. At the end of the lecture, you should be able to learn about. The complex fusion points of LVOT with Aorta. Understanding them is critical as we d...
Source: Dr.S.Venkatesan MD - April 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized aortic annulus virtual Best lecture on anatomy of aorta prof greg scalia structural heart disease australia Source Type: blogs

Great cardiac vein aspiration for refractory LAD No-reflow : A hypothesis waiting for proof.
Preamble  The resting coronary blood flow (CBF) is about 5 % of cardiac output. It amounts to 250 ml /min (0.8 ml /mt/gram of myocardium ) It is estimated, blood flow across LAD is 50% . LCX and RCA share 25% each, depending upon the dominance. No need to say , the net return to coronary sinus  should match the CBF at rest or exertion.(Minus a small fraction contributed by  thebesain and vene cardia minimi flow, into the right heart chambers)Great cardiac vein (GCV) is the venous cousin of LAD. It must receive and empty 125ml of deoxygenated blood every minute into the coronary sinus, if LAD flow is normal. ...
Source: Dr.S.Venkatesan MD - April 10, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coronary sinus aspiration great cardiac vein aspiration for no reflow microvascular obstruction retrograde thrombus aspiration for no reflow Source Type: blogs

AV synchrony in lead-less Micra AV pacemaker: How does it sense Atria ?
The Medtronic leadless Micra TPS pacemaker In 2016, EP world saw a major breakthrough when Medtronic introduced leadless Micra TPS pacemaker. This device that looked like a small bullet, was implanted in the RV apex without the need for lead insertion and surgical pocket. It was real innovation but was not able to take off even after 4 years of marketing. The reason was simple. Though it was a smart device, it was a journey backward in time, as Micra TPS provided only non-physiological VVI pacing. (In the current era of multi-site and His bundle pacing) Physiological pacing requires two are more leads.(Except single lead V...
Source: Dr.S.Venkatesan MD - April 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized atrial sensing lead in micra medtroinc dual chamber vs micra medtroinc how does micra av sense atria is micra a physiological pacing medtronic micra pacing medtronic micra tps vs av Source Type: blogs

Acute “ Corona ” syndrome : Glad to know plaques are also in lockdown mode !
The Country of mine with 140 crore population, is under complete lockdown mode. We are anxiously tense in one aspect,  but enjoying the free time due to the peculiar “Corona effect” on cardiac emergencies. Unable to understand you . . . please go away What happened to our 24/7 busy CCU ?  Does it happen only in my hospital? Can’t be.  Let me check it right now. I called my fellow, who has since become a leading cardiologist in the nearby town. I have since called many of my close contacts. In both Government and private hospitals. The pooled data were analyzed in a virtual cloud memory. I...
Source: Dr.S.Venkatesan MD - April 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -guidelines Cardiology -Interventional -PCI cardiology -Therapeutics Ethics in Medicine Uncategorized Acute corona vs coronary syndrome ethics in cardiology evidence based cardiology Source Type: blogs

How many lives ventilators can save, in a pandemic like corona ?
One of my well-educated patients asked me, how ready is our state health services. How many ventilators do we have, he asked? I told him, we have enough but short of it only technically. I had great difficulty in explaining to him that ventilators are not the antidote for coronavirus. I continued, even if we have an unlimited number of ventilator and other gadgets, the major determinant of the outcome is going to be the overall viral load, severity of lung Injury and other system involvement. Finally, it is the patient’s ultimate fighting power along with the forbidden word in medicine, ie fate. His query continued t...
Source: Dr.S.Venkatesan MD - March 30, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

STEMI management in Corona times: “ Cath lab distancing ” is not really a discrimination !
Even in the best of non-Corona times 90 -95% of STEMI population in our country (the rich and famous included) are discriminated by denying the life saving primary PCI and subjecting them to a dangerous and inferior modality of treatment called coronary thrombolysis or its slightly less inferior cousin pharmaco-invasive strategy. Now, thanks to corona, for some time it’s going to be near 100% discrimination. Fortunately, “Corona” or “No -Corona” this discrimination has never harmed in true sense in the real world. My feeling is, there is going to be little overall impact on ACS /CCS&...
Source: Dr.S.Venkatesan MD - March 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Corona and stemi how to manage stemi in corona times Source Type: blogs

A curious CT scan in Cardiology
Presentation A 38-year-old women,with  episodic chest discomfort, mild dyspnea, and occasional non-productive cough. She was investigated in a non-emergent fashion.  After an abnormal X-ray chest, A CT scan was requested.  (*X-ray chest is Intentionally not posted here to add some curiosity factor) This is probably one of the most curious Images in cardiology I have stumbled upon. At the first look, it seemed a baseball has replaced a heart. Is it not? Posted with Creative Commons Attribution License CC-BY 3.0. Afzal et al. Dept of Internal Medicine, Florida Hospital, Orlando, USA.Cureus 10(11): e3566. Whe...
Source: Dr.S.Venkatesan MD - March 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized aneurysm of coronary artery coronary artery aneurysm Images in cardiology Source Type: blogs

“ Digital distancing ” is also essential to combat “ Corona ”
As human life enters an extraordinary new phase ,”Digital distancing” is also critical for Corona(fear)control.Let us make all mobiles into “non smart mode” for the next 30 days at least . Use TV judciously. Just listen to radio for official Govt.Communication.No panic buying, relax, restrict desire. Meanwhile, let us use this lockdown period to find a good purpose for a meaningful life and help the needy. “God will definitely bless us” The anger of Corona is sure to settle down very soon and will start living with us in complete harmony, like billions of other organisms do. (Sourc...
Source: Dr.S.Venkatesan MD - March 21, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

“ Fear ” could be a more deadly virus than Corona !
Viruses are essentially lifeless molecules (A nucleic acid RNA/DNA) .In the case of CoRoNA, it is the inbuilt RNA that acts as a commander in mischief. Ironically, it gets to life only when it attaches to the host cell. How a small bit of nucleic acid with a lipid cap infects a cell and becomes a deadly factory of new viruses and spread through the body remains a deep biological mystery. Someone asked me , “Can we kill the Corona en masse”? The answer is frighteningly simple, we can’t kill them really, because they don’t have life in the first place. At best, we can deactivate or make it dormant and...
Source: Dr.S.Venkatesan MD - March 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Non- A, Non -B Aortic dissection : Incidence ,classification & outcome
Aortic dissection is a unique cardiac emergency that tests our collective understanding of vascular anatomy and pathology .It poses the ultimate challenge to the expertise and wisdom of both cardiologists, and surgeons. Freezing the Aortic Time machine The philosophy of management swings between total inaction* in some (As in most Type B & few Type A as well ) to “No holds barred” approach in others. (In most Type A and few Type B). *Read it (also) as medical management that includes powerful Aortic pulse attenuation therapy with beta-blockers ( Unfortunately medical management is considered as Inaction by ...
Source: Dr.S.Venkatesan MD - March 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic dissection Non A Non B Aortic dissection tem debakey stanford classification dissect penn Source Type: blogs

Perils of patient empowerment threaten to become a disease by itself !
Professional medical practice demands to put always the patient’s interest first. Unfortunately, current practicing methods threaten doctors to yield to patient’s whims & wishes which are influenced by significant non-academic forces. The principle of Informed consent is gradually losing its true meaning. Who is informing what ? and to whom?  is becoming a hazy conundrum in complex two-way confabulation based on severely battered evidence-based medicine. Some of the conversations not heard in silent corridors of big hospitals Why did you stent his LAD ? , He had triple vessel disease Is’int CABG...
Source: Dr.S.Venkatesan MD - March 5, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

In modified Bernoulli equation (P = 4V ²), from where number “ 4 ” came ?
Bernoulli equation is the most critical equation on which the foundation of clinical Doppler echocardiography is built. Bernoulli equation tells about fluid mechanics. Bernoulli’s principle states that the sum of potential and kinetic energy of fluid per unit volume flowing through a tube is constant. A more detailed explanation regarding Bernoulli equation is linked in this video Applying Bernoulli in Echocardiography So, if we can somehow measure the velocity gained across a point inside the heart we can deduce the pressure gradient. Here comes the Doppler principle that helps us calculate the velocity. Doppler is...
Source: Dr.S.Venkatesan MD - February 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized .Bernoulli equation in echocardiography 4 is the constant in modified bernouli equation from doppler and bernouli mass of blood vs density of blood what is four in Bernoulli equation Source Type: blogs

In modified Bernoulli equation (P = 4V ²), from where did the number 4 came ?
Bernoulli equation is the most critical equation on which the foundation of clinical Doppler echocardiography is built. Bernoulli equation tells about fluid mechanics. Bernoulli’s principle states that the sum of potential and the kinetic energy of a fluid per unit volume flowing through a tube is constant. A more detailed explanation regarding Bernoulli equation is linked in this video Applying Bernoulli in Echocardiography So,  if we can somehow measure the velocity gained across a point inside the heart we can deduce the pressure gradient. Here comes the Doppler principle that helps us calculate the velocity...
Source: Dr.S.Venkatesan MD - February 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized .Bernoulli equation in echocardiography 4 is the constant in modified bernouli equation from doppler and bernouli mass of blood vs density of blood what is four in Bernoulli equation Source Type: blogs

Current approach to acute Pulmonary embolism : A three minute algorithm
Here is a 3-minute algorithm for the management of acute pulmonary embolism. Just need to ask 3 questions. Caution: User discretion is advised as it could be tainted with reasonably acceptable levels of non-scientific content. Some of the critical  questions need to be answered What is hemodynamic stability? It is purely based on clinical signs and judgment.(One need to be doubly sure to rule out hypovolemia and sepsis-related hypotension) Is RV dysfunction equivalent to hemodynamic stability? No, it is not. Clinical instability must be associated.( The dogma is,  if the patient is stable even if there is signif...
Source: Dr.S.Venkatesan MD - February 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 2020 acute pulmonary embolism guidlines 60/60 sign acc aha acc esc guideline for pulmonary embolism esc 2019 pe guidelines guidelines for pe pulmonary embolism 2020 latest pe guidline latest review article pulmoanry embolism Source Type: blogs

Pulmonary atresia with VSD : Does routine uni-focalisation strategy justify all the trouble ?
Pulmonary atresia with VSD is one of the complex CHD subsets that requires a meticulous understanding of anatomy, physiology of pulmonary circulation. It can be termed as TAPAC -Total anomalous pulmonary arterial connection in extreme cases. Should we attempt to reverse this total chaotic pulmonary blood supply is the question? It demands a highly focused cath study(hands & brain) and CT Imaging which might actually throw more light. Post-study Interaction with surgeon and team of cardiologist are vital. The decision to take up the challenge of surgery or abandoning poses equal intellectual stress. Continuous and criti...
Source: Dr.S.Venkatesan MD - February 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized mapcas aorto pulmonary collaterals pulmonary atresia with vsd unifocalisation for pulmonary atresia Source Type: blogs

Pulmonary atresia with VSD : Does the routine uni-focalisation strategy justify all the trouble ?
Pulmonary atresia with VSD is one of the complex CHD subsets that requires a meticulous understanding of anatomy, physiology of pulmonary circulation. It can be termed as TAPAC -Total anomalous pulmonary arterial connection in extreme cases. Should we attempt to reverse this total chaotic pulmonary blood supply is the question? It demands a highly focused cath study(hands & brain) and CT Imaging which might actually throw more light. Post-study Interaction with surgeon and team of cardiologist are vital. The decision to take up the challenge of surgery or abandoning poses equal intellectual stress. Continuous and criti...
Source: Dr.S.Venkatesan MD - February 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized mapcas aorto pulmonary collaterals pulmonary atresia with vsd unifocalisation for pulmonary atresia Source Type: blogs

Pericardial effusion associated with Infective Endocarditis : Incidence , mechansim and clinical Implication.
Pericardial effusion is often detected in patients with Infective endocarditis. Incidence can be as high as 25% . Most often it is mild, can be moderate in few. Mechanism Sympathetic effusion in response to endocardial infection. It’s never more than minimal. (Evidence ? it’s only an assumption) IE related cardiac failure (Raised systemic venous pressure to which pericardial veins drain) Local sepsis, Abcess formation tracks to pericardial space through transmural lymphatics Fungal , granulomatous , Tuberculous IE (Rare) Here IE and PE  share the same pathology Part of systemic sepsis activated Immun...
Source: Dr.S.Venkatesan MD - January 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) pericardial disease pericardial effusion Pericardium infective endocarditis pericardial effusion in infective endocarditis Source Type: blogs

Pricardial effusion associated with Infective Endocarditis : Incidence , mechansim and clinical Implication.
Pericardial effusion is often detected in patients with Infective endocarditis. Incidence can be as high as 25% . Most often it is mild, can be moderate in few. Mechanism Sympathetic effusion in response to endocardial infection. It’s never more than minimal. (Evidence ? it’s only an assumption) IE related cardiac failure (Raised systemic venous pressure to which pericardial veins drain) Local sepsis, Abcess formation tracks to pericardial space through transmural lymphatics Fungal , granulomatous , Tuberculous IE (Rare) Here IE and PE  share the same pathology Part of systemic sepsis activated Immun...
Source: Dr.S.Venkatesan MD - January 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) pericardial disease pericardial effusion Pericardium infective endocarditis pericardial effusion in infective endocarditis Source Type: blogs

Time to tweak the definition of “ Professional incompetence ” in medical practice.
    (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized artificial intelligence dr s venkatesan dr venkatesan sangareddi future of medical ethics gene therapy hippocrates journal of medical ethics lown foundation madras medical college medical quotes nano medicine nejm bmj Source Type: blogs

Please mind this “ Acute coronary error ”
Science is a journey in pursuit of truth. Hence, we search for it again and again.  (Hence recurrent search becomes ReSearch) As we try to progress in our knowledge towards absolute truth,  we need to admit our errors first. I think one such is blinking right in front of us in the vibrant corridors of coronary care and cath labs every day! It is about the definition with which we deal the success of primary PCI. (A supposedly revolutionary acute coronary therapeutics  this century) Waiting for the day  . . . when all those fancy primary PCIs that leave the myocardium hurt (and retire ) with significant...
Source: Dr.S.Venkatesan MD - January 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome Cardiology -Therapeutic dilemma Uncategorized lv dysfunction primary pci successful primary PCI Source Type: blogs

Understanding a myth called “ Systolic decapitation ” in Aortic stenosis is tough !
Severe aortic stenosis will cut off the systolic BP and hence classical pulsus parvus et tardus occurs. This is what , we have been taught all along. How for it is true?   One thing is clear from clinical observation. Systolic BP need not be low, often its normal even in severe Aortic stenosis. The issue becomes curious when  high BP is associated with severe Aortic stenosis. This can happen by a variety of mechanisms.(Aging/Loss of Aortic elasticity /Pressure recovery/Hypertension)  I think, there have been little correlative studies of pulsus parvus with central aortic pressure. Can Aortic stenosis be a ca...
Source: Dr.S.Venkatesan MD - January 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: aortic stenosis Aortic stenosis and hypertension aortic stenosis causing hypertension hypertension as a cause for aortic stenosis Systolic decapitation in aortic stenosis Source Type: blogs

Pulmonary valvotomy for Tetrology of Fallot : Will soon become a worthy option
Catheter based interventions in TOF  has caught the imagination of  Interventional cardiologists.decades ago. (Quereshi reported first in 1988 Royal Liverpool hospital ) .Somehow it could not develop into a full-fledged modality. The key issue in TOF  is,  RVOT obstruction is infundibular with some degree of valvular involvement. While the valvular component is amenable for easy correction by balloon, the infundibular stenosis requires some form of cutting or splitting. Embryologically,  the malalignment of IVS is the primary mechanism of obstruction. The balloon catheter is will find it difficult ...
Source: Dr.S.Venkatesan MD - December 24, 2019 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -congenital heart disease cardiology -Therapeutics Interventions -Structural heart disease Tetrology of Fallot balloon pulmonary valvotomy in tof camera tipped catheters cyanotic spell in tof tetrology management emergency balloon Source Type: blogs

Does elevated RVEDP cause dyspnea ?
Exertional dyspnea disproportional to the effort is the most common (cardinal)symptom of heart disease. Whenever we discuss the mechanism of cardiac dyspnea , we primarily attribute it to left heart disease, elevated LVEDP and the resultant pulmonary congestion.Conventional teaching in the past (may be in the present too !) doesn’t implicate raised RVEDP in the genesis of dyspnea. It’s good to recall , the sensation of dyspnea is felt at the peri -Amygdala nuclear zone after complex processing with various cortical and sub-cortical level .It is subjected to as many afferent triggers other than J receptors in pu...
Source: Dr.S.Venkatesan MD - December 18, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Clinical cardiology Uncategorized does raised rvedp cause dyspnea dyspnea in pulmonary hypertension mechanism of dyspnea Source Type: blogs

Why ventricular tachycardia has wide QRS complex ?
Why VTs have wide QRS complex? Brief answer: VT  usually presents with wide QRS tachycardia because it originates in ventricular myocardium, travels muscle to muscle instead of the normal conduction system. However, VTs need not be wide always, if it captures the conduction system early and more proximally it can be as narrow as SVT. Further reading: Only for cardiology fellows  Two empirical statements are made here. (The scientific chances of both being reasonably correct are fair) 80 % of wide QRS tachycardia by default is VT. That means 20 % of wide QRS is not VT. We all accept that. 80 % of narrow QRS tachy...
Source: Dr.S.Venkatesan MD - December 4, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

How common is the progression of non-culprit lesion after PTCA ? What is the significance?
Whenever a patient is getting discharged after a PCI, the treating cardiologist often faces this situation. So, you fixed the block in my coronary artery doctor. Thank you so much. Now, I can have a peaceful life, free from  future heart problems. “Am I right doctor”? I wish I can answer “Yes”  to your query but I can’t for the following reasons. I have fixed only a lesion that caused maximum obstruction. Atherosclerosis is a diffuse disease and you have minor plaques scattered across your coronary artery. These can grow at its own will. So you carry a definite risk remote from ...
Source: Dr.S.Venkatesan MD - November 24, 2019 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized COURAGE ORBITA ISCHEMIA post ptca care progression of native vessel disease after ptca Source Type: blogs

CAD management in cross roads : Ischemia vs Ignorance driven PCI ?
*ISCHEMIA trial breaks not in NEJM or Lancet but in Washington Post and Wall street Journal After three decades into cardiology profession, one thing is very clear. We work so hard to create pseudo-knowledge and struggle with it for so long and feel awkward and guilty to come out of the mess. But we have to  . . .  in the overall interest of mankind, isn’t? We aptly call the whole process as continuing medical education, but in the melee, often we ditch some of the precious gems as obsolete. (This tempts me to suggest discontinuing false education is also an option for medical knowledge seekers !) Confucius...
Source: Dr.S.Venkatesan MD - November 21, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome cto management ISCHEMIA trial ischemia trial summary land mark trial in cardiology orbita courage bari 2d shid stbale cad take home message ischemia trial Source Type: blogs

Confabulation of a cardiologist – post ISCHEMIA trial !
I have never found it difficult to retrogradely cross a dangerous epicardial collateral in complex CTO. Delivering a twin stent in a partial culotte strategy for a bifurc lesion has never tested my talents. Stenting a left main across the LAD, jailing the LCX with OCT support is my favorite time pass. Crushing a calcium infested diffuse long lesion with diamond-tipped ablator appear as breezy as shopping in a mall. But this one is really challenging  What is that? Understanding these four studies (Ref 1-4 ). They dogmatically say medical management confers definitive protection in chronic coronary syndromes. It s...
Source: Dr.S.Venkatesan MD - November 17, 2019 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome acc esc guidelines scai pci ptca stable chd courage bari 2d orbita ischemia trials tips and tricks in ptca Source Type: blogs