Does the “ Non -IRA ” lesion status confuse you often ?..Try a blind primary PCI !
Primary PCI of IRA , continues to be a clinically & statisticaly validated  (Inspite of some ifs & buts) coronary reperfusion strategy. What to do, if  we happen to detect, a significant or borderline lesion in non- IRA territory ? There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is prac...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Does non -IRA lesion status confuse you : Try a blind primary PCI !
Primary PCI of IRA is a legally, & globally validated  (of course with lots of ifs & buts) coronary reperfusion strategy. What to do, if  we happen to detect, a significant or borderline lesion in non- IRA territory ? There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is practiced by s...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs

An anxious approach to a benign arrhythmia in Holter recording
A 32-year-old high-profile businessman was advised Holter monitoring for a few ectopic beats during routine screening ECG. The 72-hour extended Holter monitoring picked up a single short pause with a blocked P wave and reported as doubtful Mobitz type 2 AV block. The cardiologist in-charge, told the patient that findings are significant, and he would need further investigation. He was referred to their associate center for an EP study. After hearing about the procedure ,the patient was freighted about inserting multiple catheters inside his heart. This was the time he consulted me with Holter report. It was i...
Source: Dr.S.Venkatesan MD - March 19, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 2:1 av block a pilot with av block approach to av block in holter asymptomatic mobitz type 2 block ep study esc pacemaker guideline europace heart rhythm society holter monitoring hv interval mobitz type 2 av block we Source Type: blogs

What is the risk of ACS after PCI in a CTO related artery ?
CTOs are opened primarily for four reasons Angina which is refractory to drugs Stress test positivity with or without angina Anxiety of having a blocked coronary artery in a self educated patient Cardiologist’s clandestine pride & pursuit* * Personal experience included Some evidence based observation Most of the studies as on today do not give survival advantage of opening a CTO.(DECISION-CTO,EURO-CTO,EXPLORE,IMPACTOR) Opening a CTO, for reasons other than angina (i.e. for relief of dyspnea or improving functional capacity) is largely conjectural and based on randomly accrued data back...
Source: Dr.S.Venkatesan MD - March 16, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cto cto hardware cto trials jcto score open artery hypothesisacc esc aha guidelines Source Type: blogs

Next frontier in radiation free Cath lab : Fibro-optic guided Catheterization
It is a 120-year challenge. Can anyone replace Rontgen’s X-ray discovered in 1895 for medical imaging? The Nobel winning Invention redefined the way we looked at our body and management of diseases for over a century. However, the fact remained it is an invasive and injuring investigation. What is the alternative for the X-radiation ? CT scan was a great invention, but it turned out to be a gigantic 360-degree clone of X-ray machine. Today’s cath lab, however sophisticated , is like spending hours together inside a hot Chernobyl coffee shop. MRI was a true game changer. With zero radiation, MRI came close i...
Source: Dr.S.Venkatesan MD - March 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized FORS cardiac catheterisation ice intra cardiac echocardiography ivus mri oct proton mri imaging radiation saftety ultrasound imaging Source Type: blogs

No, we can ’ t call OMT, as a re-vascularisation  procedure.
Hi, welcome Mr George, I just reviewed your records. You have three blocks in your arteries supplying the heart. Are they serious Doctor ? Not really, but one of them appear tight What should I do Doctor ? But, I am comfortable Doctor. You may be. But I am not .You need to undergo some re-vascularisation procedure . What do you mean by that Doctor ? It means either a percutaneous coronary intervention with a stent or CABG. Can I get my heart re-vascularised by drugs alone Doctor ? No we can’t . Hmmm , wait, we do have something called OMT/GDMT. Can you put on hold for some time Mr George, ...
Source: Dr.S.Venkatesan MD - February 25, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

When medical conferences become an “ Edutainment Industry ” the speciality of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe. Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

When medical conferences become an “ Edutainment Industry ” the specialty of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe. Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

When conferences become an “ Edutainment Industry ” the specialty of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe. Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Why ICDs are less effective in Non Ischemic DCM ?
We wish, our understanding about cardiac contractile physiology is deep and nearly complete. Heart is an irreversibly coupled electro-mechanical organ , right from the fetal days until the final heart beat. In myocardial pathology, the genesis and sustainability of ventricular arrhythmia are intricately related to the degree of LV dysfunction of any cause. SCD is the leading cause of mortality in heart failure. Tackling SCD was in God’s domain, until the brilliance of Dr. Michel Mirowski shrunk the defibrillator and implanted it under the chest in 1980. (Dr. MM’s s a unique and inspiring story, from Poland a...
Source: Dr.S.Venkatesan MD - February 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized crt device crt-p vs crt-d danish trial ischemic dcm madit trial non ischemic dcm Source Type: blogs

Predicting myocardial viability from surface ECG following MI
Once upon a time, long, long ago, cardiologists used to be worried about akinetic segments, scars, dead tissue, and Q waves before attempting revascularization by either PCI or CABG. Now, the concept of myocardial viability has become a cliché ( rather demeaning) at least within the cath labs. Currently ,we follow a self administered whip . Every post-MI patient should be considered for revascularization as a default strategy irrespective of the level of dysfunction or scarring .This can happen either in the IRA territory or non-IRA territory or both. This strategy is now dis-armed with fresh evidence in the form ...
Source: Dr.S.Venkatesan MD - February 14, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidelines ECG predictors of myocardial viablity PET SCAN FOR VIABLITY REVIVE BRICS STUDY Source Type: blogs

Which doctor treats “ Y-36 ” disease ?
If anyone thinks doctors are the only unique and gifted people, who can treat diseases and mitigate human sufferings , realize how incorrect their understanding of the world, humanity & reality. The ICD-11 , the latest code lists nearly 15000 diseases. Have a look at this much celebrated (respected ?) list put up by the world health organization There are so many entities in the list , that are man made and solution is right there in our minds. Zoom your eyes on the red rectangle. Impact of Y-36 Y-36 is a contagious endemic, transmitted by power, pride and foolishness . Y-36 along with violence i...
Source: Dr.S.Venkatesan MD - February 11, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

A NOTIONal truth : Surgical AVR deteriorates faster than TAVI, for some mysterious reasons!
Conclusion The study results finds the valve deployed percutaneously under semi- blind vision, was equipoise with SAVR done under direct vision. The surprise however is, TAVI was superior to cardiac surgeons in multiple aspects .The mysterious finding is TAVI had less Structural valve dysfunction, and possibly low bio valvular failure (BVF), if Kaplan -Myer curve trend is little extrapolated. No doubt ,the Aortic interventional world is applauding and everyone is joining the party. Now, some academic queries ? 1.Did the trial compared best practices of TAVI & SAVR ? No. Because it was done in 2010-2013. (W...
Source: Dr.S.Venkatesan MD - February 10, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidlines aortic stenosis Aortic valve replacement avr core valve edward sapien notion 10 year follow up notion trial partner savr st judes valve surtavi tavi tavr in low risk category uk tavi Source Type: blogs

What is the correlation between number of doctors in a society & health of population ?
This query is lingering ever since I entered the medical profession. Though, this question might appear absurd , no correct answer is found yet .When we search the literature, the relationship between doctors and health can be 1.linear, 2.non linear, and 3. even inverse . 1 & 2 are ok 3 is forbidden. However, to put it in a nut-shell, healthiness of a society is little to do with Doctor population alone, is well known and I think it needs no proof. The following scattergram gives some idea about the Issue. Where to get answer for this controversial question ? Great times we are in. We have taught the machine...
Source: Dr.S.Venkatesan MD - February 6, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized doctors health healthcare medicine Source Type: blogs