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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Technology : Embolic protective device for TAVI,
The incidence of stroke during TAVI up to 5 % (minimum ). Stroke risk reduction during TAVI is a critical requirement that can be a deterrent against this wonderful Intervention. Many devices are being considered EmbolX (Edwards life science) Emrella Sentinel (Claret medical) TriGaurd (Keystone)   TriGaurd 3just got the approval from CE and appear promising. (REFLECT trial) It is inserted through the transfemoral route , deflects embolic material to descending aorta since it covers all the three branches of Arch.What happens to these deflected particles? Any bodys guess. So , in my understanding it conve...
Source: Dr.S.Venkatesan MD - September 10, 2020 Category: Cardiology Authors: dr s venkatesan Tags: tavr tavi Uncategorized embolic protective device for tavi tavr embolx sentinel. triguard 3 Source Type: blogs

Stable CAD strategies : Why a 90 % LAD lesion needs much attention … while a 100% doesn ’ t ?
           Practice of cardiology is simple as long we don’t dwell deep into coronary physiology. One of my patients asked, why he was told his total occlusion in LAD appears safer now, which was subtotal a few months ago.I told him, it is indeed true. It is the fear of subtotal disease that’s prone to a fresh coronary event. In total occlusion, chances of that happening are less or nil.   How can you say 100% block is safe?  Is that always true? No, it’s not always true. He was surprised when I said it is not 100 %, even 90% lesion can...
Source: Dr.S.Venkatesan MD - September 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics chronic stable angina chronic total occlusion collateral circulation csi stable angina guidelines cto cto epicardail collaterals euro cto ISCHEMIA trial open vs closed artery hypotheis ORBITA trial Source Type: blogs

Poly-pharmacy : Length of a prescription has a unique story to tell!
Can you guess how many drugs a busy physician on an average writes in their prescription in his office ? Three ? , Five , Six ,  . . . . Nine,? There is no specific study available for this non-academic query. I have got stunned to see a maximum of 18 drugs in one prescription. So, it should be anything between  1 to 18. May be a mean around 6 or so (Make your own guesstimate) There is strong evidence to suggest writing a drug prescription has become a (un)conditioned habit-forming act. My professor* used to say generally 2 to 3 drugs are sufficient for most of the common illnesses we encounter (Only in extraordi...
Source: Dr.S.Venkatesan MD - August 27, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized dr venkat ppt dr venkat presentations drvenkatesans My presentations polypharamcy polypill Source Type: blogs

Emotional factors in CAD : Anxiety vs depression , which is bad ?
   Psychological factors both depression and anxiety do confer a significant risk for CAD. However, a distinction must be made between risk factors and triggers. It is highly likely, depression has more consistent correlation with chronic CAD than anxiety.  Primary anxiety per-se is of less of a risk factor for chronic CAD, while it can still be a trigger for cardiac events. (when it occurs over heightened baseline risk) Primary depression increases the CAD risk many fold by slowing the system making it sedentary and promote endothelial dysfunction, which is the key promotor of atherogenic C...
Source: Dr.S.Venkatesan MD - August 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: emotion and cad Venkatesan -Presentations depression anxiety cad acs trigger drsvenkatesan ppt drvenkatesan presentation My presentations Neuro cardiology ONSET SHEEP TRIM studies trial on emotion and heart psychosocail factors in cad inte Source Type: blogs

Diabetes management in CAD : Who is dictating to whom ?
No one would have Imagined a generally Innocuous entity called Diabetes will emerge into a  “single disease sub-speciality” in medicine”. Thanks to the global authorities  & pharma Industry for making this speciality a formidable one. The link between diabetes and cardiology is so strong, now with pharmacological strategies looking for overlapping Indications.   Let me share a presentation in one of the cardiology meet in 2017 at Thiruvananthpuram.TAN CSI meet , India.   Click here for a  PDF version  The days are gone when anti-diabetic drugs were alleged to increase CV...
Source: Dr.S.Venkatesan MD - August 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Diabetes and Heart ada dapa hf Diabetes and cvd risk empaglifozin hba1c sglt in diabetes ukpds Source Type: blogs

PTMC : How to cross a difficult mitral valve ?
This is a PPT presentation taken from archive (Made in 2012) Please pardon , it lacks audio. PDF version : Prof SV PTMC mitral valve crossing Final message Often times I have seen my Interventional colleagues struggle more at the mitral valve crossing than at IAS puncture during PTMC. Experience prevails over Image assistance. Assessment of LA size , IAS plane , and sub valvular disease seem to be critical. Probably the secret of success which I found out was , smart guys never hesitate to repeat IAS puncture site for optimal trajectory . Over the wire technique is not forbidden. Unfortunately, TTE  guidance is of l...
Source: Dr.S.Venkatesan MD - August 22, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized dr venkatesan ppt drsvenkatesan ppt inoue vs accura balloon mitral valve crossing ptmc retrograde ptmc Source Type: blogs

Most Innovative powerpoint presentation in Echocardiography.
I don’t know whether you have seen this before. Surely , I haven’t seen a presentation such as this one. Place: Annual scientific meet ASE 2013. Minneapolis Presentor:Dr.Partho Sengupta, Mount Sinai hospital, New york. Its a 3D presentation in “space” without a screen by Holography. The stunning 15 minutes lecture take us into the myocardial architecture, with speckles , flow vortex echocardiography and fluid kinetic energy mapping. Don’t miss, a dramatic live teleporting of ASE president on to the stage.    Can you Imagine , where does this technology take ...
Source: Dr.S.Venkatesan MD - August 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Most Innovative powerpoint presentation Echocardiography.
I don’t know whether you have seen this before. Surely , I haven’t seen a presentation such as this one. Place: Annual scientific meet ASE 2013. Minneapolis Presentor:Dr.Partho Sengupta, Mount Sinai hospital, New york. Its a 3D presentation in “space” without a screen by Holography. The stunning 15 minutes lecture take us into the myocardial architecture, with speckles , flow vortex echocardiography and fluid kinetic energy mapping. Don’t miss, a dramatic live teleporting of ASE president on to the stage.    Can you Imagine , where does this technology take ...
Source: Dr.S.Venkatesan MD - August 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Coronary collaterals in STEMI : Incidence, time of appearance , & Impact on outcome.
Coronary collateral circulation is one of the major determinants of symptoms and outcomes in chronic CAD. But, we generally shrug off the value of coronary collateral circulation in acute coronary syndrome. The fact is, it has a myocardial mitigating effect following sudden total occlusion. When does it appear? We did a small analysis (PDF version) We found it is noted in 25% of patients. With reference time of appearance,  6% had it within 12hrs and in few, it was noted as early as 6 hrs. One caveat is,  we may not know whether its preexisting collateral due to chronic multivessel CAD. I am sorry to note this s...
Source: Dr.S.Venkatesan MD - August 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome Coronary collateral circulation Uncategorized collaterals in stemi importance of coronary collaterals in acs nstemi research ideas in cardiology research topics in cardiology Source Type: blogs

Hypoxia and LV dysfunction: Let us learn more from “ COPD, COVID-19 and Tetralogy of Fallot ”
Superficially, tissue hypoxia might look similar to Ischemia but differs in one important aspect. Though the hypoxic myocardium is short of oxygen, the respiratory excreta from cells ie Co2, lactic acid, and free radicles are promptly cleared and flushed as blood flow is normal. Hence, generally acute  Ischemia of tissues is more cell threatening than regional hypoxia at any organ level. How do you classify hypoxia? we need to go to physiology classes again.There are 4 types. Ischemic -Hypoxia, systemic hypoxia, Anemic hypoxia, Histo-toxic hypoxia.A good reference to read (Ošt’ádal B., Kol&aac...
Source: Dr.S.Venkatesan MD - August 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: metabolic support of heart failure anerobic cardiac metabolism copd and lv dysfunction covid heart disease hypoxia and covid lv dysfunction hypoxia vs iscehmia ketone bodies ato heart lv dysfunction in congenital cyanotic heart disease met Source Type: blogs

What is the relationship between BMI and blood cholesterol ?
Caution: Please don’t expect much scientific content in this post. I Hope, you can spare a minute to answer this hypothetical question. What will be the shape of the curve,  If you plot BMI in the X-axis and LDL/ total cholesterol in Y-axis from a thousand normal adult populations? It will be linear for sure. Maybe a little curvilinear. Its likely J shaped with age  I think it is U shaped No, it is Inverted U Sorry, I don’t know. No one knows. Answer: Though linear relation is the one we expect, all sorts of shapes are reported in various correlation studies, making the ...
Source: Dr.S.Venkatesan MD - August 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: clinical lipidology lipids lipid metabolism obesity acc aha esc csi lpi guidelies on lipids ada dyslipidemia inverted u j u curve bmi vs ldl lipids ldl lvels in obesity whats the relation missing link between obesity and cholesterol what i Source Type: blogs

What ’ s the relationship between JVP and PCWP/LVEDP?
We can consider Jugular veins of the neck as a naturally present right heart catheter. It faithfully reflects the live pressure and waveform data  from right atrium and ventricle . Can JVP tell us anything about left heart pressures? Is there any relationship between JVP and PCWP or LVEDP ? If you tell JVP reflects LV filling pressure in any graduate medical exams, you will be admonished. However in DM or post-doctoral exam, if you say there is no link between the two, you are likely to be chided.(It is unfortunate the answers vary depending upon the level of training , which I feel is not academically correct ) Thoug...
Source: Dr.S.Venkatesan MD - August 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Jugular venous pulse JVP -Jugualr venous pulse diastolic stress testing jjvp in hfref jvp cvp pcwp lvedp jvp in acute mr jvp in asd lutembacher syndrome jvp in bernheom effect jvp in isolated lv failure jvp in jfp Source Type: blogs

Tribute to my professor Dr M.B Pranesh
Covid has struck hard and this time it has consumed one of the Doyens of Neurology, from Coimbatore, India –Dr.M.B.Pranesh. Privileged to have him as my professor in Coimbatore medical college, my alma mater, watched him in close quarters during my undergraduate and MD days in the late 1980s.Still recall, how he empathizes with the patient and their family in distress, practiced medicine in the best scientific manner at the same time with a humane and philosophical touch. I can’t forget, how the little genius standing beside the comatose patients In IMCU and tells so precisely the difference between metabolic v...
Source: Dr.S.Venkatesan MD - August 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized best neurologist India coimbatore medical college doyens of neurology India Dr M.B.Pranesh neurologist dr pranesh coimbatore tribute neurologist history of medicine tribute to dr m b pranesh Source Type: blogs

One more cause for acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some c...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs

Please add, one more cause for Acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some c...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs

A quiz : What is this list & What are the numbers?
Got it? One clue, you are part of these numbers! It crossed  5 million reads recently across 160 countries. Thanks. I know,It amounts to self-promotion. Such boosters are required when energy level sags. Sorry. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - July 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized drsvenkatesan madras medical college Source Type: blogs

Department of error: GLS doesn ’ t really reflect the global LV function.
*The post is not meant for those who understood GLS (Global longitudinal  strain) in a proper perspective. I am writing this, after a surprising answer from many students of Echocardiography, when I asked them what is GLS?  Most answered, GLS currently is the best global LV functional index available. What a misunderstanding? The fact is, EF % will always be the best global parameter*, while GLS remains a regional function index.(*The limitation of EF% is in the methods of measuring it and not in EF itself.)                               &...
Source: Dr.S.Venkatesan MD - July 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Echocardiography - LV dysfunction Echocardiography-hemodynamics 2d current role of m mode echocardiography global longitudinal function gls vs ef% limitations of gls echo radial strain m mode deforamtion Imaging strain rate speckle track Source Type: blogs

Department of error: GLS doesn ’ t really reflect the global LV function .
*The post is not meant for those who understood GLS (Global longitudianl strain) in a proper perspective. I am writing this, after a surprising answer from many students of Echocardiography, when I asked them what is GLS?  Most answered, GLS currently is the best global LV functional index available. What a misunderstanding? The fact is, EF % will always be the best global parameter*, while GLS remains a regional function index.(*The limitation of EF% is in the methods of measuring it and not in EF itself.)                                 ...
Source: Dr.S.Venkatesan MD - July 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Echocardiography - LV dysfunction Echocardiography-hemodynamics 2d current role of m mode echocardiography global longitudinal function gls vs ef% limitations of gls echo radial strain m mode deforamtion Imaging strain rate speckle track Source Type: blogs

Mitra clip magic : Switch off LA “ V ” waves & Aortic pulse will rejoice Instantly !
Truely a great demonstration of life saving Mitra clip procedure. Found this from Observing the acute hemodynamic effects of MitraClip in patients with a flail leaflet remains among the most rewarding moments in the Cath lab. pic.twitter.com/LYbBD3vSvw— Mohamad Alkhouli (@adnanalkhouli) July 11, 2020 (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - July 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acute mitral regurgitation left atrium mitra clip v waves in mr Source Type: blogs

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