Furore over FOURIER is (un)warranted : Evolocumab is an Innocent molecule !
Welcome back to the big molecular science of PCSK and its antagonist Evolocumab, a monoclonal antibody designed to target and prevent the LDL receptor catabolism inside the lysosomes. Evolocumab was approved by FDA for aggressive lowering of LDL, following a  customary study published in NEJM 2017, that released this double-edged anti-lipid molecule into the human domain with all fanfare. It aimed to reduce the LDL as low as possible in selected patients with familial LDLemia & and those who don’t tolerate statins.  Now, a study was silently released in BMJ open, at the fag end of 2002, which is causing ripp...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: lipid metabolism evolocumab fourier study how low ldl can go inclisiron lipid guidelines acc aha esc csi Source Type: blogs

Take a break from cardiology : How to debate a complex topic in a forum ?
Pardon ,this video is nothing to do with cardiology. It is from the archives of the United nations library .This can teach some important lessons in art of communication , sharing to all folks, especially medical students. It was recorded in 1959 in Newyork, UN head quarters.Four 17 year old school girls & boys were invited for a debate on a complex topic. Does God exist ? How do you pray ? and what is the purpose of different religions ? I keep wondering , how these youngsters accumulated so much wisdom and express it in such a polite manner too. Mind you, this was recorded , when learning happened with ...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized evidence based cardiology medical education religion and god medical profession Source Type: blogs

Which is the Ideal site to ablate VT circuit ?
Management of recurrent ventricular tachycardia has developed a lot in recent times. Anti-arrhythmic drugs(AADs) were a cornerstone for recurrent and refractory VTs .Surgeries including CABG,  repair of the aneurysm, and subendocardial resection has helped to control many post-MI ischemic VTs. Soon they became obsolete. Realistically, PCIs had little impact on post-MI VT for some unknown reasons. However, with the advent of ICDs and RF, ablation, a new dimension is added to this field.  ICDs, though an attractive device, don’t prevent a VT but vow to nullify the consequence of VT. This is problematic. ICDs in spit...
Source: Dr.S.Venkatesan MD - January 12, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

An unpalatable medical quote
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 11, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Ethics in Medicine medical quotes drsvenkatesan hippocrates ethics medical ethics medical practice primum non nocere voltaire Source Type: blogs

Missing links in IHD : What is the relationship between Ischemia & cardiac arrhythmias ?
The term Ischemic heart disease (IHD) was once very popular, but many abandoned it as it became an academic cliche.  CAD & CAHD are the other terms that are equally popular and prevalent. Stable IHD was in vogue till recently, which was again replaced by “chronic coronary syndrome’ now. Honestly, I feel the original term IHD to be restored however outdated it may look. it encompasses the entire spectrum of clinical cardiac disorders. Manifestation of Ischemia heart disease  Angina Infarction Cardiac failure Arrhythmias  Silent ischemia Sudden cardiac death  The ...
Source: Dr.S.Venkatesan MD - January 5, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions Cardiology-Arrhythmias Relationship between Ischemia and arrhytmias Source Type: blogs

Reviewing top 10 Interventional papers of 2022 : A good lesson on NSTEMI management
Conclusion is pasted for the busy guys. Post-test What is overall NSTEMI in-hospital mortality? (Everyone knows for STEMI it is around 4-8 %, no one seems to be sure about NSTEMI. I think it can’t be estimated accurately, guess it is 1 -2% ) Is there a primary PCI equivalent situation in NSTEMI?  What are they? (Left main UA with AVR ST elevation comes first on the list) Based on the urgency to treat how does the ultimate outcome change? (This is what this meta-analysis by Kite et all proved.It is not a new revelation though . Recall the landmark ICTUS study  of 2010 which was ...
Source: Dr.S.Venkatesan MD - January 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha nstemi nsteacs guidelines Source Type: blogs

Happy new year & memories of 2022 !
Wishing every one of you an Enlightening New year. As we begin a new journey around the sun, yet another time, let us re-dedicate ourself, to use science, for the welfare of our planet & people. Thank you , for visiting this site and make all its worth. Just one memory of 2022, lingers ! Retired and left Madras medical college,Chennai after 3 decades, which grew me up as a Cardiologist. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Who can answer this unusual query in mitral stenosis?
I will go with the last response. As for as I understand, we have never quantified Atrial muscle mass properly even in normality. One may be tempted to think there is no purpose to measure it, other than academic reasons. The fact that the incidence of atrial fibrillation in mitral stenosis is not linearly correlating with LA size makes us think, LA mass (Virtual LAH) may have a say in triggering AF. This post is meant for cardiology fellows. Maybe someone can do a study on this by measuring LA mass pre and post-PTMC, we might get an idea about regression as well. Meanwhile, we are well versed with infiltrative disease...
Source: Dr.S.Venkatesan MD - December 20, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation Mitral stenosis Uncategorized Atrial mass in mg LAH in mitral stenosis left atrial hypertrophy left atrial mass thickness of left atrium Source Type: blogs

Department of artifact : Normal “ wall motion defect ” in echocardiography
(This post is about some basics in echocardiography meant for fellows, and echocardiographers. Others can skip please )  This is a 27-year-old woman who was referred for routine* cardiac evaluation. What do you see? What is the diagnosis? This echo clip is from a woman who is 8 months pregnant. What you are seeing is perfectly physiologically and normal. On lying down there is a mechanical push of the diaphragm altering the LV shape and contraction. In the short axis, the left ventricle is contracting well, but the shape is not spherical in systole implying some desynchrony. Further, the  IVS arena is contract...
Source: Dr.S.Venkatesan MD - December 14, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Hemodynamics Echocardiography -Normal measurement Echocardiography-hemodynamics Teaching points cardiology research topic non ischemic wall motion defect in echocardiography wall motion defect in ers wall motion defect in lbbb Source Type: blogs

What are the mechanisms of beneficial action of alcohol in moderate amounts ?
Putative mechanisms  Alcohol dis-engages platelets that are in aggregation mode  (Renaud et al Clin Chim Acta. 1996 Mar 15;246(1-2):77-89)  Alcohol has anti-atherogenic properties (BRUNECK study Stroke. 1998;29:900–907  ) Alcohol Increases HDL which we still believe to be good cholesterol ( Elizabeth R. De Oliveira e Silva Circulation. 2000) Alcohol causes less Ischemic stroke, that is documented ( Hillbom M  Alcohol and stroke: pathophysiologic mechanisms. Neuroepidemiology. 1998) Alcohol promotes energy consumption. It is a sort of baseline exercise equivalent (ELI* )  Alcohol can make a perso...
Source: Dr.S.Venkatesan MD - December 8, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Alcohol and heart disease ada guidelines alcohol alcohol and cad alcohol and Interheart alcohol is it really beneficial INTERHEART study lancet interheart gbd study moderate alcohol beenfits what is moderate alcohol intake Source Type: blogs

“ Professional etiquette ” need not be misplaced
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - November 29, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Anemia in cardiac failure : Needs little more attention
HF is the inability (or reduced ability) to supply oxygen and other nutrients to fulfill the body’s demands. In the process, the heart either fights or flights, and results in symptoms due to hemodynamic alterations, or adversities of neuro-hormonal activation. Now, what is Anemia? Anemia is a condition with reduced or dysfunctional RBCs. that directly interferes with oxygen delivery to tissues. It is not at all a coincidence, the core functions of the heart and blood are strikingly similar and intertwined. While the heart is the powerhouse of the circulatory system, without good-quality blood, the greatness of th...
Source: Dr.S.Venkatesan MD - November 19, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized anemia in cardiac failure Source Type: blogs

Patient empowerment movement, definitely has a good intention , but …
    The definition & intended purpose of patient empowerment WHO defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health” and should be seen as both an individual and a community process.1 Four components have been reported as being fundamental to the process of patient empowerment: 1) understanding by the patient of his/her role; 2) acquisition by patients of sufficient knowledge to be able to engage with their healthcare provider; 3) patient skills; and 4) the presence of a facilitating environm...
Source: Dr.S.Venkatesan MD - November 11, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiology-ethics Medical education ethics in medicine patient empowerment Source Type: blogs

Loyalty in the medical profession: Something seems to be wrong!
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - November 10, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Quotes Uncategorized wisdom in cardiology best quotes in medical ethics dr s venkatesan dr venkat quotes madars medical college medical education venkatesan sanagreddi Source Type: blogs

Pathological VVI pacing pips DDD,.. one more time in the EP race !
This study reaffirmed the lack of appreciable hemodynamic and clinical benefits with DDD mode yet again.  We have also contributed a little on this issue. It was found cardiac failure in VVI pacing was not a real big issue in the long-term follow-up. We presented and published in world congrees of cardiology Dubai 2012, and Circulation journal.  How is that? A dual chamber pacer with AV synchrony fails to show a hemodynamic benefit? The answer is simple..VV desynchrony is a common denominator for both VVI and DDD pacers. Providing AV synchrony without VV synchrony doesn’t make real sense in the long term to ...
Source: Dr.S.Venkatesan MD - November 3, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Pace maker Tips and tricks Uncategorized pacemaker mode selection vvi vs ddd pacing Source Type: blogs