Defining Hypertension : Why we remain in “ Status confusious ” despite 50 years of clinical trials ?
Next to the atmospheric pressure, the most curious pressure to understand is stored within human blood. Yes, it is the “blood pressure”, fondly referred to as BP by both physicians and patients. (When worried men & women visit us and say, that they are suffering from BP, please make it a point to clarify, BP is a sign of existence of life, rather than a dreaded pathology )
Why should blood have pressure?
BP is lateral pressure exerted by flowing blood on the vessel wall (or is it the propelling pressure head ? It is to be noted, cuff pressure doesn’t measure this !) BP is generated by the heart in...
Source: Dr.S.Venkatesan MD - May 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Hypertension 2013 STEMI AHA ACC Guidelines blood pressure lowering treatment trialist collaboration hypertension and dyslipidemia Hypertension current guidelines jnc 6 7 8 hypertesnion Lancet BP LTT trial LDL vs diastolic BP vs fasting blood Source Type: blogs
Cerebral hemodynamics in AF : ” Irregularly irregular ” brain perfusion and risk of “ dementia cordis ”
No doubt, the heart is a biological wonder with its non-stop pump function. Still, it cannot function as a continuous rotary pump like the electrical motors do. It has no other option but to contract in a pulsatile manner. However, the mean pressure in circulation is fairly constant, flow is kept continuous, and fairly laminar. This is made possible by the built-in elastic pressure in the aorta and the poorly understood but vitally important parameter vascular tone. Aging widens the pulse pressure due to dissipation of vascular tone. Atrial fibrillation adds new bizarre dynamism to this pulsatility and challenges the aorti...
Source: Dr.S.Venkatesan MD - May 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized affirm race trial atrial fibrialltion rate vs rhythm control atrial fibrillation cerebral bllod flow in atrial fibrillation nir spectroscopy in atrial fibrillation Source Type: blogs
Troponin positivity in AVNRT: A panic reaction and its mechanism.
Here is an uncommon story of a patient with palpitation,SVT , Troponin +ve, and suspected ACS.
Palpitation in ER ⇒ {Tachycardia +Troponin positive ≠ ACS}
Mechanism of troponin elevation following any SVT
At high heart rates (>200) myocardium is subjected to non-Ischemic mechanical strain & squeeze. Minute amounts of Troponin is let out like a myocardial juice into the circulation (Like atrial natriuretic peptide release which causes polyuria during AVNRT)
Tropinin releases have been shown to correlate with both heart rate and duration of ST depression (Subendocardial strain /AVRT left lateral pathways)
Short d...
Source: Dr.S.Venkatesan MD - May 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized avnrt avrt af biomarkers in tachycardia cpk troponin in avrt false positive troponin in avnrt svt troponin t troponin 1 Source Type: blogs
What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !)
What is an intermediate coronary lesion? (ICL)
Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any revascularisation debate).
Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs
Z va score in Aortic stenosis : No more a theoretical concept
It was the final case on weekend Echocardiogram review day, I asked my fellow for a brief summary of the patient. A 3 minute conversation“Yes, sir, he is a 62-year-old male retired govt officer. He has a severely stenosed aortic valve, with a peak gradient of 90 mmHg and a mean gradient that comes to almost 50 mmHg. LV EF is 58%, GLS is 18, LVH is obvious. LA is not dilated (Didn’t measure volume though), but DT is short. Valve orifice is hovering around 1cm, mild calcium noted in LCC I am not sure whether it’s bi or tricuspid still. The annulus is 22mm. The mitral valve is perfect, no calcium spill ...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: aortic stenosis Aortic valve replacement asymptomatic severe aortic stenosis tavr vs savr for aortic stenosis zva score in aortic stenosis Source Type: blogs
Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(<35mm). The stupendous success of this procedure is attributed to careful pre and Intra-procedural Imaging, new generation hardware and of course the ever-improving expertise among Interventional cardiologists.
Still, there is one issue that is bothersome. It is the late complications of this device and the need for follow-up (Unlike surgery where close and forget option seems real and confer lot of comforts) The delayed mechanical complications are now extremely rare still follow up of these patients is advised.
What is the mechanism o...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs
Heart disease in pregnancy: Overview & management
Some of the questions addressed in this presentation
1.What happens to fetal blood pressure during maternal hypotension how good is fetal autoregulation?
2.Why is LSCS increasingly preferred mode of delivery in heart disease complicating pregnancy challenging the traditional scientific concept?
3.What is likely hood of patients with moderate mitral stenosis developing pulmonary edema during prolonged 2nd stage of labor?
3.What is the missing link between PIH and PPCM? How prepartum cardiomyopathy differs from postpartum?
4.Is Eisenemneger really an absolute contraindication for pregnancy?
5. How can we continue VKAs wa...
Source: Dr.S.Venkatesan MD - April 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Pregnancy and heart pregnancy and heart disease cardiac disease in pregnancy esc aha pregnancy heart disease fetal aortic blood Source Type: blogs
Sailing the Osler ’ s ship of medicine in the third millennium
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - March 31, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Patient page cardiology -Therapeutics Clinical cardiology general medicine Medical education Medical ethics medical quotes Two line sermons in cardiology clinical acumen dr venkat quotes ethics in medicine ev Source Type: blogs
Rheumatic fever : Dr Jones would smile if we get rid of the “ supportive criteria ”
Dr. Duckett Jones, the famed American physician, from Good Samaritan hospital, Boston would be a proud man in heaven, to find his criteria still being celebrated all over the globe. He will also be pleased to know his home country USA is painted green on the world RHD map due to his untiring efforts that began in 1944. Of course, what the rest of the world has done in the last century has left us wanting (including the WHO).
Global RHD map. Note the red and brown shading in south Asia and Africa. It is obvious, RHD is more about economics, equality, and poverty, rather than aggression from an otherwise innocuous...
Source: Dr.S.Venkatesan MD - March 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: rheumatic heart disease acute rheumatic fever aso titer chronic rheumatic fever dr duckket jones jones criteria primary vs secondory prevention rtpcr for rheumatic fever supportive criteria for acute rheumatic fever essential Source Type: blogs
D-dimer levels in normal pregnancy : Learnt something Important recently !
Have we ever wondered how six liters of blood in our body flows like a live stream, maintaining the fluidity life long, in spite of an active coagulation system in situ, ready to freeze at the slightest provocation (Invisible vascular wear & tear!) This housekeeping job, within the vast network of the human vascular tree, is silently accomplished by a less apparent system called fibrinolytic system. D-dimer is a physiological breakdown product of this system . D-dimer comes from fibrin monomer. The D in D-dimer stands for the domain. (See below) The ability to detect the D-dimer in the bedside has given us a good oppor...
Source: Dr.S.Venkatesan MD - March 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease fdp vs d dimer pulmonary embolism dvt in pregnancy what is the normal d dimer in pregnancy Source Type: blogs
Coronary collateral circulation : Why many scientific cardiologists Ignore it ?
A consult with a 62-year-old patient in my office
Hi, welcome? What is your problem?
Nothing doctor. I am good.
What brings you here then?
I used to have angina before. Now, I am fine doctor but confused after undergoing this angiogram. I need an opinion.
How is your exercise capacity?
I do walk, work, and able to do almost all regular activities.
Why did you do this angiogram then?
Had to undergo this after a doubtful stress test, Now, I am told by at least 2 eminent cardiologists, that I am having just one functional coronary artery, and it is dangerous for the all-important LAD to live at the merc...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chronic total occlusion collateral circualtion in cto coronary collateral circulation interventions in cto Source Type: blogs
Mobile right heart thrombus : Capture by Flowtriever device is possible
What shall we do when encountering a mobile right heart thrombi waiting to get dislodged at any time?
A series of question comes as the answer to this query
Feeling helpless? What will be the consequence?Massive pulmonary embolism? Can we thrombolyse and dissolve it ?
Logistics of emergency open-heart surgery are too many. What about capturing the thrombus? A dream thought, now seemingly possible.Inari Flowtriever though made originally for pulmonary embolism can come in handy in any foreign body removal. I think It is approved by FDA. Here is a case report from Dr Gautam reddy.
Echo...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: New hardware pulmonary embolism Inari flow triever mobile ra rv clot Source Type: blogs
Why evidence-based medicine continue to have a turbulent course?
Because . . . its current course is not always in the right direction & not everyone is ready for course correction as well!
Reference
1.Hasnain-Wynia R. Is evidence-based medicine patient-centered and is patient-centered care evidence-based? Health Serv Res. 2006;41(1):1-
2. Wyer PC, Silver SA. Where is the wisdom? I—a conceptual history of evidence-based medicine. J Eval Clin Pract. 2009;15(6):891-898.
3.Tonelli MR. The philosophical limits of evidence-based medicine. Acad Med. 1998;73(12):1234-1240.
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - February 13, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology quotes cardiology-ethics best medical quotes dr venkatesan quotes ethics in medicine evidence based medicine evidence vs experience based medicine hippocrates ethics limitations of ebm medical education medical ethics quote Source Type: blogs
How to follow up Hypertrophic cardiomyopathy ? : Too much reliance on LVOT gradient is problematic
Hypertrophic cardiomyopathy (HCM) is the most common primary disorder of cardiac muscle. The incidence is about 1 in 500, which would mean 1.5 crore HCM patients will be living on our planet at any moment. The root cause of pathology is located in 20 odd genes that define cardiac muscle protein integrity. (Myosin, Troponin, Titin, etc) This leads to the bizarre architecture of cardiac muscle, prone to progressive fibrosis.(Paradoxically, 90% of HCM have normal or supernormal contractility till very late stages, proving that the much-dreaded term myocardial disarray has little effect on contractility. It is all the more f...
Source: Dr.S.Venkatesan MD - February 5, 2021 Category: Cardiology Authors: dr s venkatesan Tags: hypertrophic cardiomyopathy criley concept hocm hcm lobster claw hcm lobster claw is pulsus bisferiens mavacamten explorer trial what is the mechanism of hocm gradient lvot Source Type: blogs
Why didn ’ t you try ECMO for my dad , doctor ? I feel really guilty !
It is just past midnight: This is a gloomy conversation between a patient’s son and a cardiologist in the silent waiting room, just outside the dim-lit ICU of a popular 4-star hospital in Chennai.
“I am sorry to say, Mr. B., your father didn’t make it. Has succumbed to the heart attack. We have been trying to resuscitate him for the past one hour. We have done everything. We have managed to open up IRA, and 2 more critical blocks still it couldn’t help. It was a massive one. Sorry again.
“Doctor, I feel very bad. What went wrong, I want to know. Doc, did you try ECMO ?,” the ...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Technology ecmo IABP impella tandem heart ecmo Source Type: blogs
