Wrong-way catheter during radial angiogram : An Illustration
The commonest cause* for repeated entry of right radial catheter to descending aorta is not due to any anomaly. Most times,it is just a skewed angle between right brachio-cephalic artery with Aortic arch, that deflects the catheter to the descending aorta . Just make sure, aortic root is entered with a deeply held inspiration.
*Anomalies of the aortic arch, aberrant right subclavian, Kommerell’s diverticulum, vascular ring must be kept in mind.
Postamble: A true abnormal course
Though, It might appear prudent to avoid the radial route when encountering anomalous subclavian ...
Source: Dr.S.Venkatesan MD - January 19, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart aberrant right sub clavian artery aortic arch anomalies arteria lusoria ptca brachio cephalic artery aortic arch angle radial angiogram tips radial pci Source Type: blogs
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 SVC/P...
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 has a ...
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 mechanism of mit...
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 the...
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 HCM
Incre...
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 arrhy...
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
