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 be safe, if it’s not ...
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 extraordinary sit...
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 CAD.
...
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 CVD mortality. New...
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 littl...
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 us t...
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 study did...
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., Kolář F. (1999) Myocardial Hy...
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 resp...
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?
This study elegantly shows a correlation (or lack of it) in different subsets of heart failure. It tells us very clearly If JVP(RAP) is not correlating or disproportionate to PCWP, it implies RV dysfunction.
2. This paper suggests a really useful scheme to classify heart failure as concordant and discordant with reference to right and left heart.
It throws some interesting facts. I guess it will help us guide diuretic management and prognosticate chronic heart failure. (Source: Dr.S.Venkatesan MD)
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 cente...
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
