A NOTIONal truth : Surgical AVR deteriorates faster than TAVI, for some mysterious reasons!
Conclusion
The study results finds the valve deployed percutaneously under semi- blind vision, was equipoise with SAVR done under direct vision. The surprise however is, TAVI was superior to cardiac surgeons in multiple aspects .The mysterious finding is TAVI had less Structural valve dysfunction, and possibly low bio valvular failure (BVF), if Kaplan -Myer curve trend is little extrapolated. No doubt ,the Aortic interventional world is applauding and everyone is joining the party.
Now, some academic queries ?
1.Did the trial compared best practices of TAVI & SAVR ?
No. Because it was done in 2010-2013. (W...
Source: Dr.S.Venkatesan MD - February 10, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidlines aortic stenosis Aortic valve replacement avr core valve edward sapien notion 10 year follow up notion trial partner savr st judes valve surtavi tavi tavr in low risk category uk tavi Source Type: blogs
What is the correlation between number of doctors in a society & health of population ?
This query is lingering ever since I entered the medical profession. Though, this question might appear absurd , no correct answer is found yet .When we search the literature, the relationship between doctors and health can be 1.linear, 2.non linear, and 3. even inverse . 1 & 2 are ok 3 is forbidden.
However, to put it in a nut-shell, healthiness of a society is little to do with Doctor population alone, is well known and I think it needs no proof. The following scattergram gives some idea about the Issue.
Where to get answer for this controversial question ? Great times we are in. We have taught the machine...
Source: Dr.S.Venkatesan MD - February 6, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized doctors health healthcare medicine Source Type: blogs
Why is Aspirin, everyone ’ s nemesis ?
Here is a current review on a topic, which needs some soulful Introspection
For a kid, A stands for apple in kindergarten, while in the school of cardiac sciences, A would sound as Aspirin. Such is the importance of this drug, known for its obedient, predictable efficiency in the entire spectrum of CAD right from primary prevention of CAD to emergent primary angioplasty in Cath lab. Most of us will also agree, It is a work horse drug for not only for the cardiologists , but been an anchor drug in as many critical medical therapeutics, wherever platelets are to be passivated.
We are well aware of molecular bas...
Source: Dr.S.Venkatesan MD - February 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha guidelines aspirin bias-against-aspirin dapt esc guidelines mapt Source Type: blogs
Major research papers from NEJM in 2023
Here is a pleasant surprise, a collectors issue of NEJM year book 2023, is made available free (even for a non subscribers in its website) .It is fascinating to know how fast the Internal medicine has grown. For the busy cardiologists, this will a be refreshing reminder, that there are other important organs and specialties do exist in medicine , with equal breakthroughs and Innovations.
It is indeed an amazing , whirlwind tour of medicine for all those who see medical science as single holistic specialty. It has articles, ranging from from simple clinical studies on postpartum hemorrhage (E-MOTIVE study) from deep ...
Source: Dr.S.Venkatesan MD - January 25, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 2023 review articles acc aha esc guidlines an Aldosterone synthase antagonist for Treatment-Resistant Hypertension Baxdrostat bmj E MOTIVE STUDY PPH lancet nejm Of-course semaglutide TRUNCATE TB Source Type: blogs
HDL dysfunction & It ’ s clinical Implication
High-density lipoproteins (HDLs) represent a class of lipids, very heterogeneous in structure, composition, and biological functions .The density is between 1.063 to 1.210. It has at least 5 sub-types. Normal HDL level in blood should be above 35mg (50-60mg Ideal). When it goes beyond 60 there is not much benefit to accrue and also some surprise findings are there.(Article will be linked)
We know ,HDL carries free cholesterol from peripheral cells, including macrophages and endothelial cells. After reaching the liver, HDL receptors in the hepatocellular surface, metabolize it into bile acid or neutral lipids, which are ...
Source: Dr.S.Venkatesan MD - January 21, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
ACS management philosophy : A thought provocation
Question
A cath lab is an “optional accessory” in the management of Acute coronary syndrome (ACS).
True or False ?
Answer
“Without a CCU…you can never, treat any Acute coronary syndrome … while we can treat most ACSs successfully without a cath lab “ (If you still got the answer wrong …sorry, no comments)
Best comment
Accessory is ok , but it is “20% foolish” to state cath-lab is optional, it should be mandatory. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - January 19, 2024 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome acc aha esc guidlines coronary care unit pci ptca role of cath lab in cardiology Source Type: blogs
An unusual query in Wellen ’ s syndrome
What will happen if you happen to thrombolyse Wellen syndrome?
Will evolve into STEMI by prothrombotic trigger of lytic agent
ECG will get normalised with clinical stability in some
Nothing happens. ECG will remain same.
Worsen the situation in majority
Will be severely reprimanded by your consultant and peers.
Answer:
4 will be answer for most of us , while 2 and 3 is a lesser, but distinct possibility. I have never seen 1 happen .Whatever is the correct answer , response 5 will always be correct.
What is the criteria to diagnose Wellen syndrome ?
The criteria used to diagnose Wellen...
Source: Dr.S.Venkatesan MD - January 14, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
An unusual query in Wellen ’ s syndrome ?
What will happen if you happen to thrombolyse Wellen syndrome?
Will evolve into STEMI by prothrombotic trigger of lytic agent
ECG will get normalised with clinical stability in some
Nothing happens. ECG will remain same.
Worsen the situation in majority
Will be severely reprimanded by your consultant and peers.
Answer:
4 will be answer for most of us , while 2 and 3 is a lesser, but distinct possibility. I have never seen 1 happen .Whatever is the correct answer , response 5 will always be correct.
What is the criteria to diagnose Wellen syndrome ?
The criteria used to diagnose Wellen...
Source: Dr.S.Venkatesan MD - January 14, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Wrong lessons in lipidology : Eradicating LDL is not our goal !
15 % of body weight is fat. (10kg) Out of which just 250 mg of cholesterol is streaming in blood. We must understand fat, lipid and cholesterol are different entities. LDL is obviously a target against atherosclerosis. While the total body fat seems to do little in determining blood cholesterol levels, what is more scientifically shocking is the slope of curve between blood LDL levels and plaque burden is rarely linear. Mind you, LDL constitutes .000025% of total fat. We have many other targets in dyslipidemia like free cholesterol, harmful fatty acids, remnant cholesterol, TGLs, dysfunctional HDLs
LDL is not innocen...
Source: Dr.S.Venkatesan MD - January 9, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cut off value for ldl esc aha guidlines for lipids functions of ldl molecule good and bad cholesterol how low ldl can go inclisiron lipid metabolism lipidology pcsk inhibitors repatha Source Type: blogs
Lancet : A 200 year old Idea and a process towards righteousness
It was 1823, a genesis of a new thought process in medical publication began. The man who started it all, Dr.Thomas Wakley the founder of the most famous medical journal (Ref 1)
One of his peers described him what sort of an Image he had. “Thomas Wakley the editor as we find him—a courageous challenger of the medical establishment who was usually right and whose language, however tasteless it might seem today, was well suited to the rough and tumble of the time in which he wrote and spoke”
Lancet celebrates 200 year anniversary
On this 200th anniversary Lancet , looks back ,introspects and red...
Source: Dr.S.Venkatesan MD - January 4, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Medical ethics Uncategorized lancet lancet 200nyears medical education principles ofpractice of medicine Source Type: blogs
How cardiogenic shock in NSTEMI is different from STEMI?
Cardiogenic shock (CS)is the most feared event following STEMI. The incidence is up to 5 to 10% with a mortality rate of around 50-60%. Still, we are finding it hard to bring this down below 50 % .There is one less addressed issue in ACS literature. We tend to perceive CS as an exclusive complication of STEMI. The fact is that NSTEMI can also result in CS is less recognized. The incidence is half of that of STEMI, i.e., 2.5-5%.
Mechanism of CS in NSTEMI
One may ask, how can CS occur in NSTEMI with partial occlusion with a non trans-mural MI. ACS pathophysiology is not that simple. Ischemic LV dysfunction (Global stun...
Source: Dr.S.Venkatesan MD - December 30, 2023 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Uncategorized acc aha esc guidlines on stemi shock cardiogenic shock cardiogenic shock in stemi vs nstemi cs in stemi vc nstemi grace registry how is cardiogenic shock in nstemi different from stemi ? iglobal lv stu Source Type: blogs
A forbidden quote about science
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - December 20, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized forbidden quotes medical education medical ethics medical quotes science quotes venkat quotes venkatesan sangareddi Source Type: blogs
Rules of myocardial revascularisation REVIVEed : Quantify ” non-viable tissue ” first.
”It looks like, science oftentimes struggles at the hands of scientists“
The weakest link in medical research is framing the right research question. How will you explain the drama of research on myocardial viability studies that have been going on full steam for more than 3 decades,? Which has become junk now.
This truth came out from a secondary analysis of the famous REVIVED-BCIS2 trial. For the busy guys, the conclusion is given in the box below.
JAMA Cardiol. 2023;8(12):1154-1161.
Final message
We realize, in the game of myocardial revascularisation t...
Source: Dr.S.Venkatesan MD - December 20, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized accc aha esc guid;ines on myocardial revascularisation cabg cabg patch study ischemic dcm myocardail viablity pet scan for myocardial viablity REVIVED BCIS2 viablity study myocardial Source Type: blogs
What is conservative management ?
Conservative management conveys two tangentially opposite meaning.
For the superior “physicians & Interventional cardiologists” it would mean
For the “Inferior genre of physicians” it will sound like this
Reference
This is a partial repost from a 2008 article . https://drsvenkatesan.com/2008/11/30/what-do-we-mean-by-conservative-management-why-it-is-often-considered-as-an-inferior-form-of-treatment-in-medicine/ (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - December 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized accc aha guidlines ethics in medicine GDMT OPTIMAL MEDICAL THERAPY principles of practice of medicine WHAT IS CONSERVATIVE MEDICAL MANAGEMENT Source Type: blogs
A basic query in LV function measurement
Which point in ECG is taken as reference for End systolic dimension for LV function assessment?
Marking the end diastolic point in ECG is quiet straight forward. Peak of R wave.(or Q)*
But, what about the reference point for end systole.
Descending slope of T wave
Peak of T wave
End of T wave
If T is absent or not clear , I will be confused
To be realistic, ECG has no reliable reference point for end systole.
Answer: If I say the answer is 5, no one is going to agree. Please note, the relationship between the T wave and the peak systolic phase in echocardiography is weak. Is there any relat...
Source: Dr.S.Venkatesan MD - December 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ase criteria for lv function measurement ecg gating in ct scan ecg gating volume correlation ecg vs echo gating end diastole in ecg end systole in eco vs ecg end systolic point in ecg peak r and peak t systole and diastole Source Type: blogs
