STREAM -2, bats for “ half dose ” TNK-Tpa in elderly over pPCI
STREAM trial (New Engl J Med 2013) was a sort of paradigm-creating study, that made Pharamco-Invasive approach – PIA an authentic via-media strategy, trying to accure benefits from both lysis and PCI in the management of STEMI.
However, one question remained. Does PIA work safely in the elderly, where bleeding risks are higher? Do they tolerate the double whammy of P and I ? Both procedures keep the blood clotting process tentative for a prolonged period of time.
Emprical usage of half dose lysis is not new, is existingn, for more than 4 decades, right from streptokinase days.
Now the multi-center STREAM-2 ...
Source: Dr.S.Venkatesan MD - October 13, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Chronic stable AF on warfarin: Don ’ t DOAC them just like that!
Are you still on warfarin? Come on, switch to DOAC./NOAC This seems to be a fashion statement among cardiologists and their patients with chronic AF. (By the way, NOAC has a new name, i.e., DOAC. NOAC stands for non-vitamin K anticoagulants. Now, N is replaced with D, direct-acting oral anticoagulants.)
NOAC does have some advantages. the major one is better patient compliance, and ease of administration as it doesn’t need routine monitoring. (One may wonder how this transforms into a real advantage? ) The drug acts in a dark invisible mode. Bleeding risks are either less, equivocal, or high. So we can’t con...
Source: Dr.S.Venkatesan MD - October 12, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized apixaban doac factor xa antagonist noac noac for atrial fibrillation oac vs noac swtiching to noac from warfarin warfarin vs noac Source Type: blogs
When does a fact become an opinion & vice versa?
When class 1-A indication tends to blink at the bed side ,... while class III-C evidence appear to pour all the sense ...practicing cardiology becomes "Tough and exhilarating” . (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - October 11, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized class c evidence evidence based medicine evidence vs opinion Source Type: blogs
What is the natural history of TCFA “ Thin cap fibro atheroma ” ?
(Why should the number 65 bother us in TCFA-detected by OCT? Does this number really deserve that respect? Trying to find some truths from 8 questions with & without evidence.)
1. Does TCFA really make a plaque vulnerable?
A.Yes
B. No
C. Maybe
Answer: Yes & Maybe. But there seem to be more important factors other than TCFA for a plaque to become vulnerable making TCFA not really a big deal.
2. TCFP is more common in which lesions?
A.Flow limiting lesion
B.Nonflow limiting lesion
C.No relationship between TCFA and flow
Answer: No relation, rather a random relationship.
3. What...
Source: Dr.S.Venkatesan MD - October 10, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
An Image quiz : What is the Investigation & What is the diagnosis ?
Image courtesey : Sekhar, S. et al Canadian Journal of Cardiology, 2015 (Ref 2)
Coronary stent infection (CSI) is no longer a rare and fancy diagnosis. It is increasingly recognized and is equivalent to infective endocarditis. Though CSI appear simple & practical terminology, Infective endo-coronary arteritis may be the ideal term for this device-related infection.
Any prolonged fever following PCI must be investigated with this condition in mind. Unlike other forms of infective endocarditis, vegetations are rare, or do not occur . Instead, the infection erodes endothelium, often leading to the development o...
Source: Dr.S.Venkatesan MD - October 6, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Mechanism of Troponin release in “ Marathon runners ” ?
Can you believe that 68% of marathon runners show elevated Troponin levels after crossing the finish line? . 11% of them have significant levels that could lead to a diagnosis of ACS if they experience chest pain and end up in the hospital. (Fortescue EB 2007 )
Clinical experience suggest, that it doesn’t require a marathon race to bring troponins into the bloodstream. Any heavy, prolonged physical exertion can potentially release these biomarkers.
How much Troponins are released in these runners ? (Ref 3)
Most runners (68%) had some degree of troponin increase (troponin T > or = 0.01 ng/mL or t...
Source: Dr.S.Venkatesan MD - October 6, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cardaic biomarkers free cytosolic troponin mechansim troponin release non cardiac troponin troponin in marathon runners troponin t vs i Source Type: blogs
Does LAFB cause wall motion defect ?
The heart is a mechanical pump, still electrically wired delicately and extensively, right from the SA node to the vast Purkinje network, which is activated by sequential propagation. Myocardial contraction occurs with amazing electro-mechanical coordination with millisecond precision. If the wiring line is interrupted, it is natural to expect some bumpy rides. This local delay often manifests as, wall motion abnormality.
WMA is commonly occurs in LBBB .What about LAFB ? LAFB is a term used if one of the fascicles of the left bundle is delayed or completely cut off. Wall motion defects are also expected in LAFB, but...
Source: Dr.S.Venkatesan MD - October 4, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
What is the effect of coronary vasospasm in ECG ?
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Source: Dr.S.Venkatesan MD - October 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
66 yr old female : What is your diagnosis? Can you rule out CAD with out Angiogram ?
ECG diagnosis any one can make.
The second part of the question, needs some …
If you think, its worth commenting ,please. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - October 2, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
“ World heart day ” : Two conflicting messages
World heart day is being celebrated every year on September 29th ,Initiated by the World heart federation with a genuine purpose, vision & goal. It has become big hit in recent times. In India, the theme has captured the imagination of the main stream media . Every one wants to propogate a message. I am not an exception. Please bear with this skewed message “One for the patients and the other for the self” ! (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - September 29, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc ethics in cardiology lancet medcial education nejm right treatment movement world heart day world heart federation Source Type: blogs
No, we can ’ t allow BAV, to be a threat for TAVR !
Interventional cardiologists generally do not believe (rather relish) in simple balloon dilatations to remove any vascular blocks. It is a mundane job for their talent-rich hands. After conquering the coronaries, we made exclusive valvular stents. No surprise, TAVR has taken over the aortic interventions with all its glamour and vigor, though it is definitely not an ideal choice in all.
SCAI, the prestigious journal in Interventional cardiology has a recent article , that has a not-so pleasant message for TAVR lovers.
PIIS2772930323004453Download
Very soon, BAV could pose a direct challenge to cardiologists&#...
Source: Dr.S.Venkatesan MD - September 18, 2023 Category: Cardiology Authors: dr s venkatesan Tags: bav vs tavr TAVR /TAVI tavr tavi TAVR VS SAVR Uncategorized Source Type: blogs
No, we can ’ t allow BAV to be a threat,.. to our heart-throb !
Interventional cardiologists generally do not believe (rather relish) in simple balloon dilatations to remove any vascular blocks. It is a mundane job for their talent-ridden hands. After conquering the coronaries, we made exclusive the valvular stents. No surprise, TAVR has taken over the aortic interventions with all its glamour and vigor, though it is definitely not an ideal choice in all.
SCAI, the prestigious journal in Interventional cardiology has a recent article , that has a not-so pleasant message for TAVR lovers.
PIIS2772930323004453Download
It poses a direct challenge to cardiologists’ heart...
Source: Dr.S.Venkatesan MD - September 18, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
A potential new face of “ Ethical dysfunction ” is waiting to unfold !
Postamble
This quote is being sent for the annual meet of “Right care movement” I know ,this can sound outrageous, permissble limits of abuse ? Up to 2% or 5% ? Let it be anything . Meanwhile try to enlighten yourself , the key differences between misuse & abuse. (Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - September 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Medical education Medical ethics medical satistics best medical quotes bmj dr venkatesan sangareddi first do no harm primum nocere hippocrates Hippocratic oath inappropriate medcial care jamanetwrok lancet madras medic Source Type: blogs
Life style modification & CVD prevention : Spot the new entry
Discussing lifestyle modification is an essential cliché in every preventive cardiology consult, For most, it still means good nutrition exercise, and stress relief. It is true, that the average human longevity has increased considerably in the last century. However, this apparent gain in life expectancy by the stunning discoveries in science ( 10 years ?) has already been eaten up, by the self-inflicted, poor styles in life. The new kid on the block, i.e. social media is playing a powerful amplifying effect.
Spot a new entry in lifestyle interventions.
Here is a fresh list of lifestyle modifications from the ...
Source: Dr.S.Venkatesan MD - September 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
New ESC 2023, ACS guidelines : “ STEMI merges with NSTEMI ” for some good reasons.
Is it a STEMI or Non -STEMI ? The apparently realistic dichotomous thinking about ACS among physicians has existed for quite a long time. However, since the underlying pathobiology being same , it is worth wondering whether the conventional bifurcation of ACS is fool -proof , when applied to management decsions. The rapidity and totality of plaque fissusre, rupture eruption,or erosion and the subsequent response of the local hemorheological system, determine the ferocity of the event.
How to recognise all these deep intracellular events in bed side ? Unfortunately, still with a lot of gratitude, we have to rely on the ...
Source: Dr.S.Venkatesan MD - September 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
