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Be happy with the “ H ” Index of Hippocrates
“Publish or perish “ This sound bite is regularly uttered by all academic leads in any university or medical school. I don’t know, why this bothers me. Looking back, many of our mentors & professors never had any great publications. Still, they were extraordinary teachers and wonderful clinicians with great wisdom. They created generations of high-quality doctors who are present all over the globe now. Is scientific publication that important in a doctor’s life? After pondering for quite some time, got a hazy answer to that query in one of my sleepless early morning academic dreams. Hi...
Source: Dr.S.Venkatesan MD - March 5, 2022 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology quotes cardiology-ethics Uncategorized bmj future of medicine google scholor H index hippocrates ethics Hippocratic oath i Index Impact factor jama network kos island lance medical ethics medical research issues Source Type: blogs

A man in his 50s with " no reciprocal ST depression " and " diffuse " ST elevation. What does diffuse actually mean?
CONCLUSION: I completely agree with Dr. Meyers that ST-T wave changes in thisinitial ECG shown inFigure-1 are definitely not  “diffuse”.The “beauty” of medicine — is that there is often more than a single appropriate answer or approach to any clinical situation. As a result — I choose to continue my use of the term“diffuse”for those selective situations that I describe above.
Source: Dr. Smith's ECG Blog - February 12, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

A man in his 60s with syncope. In syncope, what are we looking for on the ECG, and why?
 Submitted and written by Rachel Plate M.D., with some edits by Smith and Meyers A man in his 60s with history of type 2 diabetes, obesity, obstructive sleep apnea requiring nightly CPAP, and hypertension presented for evaluation following a witnessed syncopal episode at home. The patient noted this occurred after standing and he did have prodromal symptoms including lightheadedness. EKG was obtained and shown below.What do you think?  The ECG shows sinus rhythm a bifascicular block, both a right bundle branch block and a left anterior fascicular block. The P waves are hard to discern with the artifact ...
Source: Dr. Smith's ECG Blog - January 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Cardiac failure Info desk : Diuretics never save lives, while Dapagliflozin does it in style !
An Interaction in IMCU How is Mr. K, who was shifted from ward 102 ? Yes sir, It was acute decompensated LV failure, Patient was in impending pulmonary edema. In fact, he developed. He is fine now, How did he come around? He was too sick I thought. “Just pushed 60 mg Frusemide IV, luckily he also had good BP, so with an infusion of NTG, titrated Carvedilol a little bit, he came out nicely. I guess it is Ischemic DCM”. “Good, You have done a nice job” “Don’t make me embarrassed sir. It is such a routine in our ER.  To make him curious, I asked “Which drug do you think that saved hi...
Source: Dr.S.Venkatesan MD - December 17, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure Cardiology -guidelines cardiology -Therapeutics cardiology wisdom cardiology-ethics Cardiology-Land mark studies Ethics in Medicine evidence based cardiology acc aha esc guidelines on heart failure bumatanide Cardiac fa Source Type: blogs

Sudden cardiac death of an Indian superstar and the “ Non-academic aftermath ”
A young Indian superstar actor Punnet Rajkumar, suffered a sudden cardiac death last week during a workout at his gym. We don’t really know what happened, was it really a conventional heart attack ? or simply an exercise Induced arrhythmia or an isometric dissecting injury to the coronary arterial (or Aortic) wall. Only a postmortem would have thrown some light. (I am not sure what the ER room ECG showed though) He had excellent physical fitness and was following a good healthy lifestyle. One possibility is extreme physical exertion. It is ironic, while a sedentary lifestyle is a chronic coronary risk factor, exces...
Source: Dr.S.Venkatesan MD - November 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -unresolved questions RIsk factors wisdom in cardiology aha guidelines acc physical activity exertion coronary risk factors scd Source Type: blogs

Hypertrophic cardiomyopathy : Two posters that summarise everything essential
Check out these two posters* for are a quick reference on HOCM with current updated evidence. The first one details about  Echo evaluation. The second one illustrates the genetic screening flow chart of the HOCM families. Some of the queries, you will find the answers from these posters are, 1. How to recognize Intrinsic mitral valve defect by MR jet morphology? 2. How to cross-check the true LVOT gradient from MR jet? 3. When to do a provocative test to document the LVOT gradient? 4. What are the standard pre-myectomy measurements by Echo? 5. How to screen a family member of HCM?  Pros and cons of  Phenotyp...
Source: Dr.S.Venkatesan MD - November 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology Illistrations Cardiology Illustrations Cardiology teaching websites Cardiology-Echocardiography cardiomyopathy hocm hcm hypertrophic cardiomyopathy Uncategorized Alcohol septal ablation ASE posters on hocm hcm best illistrat Source Type: blogs

Dr .K.A.Abraham : India lose a pioneering cardiologist
With deep regret, reporting the demise of Dr. KA Abraham, cardiologist, par excellence in our part of the world(Chennai, Tamil Nadu, India.) He was a man of great knowledge,  wisdom, and integrity and was an inspiration to generations of cardiologists like us. Dr.K.A Abraham 1942-2021 A life, that was fully dedicated to all those heart patients, many of them sick children in his den, the Railway hospital, Chennai for three decades. Though, never had the privilege to be associated with him either directly, nor does he know me, one could feel instantly the greatness and simplicity in him. It’s 1994-95, vividly recal...
Source: Dr.S.Venkatesan MD - October 24, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cmc vellore cardiologist Dr.A K.Abraham great cardiologist of India pioneering cardiologist india tribute to dr k a abraham Source Type: blogs

Paradoxical Low flow-Low gradient- Aortic stenosis: What is the paradox & why does it happen?
Aortic stenosis evaluation was so simple in our early days. Gradients across the valve were the key. Now, we have more parameters to bother about. Dynamic AVOs, flow state, resting LV function, contractile reserves, GLS, dobutamine response, etc. MRI assessment will soon overtake echocardiography.  Hemodynamics of flow across LVOT. MRI 4D volumetric model of normal Aortic stenotic flow in the bicuspid valve (On the left). The more we know, the more we tend to miss! Image courtesy: Northwestern Medicine The current AS algorithms, though scientific, I am afraid, appear much complicated with some frightening terminol...
Source: Dr.S.Venkatesan MD - October 17, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic stenosis amyloidosis in aortic stenosis ASE ACC AHA ESC guidelines for aortic stenosis dobutamine stress in aortic stenosis doppler error in aortic stenosis grading severity of aortic stenosis hypertension and aortic s Source Type: blogs

What is the effect of Atrial fibrillation on blood pressure ?
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing  RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In dysfunctional ventricles or in acute AF* this variation in systolic  BP can be significant. Also realize, If the preload is changing every beat, there is a consider...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs

What is the Impact of Atrial fibrillation on blood pressure ? … It is also irregularly irregular !
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing  RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In severely dysfunctional ventricles this variation in systolic  BP can be minimal. Also realize, If the preload is changing every beat, there is a considerable dynami...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs

Chest pain in a 30-something: Is it Normal variant STE or OMI? Get the prior ECG, and don ' t trust Point of Care troponin assays!
In this study, Smith and others show that the initial high sensitivity troponin is often below the 99th percentile in true STEMI (+) OMI (and sometime even below a very low threshold).[1] Wereski, R., Chapman, A. R., Lee, K. K., Smith, S. W., Lowe, D. J., Gray, A.,& Mills, N. L. (2020). High-Sensitivity Cardiac Troponin Concentrations at Presentation in Patients With ST-Segment Elevation Myocardial Infarction. JAMA Cardiology, 5(11), 1302 –1304.
Source: Dr. Smith's ECG Blog - October 2, 2021 Category: Cardiology Authors: Bracey Source Type: blogs

Still, trying to get rid of these “ Seven sins in medicine ” !
Dr.Richard Asher,  a British physician from Sussex addressed a group of young passing out medical students way back in 1948 in London. The lecture was titled seven sins of medicine! We should thank the Lancet for having published this brief speech the subsequent year in its journal making it immortal medical teaching! Though he was listing these sins among medical students, it is very relevant to every health professional. 1. Obscurity Asher endorses the use of clear communication and plain language whether writing or speaking. Obscurity may be used to cloak one’s own ignorance, or due to an inability to communi...
Source: Dr.S.Venkatesan MD - September 15, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology-Land mark studies Great men in Medicine Hippocratic oath medical quotes Two line sermons in cardiology Wintage cardiology Source Type: blogs

My journey to the root of empathy and why we must try to teach it
“Are there specific ways empathy will be tested in the standardized patient exam?” a medical school classmate of mine earnestly asked following a lecture years ago. I laughed, thinking that teaching empathy was impossible. As an optimistic and naive medical student, I had thought of myself as na turally empathetic. During those days, I was ableRead more …My journey to the root of empathy and why we must try to teach it originally appeared inKevinMD.com.
Source: Kevin, M.D. - Medical Weblog - September 7, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/nikhil-sikand" rel="tag" > Nikhil Sikand, MD < /a > < /span > Tags: Physician Cardiology Primary Care Source Type: blogs

How did all those calcium entered my father ’ s coronary artery doctor ?
“It was severe double vessel disease &  turned out to be a complex angioplasty in LAD ”  Why doctor? what happened? It was a hard lesion, there was plenty of calcium deposits. It was not clearly visible in the angiogram. I had to do IVUS. Curiously, the calcium was clustered in all the three planes of the vessel ( intima the media and adventitia) and they projected into the lumen blocking the path. Image collage representation purpose Thank you, doctor,  how did you manage to remove it,? It was a real struggle. I had to break the calcium shell before deploying the stent. (What we refer to as...
Source: Dr.S.Venkatesan MD - September 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions calcium supplementation coronary calcification intimal medial adventitial calcium ivl wolverine angiosculpt opn balloon orbitel atherectomy osteoporosis plaque calcium rotoablator serum calcium vs coron Source Type: blogs