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Corona times: Clinical cardiology gets up from graveyard, for a while !
Surprised to see many of my colleagues, physicians and fellows are beaming with a new pride even in this troubled corona times. Paradoxically, I could see some fresh clinical sense in their approach to problems as well. Each one of them had a story to tell. Sir, I could suddenly diagnose heart failure for the first time with my eyes and ears without NT- Pro BNP or E/E’ . I agree with you sir, textbooks seem to be right. There was indeed basal rales and JVP was elevated. I was astonished I could diagnose CHF clinically! Suddenly, I found, I have acquired the rare expertise of giving fitness to an emergency appendect...
Source: Dr.S.Venkatesan MD - May 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Corona times: Clinical cardiology wakes up from deep coma, for a while !
Surprised to see many of my colleagues, physicians and fellows are beaming with new pride even in this troubled corona times. Paradoxically, I could see some fresh clinical sense in their approach to problems as well. Each one of them had a story to tell Sir, I could suddenly diagnose heart failure for the first time with my eyes and ears without NT- Pro BNP or E/E’ . I agree with you sir, textbooks seem to be right. There was indeed basal rales and JVP was elevated. I was astonished I could diagnose CHF clinically! I feel proud, that I have acquired the rare expertise of giving fitness to an emergency appendectomy...
Source: Dr.S.Venkatesan MD - May 18, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Issues in thrombolysis: There may not be anything called “ Absolute contraindication ”
This post was originally written in 2013. A middle-aged man with STEMI  came to our CCU.  It is just another case of STEMI and asked my fellow to lyse. But it was not the case . He, told me, Sir, the patient had a syncope following chest pain and he has injured his face and Jaw. He was actively bleeding. When I saw this face, it was indeed  frightening. What shall we do ? When a patient  with STEMI presents with bleeding facial Injury Rush for Immediate PCI (Which was  of course not possible in our place as it happened out of office hours! ) Take that ultimate risk and thrombolysis Give only heparin ( Many times it ...
Source: Dr.S.Venkatesan MD - May 16, 2020 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Cardiology Risk assesment cardiology- coronary care Cardiology-Coronary artery disese Primary PCI Thrombolysis relative and absolute con Source Type: blogs

Is there an entity called “ Isolated ” systolic pulmonary arterial hypertension ?
What is the incidence of Isolated systolic pulmonary arterial hypertension (ISPAH) and its Implication? We attempted to answer this question and found some interesting answers. It was published in the Indian heart journal  December 2007 Abstract issue. More than a decade gone. I think this issue is still largely misunderstood. Fellows may pursue this. One more parameter that can be explored is pulmonary artery pulse pressure and effect on progressive pulmonary vascular disease and PVR. Mean while  PAH definition and classification has changed many times, ISPAH definitely requires a place in the new scheme of things. The ...
Source: Dr.S.Venkatesan MD - May 15, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Pulmonary arterial hypertension Pulmonary circulation Pulmonary vascular resistance Thesis/Research topics for cardiology fellows isolated pulmonary arterial hypertension ispah normal pulmoanry arterial pressure pulmonary hypertension syst Source Type: blogs

Difficult calls in cardiology : Be ready for DC cardioversion during pregnancy !
This report from Taiwan  reassures there is no adverse effect by measuring umbilical artery flow (Yu-Chi Wang European Journal of Obstetrics & Gynecology and Reproductive Biology 126 (2006) 268–274)While we consider DC shock during pregnancy is safe for the fetus, still, shock pads close to the abdomen, amniotic fluid being a good conductor of electricity at least one mother showed a sustained contraction of the uterus and fetal distress. This was possibly attributable to DC shock  Eleanor J. Barnes BJOG 2003 https://doi.org/10.1046/j.1471-0528.2002.02113. Final message Most cardiac arrhythmias in pregnancy ...
Source: Dr.S.Venkatesan MD - May 11, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology women Pregnancy and heart Uncategorized amiodarone verapamil in pregnancy avnrt avrt during pregnancy cardioversion during pregnancy dc shock during pregnancy fetal distress during dc shock peripartum cardiomyopathy vt vpd managem Source Type: blogs

Aortic valve anatomy : A complete exploration
Found a wonderful anatomy teaching resource. A succinct yet comprehensive lecture on Aortic valve .A must-read for anyone who deals with valvular Interventions. For the cardiology fellows , I can tell you can’t find anything better than this. Thanks to Prof Gregory M Scalia and the structural heart disease Australia. It starts with this one master diagram of Aorta in the center with all surrounding structures and goes on to ensure we watch this 25-minute lecture nonstop. At the end of the lecture, you should be able to learn about. The complex fusion points of LVOT with Aorta. Understanding them is critical as we d...
Source: Dr.S.Venkatesan MD - April 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized aortic annulus virtual Best lecture on anatomy of aorta prof greg scalia structural heart disease australia Source Type: blogs

Acute “ Corona ” syndrome : Glad to know plaques are also in lockdown mode !
The Country of mine with 140 crore population, is under complete lockdown mode. We are anxiously tense in one aspect,  but enjoying the free time due to the peculiar “Corona effect” on cardiac emergencies. Unable to understand you . . . please go away What happened to our 24/7 busy CCU ?  Does it happen only in my hospital? Can’t be.  Let me check it right now. I called my fellow, who has since become a leading cardiologist in the nearby town. I have since called many of my close contacts. In both Government and private hospitals. The pooled data were analyzed in a virtual cloud memory. I am fairly c...
Source: Dr.S.Venkatesan MD - April 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -guidelines Cardiology -Interventional -PCI cardiology -Therapeutics Ethics in Medicine Uncategorized Acute corona vs coronary syndrome ethics in cardiology evidence based cardiology Source Type: blogs

STEMI management in Corona times: “ Cath lab distancing ” is not really a discrimination !
Even in the best of non-Corona times 90 -95% of STEMI population in our country (the rich and famous included) are discriminated by denying the life saving primary PCI and subjecting them to a dangerous and inferior modality of treatment called coronary thrombolysis or its slightly less inferior cousin pharmaco-invasive strategy. Now, thanks to corona, for some time it’s going to be near 100% discrimination. Fortunately, “Corona” or “No -Corona” this discrimination has never harmed in true sense in the real world. My feeling is, there is going to be little overall impact on ACS /CCS  outcom...
Source: Dr.S.Venkatesan MD - March 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Corona and stemi how to manage stemi in corona times Source Type: blogs

A curious CT scan in Cardiology
Presentation A 38-year-old women,with  episodic chest discomfort, mild dyspnea, and occasional non-productive cough. She was investigated in a non-emergent fashion.  After an abnormal X-ray chest, A CT scan was requested.  (*X-ray chest is Intentionally not posted here to add some curiosity factor) This is probably one of the most curious Images in cardiology I have stumbled upon. At the first look, it seemed a baseball has replaced a heart. Is it not? Posted with Creative Commons Attribution License CC-BY 3.0. Afzal et al. Dept of Internal Medicine, Florida Hospital, Orlando, USA.Cureus 10(11): e3566. When you see su...
Source: Dr.S.Venkatesan MD - March 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized aneurysm of coronary artery coronary artery aneurysm Images in cardiology Source Type: blogs

Non- A, Non -B Aortic dissection : Incidence ,classification & outcome
Aortic dissection is a unique cardiac emergency that tests our collective understanding of vascular anatomy and pathology .It poses the ultimate challenge to the expertise and wisdom of both cardiologists, and surgeons. Freezing the Aortic Time machine The philosophy of management swings between total inaction* in some (As in most Type B & few Type A as well ) to “No holds barred” approach in others. (In most Type A and few Type B). *Read it (also) as medical management that includes powerful Aortic pulse attenuation therapy with beta-blockers ( Unfortunately medical management is considered as Inaction by ...
Source: Dr.S.Venkatesan MD - March 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic dissection Non A Non B Aortic dissection tem debakey stanford classification dissect penn Source Type: blogs

Pulmonary atresia with VSD : Does the routine uni-focalisation strategy justify all the trouble ?
Pulmonary atresia with VSD is one of the complex CHD subsets that requires a meticulous understanding of anatomy, physiology of pulmonary circulation. It can be termed as TAPAC -Total anomalous pulmonary arterial connection in extreme cases. Should we attempt to reverse this total chaotic pulmonary blood supply is the question? It demands a highly focused cath study(hands & brain) and CT Imaging which might actually throw more light. Post-study Interaction with surgeon and team of cardiologist are vital. The decision to take up the challenge of surgery or abandoning poses equal intellectual stress. Continuous and criti...
Source: Dr.S.Venkatesan MD - February 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized mapcas aorto pulmonary collaterals pulmonary atresia with vsd unifocalisation for pulmonary atresia Source Type: blogs

Pulmonary atresia with VSD : Does routine uni-focalisation strategy justify all the trouble ?
Pulmonary atresia with VSD is one of the complex CHD subsets that requires a meticulous understanding of anatomy, physiology of pulmonary circulation. It can be termed as TAPAC -Total anomalous pulmonary arterial connection in extreme cases. Should we attempt to reverse this total chaotic pulmonary blood supply is the question? It demands a highly focused cath study(hands & brain) and CT Imaging which might actually throw more light. Post-study Interaction with surgeon and team of cardiologist are vital. The decision to take up the challenge of surgery or abandoning poses equal intellectual stress. Continuous and criti...
Source: Dr.S.Venkatesan MD - February 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized mapcas aorto pulmonary collaterals pulmonary atresia with vsd unifocalisation for pulmonary atresia Source Type: blogs

Pericardial effusion associated with Infective Endocarditis : Incidence , mechansim and clinical Implication.
Pericardial effusion is often detected in patients with Infective endocarditis. Incidence can be as high as 25% . Most often it is mild, can be moderate in few. Mechanism Sympathetic effusion in response to endocardial infection. It’s never more than minimal. (Evidence ? it’s only an assumption) IE related cardiac failure (Raised systemic venous pressure to which pericardial veins drain) Local sepsis, Abcess formation tracks to pericardial space through transmural lymphatics Fungal , granulomatous , Tuberculous IE (Rare) Here IE and PE  share the same pathology Part of systemic sepsis activated Immune mechan...
Source: Dr.S.Venkatesan MD - January 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) pericardial disease pericardial effusion Pericardium infective endocarditis pericardial effusion in infective endocarditis Source Type: blogs

Pricardial effusion associated with Infective Endocarditis : Incidence , mechansim and clinical Implication.
Pericardial effusion is often detected in patients with Infective endocarditis. Incidence can be as high as 25% . Most often it is mild, can be moderate in few. Mechanism Sympathetic effusion in response to endocardial infection. It’s never more than minimal. (Evidence ? it’s only an assumption) IE related cardiac failure (Raised systemic venous pressure to which pericardial veins drain) Local sepsis, Abcess formation tracks to pericardial space through transmural lymphatics Fungal , granulomatous , Tuberculous IE (Rare) Here IE and PE  share the same pathology Part of systemic sepsis activated Immune mechan...
Source: Dr.S.Venkatesan MD - January 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) pericardial disease pericardial effusion Pericardium infective endocarditis pericardial effusion in infective endocarditis Source Type: blogs

Please mind this “ Acute coronary error ”
Science is a journey in pursuit of truth. Hence, we search for it again and again.  (Hence recurrent search becomes ReSearch) As we try to progress in our knowledge towards absolute truth,  we need to admit our errors first. I think one such is blinking right in front of us in the vibrant corridors of coronary care and cath labs every day! It is about the definition with which we deal the success of primary PCI. (A supposedly revolutionary acute coronary therapeutics  this century) Waiting for the day  . . . when all those fancy primary PCIs that leave the myocardium hurt (and retire ) with significant LV dysfunction ...
Source: Dr.S.Venkatesan MD - January 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome Cardiology -Therapeutic dilemma Uncategorized lv dysfunction primary pci successful primary PCI Source Type: blogs

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