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Source: Dr.S.Venkatesan MD
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Cath lab tips : Post dilatation is an unique “ Art ” . . . can ’ t learn it from textbooks or workshops !
In the modern era of cardiology, PCI has become the single therapeutic modality that determines the survival of both cardiologists and possibly their patients! The procedure is all about launching a metal coil inside the coronary artery of a live beating heart.
Millions of diseased and (not much) diseased coronary arteries are serviced (either re/deconstructed ) world-wide on a day-to-day basis.The benefits of the modality is directly related to the wisdom of treating cardiologist and patient’s luck than the original severity of the disease. However, with greatly improved coronary metallurgy , well assist...
Source: Dr.S.Venkatesan MD - December 24, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized post dilatation pre vs postdilatation ptca post dilatation Source Type: blogs
Pressure recovery phenomenon : A brief attempt to understand it !
Bernoulli principle states when high pressure jet (Air, Water, blood etc ) moves over a conduit, the pressure exerted by the jet on its sides (Lateral aspect) reduces . The velocity gain is equal to pressure drop .This is why we take velocity as a rough guide to pressure gradient and the sacred formula in doppler echocardiography 4V2 came in to vogue . (Incidentally Bernoulli principle shares the same principle when aircrafts lifts from runway at its peak speed as the pressure above the wings drops to zero or negative and the plane lifts up.)
In Echocardiography the Bernoulli equation is modified.
...
Source: Dr.S.Venkatesan MD - December 20, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions Cardiology-Echocardiography Infrequently asked questions in cardiology (iFAQs) bernoulli equation doppler echocardiography doppler principles overestimation of doppler gradient by pressure recovery pressure r Source Type: blogs
Pre-op cardiac risk assessment : No worries . . . Dr.Hippocrates is on call !
Pre-op cardiac evaluation prior to non cardiac surgery is an important area for cardiology consultation . Unlike other clinical consults this one primarily involves in the delicate and tricky job of predicting future events !
Peri-operative cardiac evaluation is done for what ?
1.To evaluate and assess established CAD or other heart disease and get a proper pre-operative work up , drug adjustment and risk reduction for a possible peri-operative event.
2.To screen for any significant CAD or other heart diseases which is hiding and asymptomatic.
3.To treat those conditions that are detected prior to surgery .(O...
Source: Dr.S.Venkatesan MD - December 12, 2017 Category: Cardiology Authors: dr s venkatesan Tags: perioperative risk assessment: Non cardiac surgery Preoperative evaluation acc aha guidelines peri operative pre operative risk fitness cardiac fitness prior to surgery peri operative cardiac risk assesment preop cardiac evaluation Source Type: blogs
“ Non academic ” Tips and tricks in CTO – PCI : Open sesame ! , Show me your treasures !
We know, The Mysterious Alibaba cave opens with a voice password . . . legend tell us it had unlimited hidden treasures. It would appear , CTOs mimic the cave in several ways. What is inside ? Should we open it ? Can we come out safely ? Do we have any magical password in cath lab to get across the complex tissue boulders ?, every cardiologist would love to have one !
Dear CTO,Open Sesame . . . I have come with all the wires you love ! Please let me in !
Indication
“CTOs are never an emergency . . .but please realise we can very easily create one while resuscitating a dead snake !
Don’t...
Source: Dr.S.Venkatesan MD - November 27, 2017 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cath lab Hardware cath lab tips and tricks cto chronic total occlusion absolute refractory period Best guideline on cto pci cart reverse cart chronic total occlsuion cross boss sting ray cto club CTO club euro Source Type: blogs
Perils of sixth sense : SPRINT trial, a false GOD in a hypertensive world !
One big hypertension trial called SPRINT was published in 2015, has caused major delayed aftershocks in the hypertensive world now in 2017.
The new guidelines by 2017 AHA/ACC is based primarily on SPRINT data which in my opinion has so much flaws it shouldn’t have been accepted for publication in the first place. !(Intentions and Aim of a study can never be questioned even by most prestigious journals you know !)
The flaws begin right from study design itself. Why diabetic population was excluded from the SPRINT trial is not clearly answered in the true interest of public.The Ironical argument is diabetic...
Source: Dr.S.Venkatesan MD - November 18, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Ethics in Medicine hyperlipidemia wisdom in cardiology acc aha 2017 american hypertension society SPRINT trial Source Type: blogs
Perils of sixth sense : SPRINT trial a false GOD in a hypertensive world !
One big hypertension trial called SPRINT was published in 2015, has caused major delayed aftershocks in the hypertensive world now in 2017.
The new guidelines by 2017 AHA/ACC is based primarily on SPRINT data which in my opinion has so much flaws it shouldn’t have been accepted for publication in the first place. !(Intentions and Aim of a study can never be questioned even by most prestigious journals you know !)
The flaws begin right from study design itself. Why diabetic population was excluded from the SPRINT trial is not clearly answered in the true interest of public.The Ironical argument is diabetic...
Source: Dr.S.Venkatesan MD - November 18, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Ethics in Medicine hyperlipidemia wisdom in cardiology acc aha 2017 american hypertension society SPRINT trial Source Type: blogs
ORBITA trial : First let us do some harm . . . second , we shall . . !?
Cardiologists at confused cross roads !
Perils of limited Intellect & Infinite greed
When not so appropriately trained cardiologists do Inappropriate things and when “use becomes misuse” . . . it won’t take much time for science to become total abuse .Then, it’s time to firefight the healers instead of the disease ! That’s what happened with the murky world of coronary stents .
Now ,Comes the ORBITA . Yes , it looks like a God sent path breaking trial that spits some harsh truths not only in cardiology, but also in behavioral ethics .Let us not work over time and find the non-exist...
Source: Dr.S.Venkatesan MD - November 6, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Interventional -PCI Cardiology -Technology Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions cardiology journal club cardiology wisdom Medical education Medical ethics Uncategorized A Source Type: blogs
Interventional closure of potholes outside cath lab with simple concrete device !
https://timesofindia.indiatimes.com/india/potholes-claimed-6-lives-a-day-in-india-in-2016/articleshow/61283355.cms
I guess , potholes kill more humans than holes in the heart (VSD and ASDs) in India and would argue the cardiologists to switch profession temporarily and help close these deadly holes first !
Source: Dr.S.Venkatesan MD - October 29, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Early thrombolysis knocks out pPCI yet again . . . this time from Shanghai !
Primary PCI (pPCI) is a glorious revascularization strategy for STEMI practiced for over 2 decades but still has not proved its perceived mettle convincingly as a large population based strategy. In the mean time, the utility value of thrombolysis was systematically (Intentionally too! ) downgraded in the minds of both academic and public mind.
Truth can’t be buried for long. Series of revelations are coming up restoring the superiority of early thrombolysis over pPCI even in PCI capable centers.
In 2013, the high Impact STREAM trial argued for pharmacoinvasive approach within 3 hrs as it was at e...
Source: Dr.S.Venkatesan MD - October 18, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines cardiology -Therapeutics cardiology journals EARLY MYO trial circulation ppci vs thrombolysis primary PCI vs thrombolysis stream trial Source Type: blogs
Hemodynamics of sudden “ Toilet deaths ” following STEMI !
The age old statistics , 30 % of deaths following STEMI happen even before patients reach the hospital may still be true. But ,there is an untold story that happen regularly in the rehabilitation phase .Its ironical many apparently stabilised STEMI patients still lose their life just before they get discharged or within 30 days .More often than not this happens in the toilet when they strain for defecation. At least a dozen deaths I have witnessed in the last few years. Of course we have resuscitated many near deaths as well.
What exactly happens to these ill-fated patients inside the toilet ?
Straining is often an ...
Source: Dr.S.Venkatesan MD - October 1, 2017 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome Cardiology -Interventional -PCI cardiology -Preventive Cardiology -unresolved questions acs hemodynamics in LAD following valsalva predischarge stress test primary pci stemi Sudden cardaic deaths in bath room toil Source Type: blogs
Ignorance based Primary PCI : A landmark article that couldn ’ t correct our coronary Intellect !
How often you assess the success of Primary PCI with degree of ST segment regression or resolution ?
I posed this query to a freshly hatched , Intelligent and energetic cardiologist in an upscale dedicated heart care center.
He said, “No, we don’t .We always go with TIMI flow in IRA .TIMI 3 flow with less than 30% narrowing of IRA is success, that’s it ! He continued ,very often ,we don’t even Insist to take serial ECGs after the procedure . . . forget about analysing ST segment ! His body language seemed to suggest, he didn’t expect such a question (Silly !) from me , talking ...
Source: Dr.S.Venkatesan MD - September 29, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized pPCI primary pci stemi st segment regression more important than ira patency st segment regressionafter ppci timi blush score timi three flow Source Type: blogs
Bifurcation snakes : Which side its going to sting ?
If human coronary artery is comparable to live wire , attempting bifurcation (BFL) stenting is akin to tame a live snake .True BFL (with Medina 1, 1, 1) being the most complex of all .The fact is ,we have atleast a dozen strategies for BFL with varying loads of metal abutting the ostia ,side branch and carina.This would essentially Imply we are still struggling with these lesions .
While current science tends to vouch PCI* for most BFLs . . . wisdom might whisper CABG in atleast some of us !
Who should do complex PCI ?
Obviously, not every interventional cardiologist can. Confidence is one thing , but , f...
Source: Dr.S.Venkatesan MD - September 4, 2017 Category: Cardiology Authors: dr s venkatesan Tags: bifurcation pci Cardiology -Interventional -PCI Cardiology -unresolved questions Tips and tricks in cath lab bbc 2 study bifurcation lesion dapt after bifurcation stenting european bifurcation club Proximal optimisation pot single vs dou Source Type: blogs
What exactly constitute posterior wall of heart ?
Heart is not like a rigid structure built with bricks . . . . so , its too architectural mindset to describe cardiac chambers to be made up of walls. Rather , Its a four chambered muscle mass moulded together in a complex 3D interface with distinct surfaces rather than walls. It’s also important to realise, since the heart is positioned (rather hanging )delicately in the middle mediastinum resting on the diaphragm , its subjected to one more dynamism due to respiratory motion blurring the definition of surfaces as well. (Vertical vs Horizontal)
Posterior surface is now referred to as infero-posterior
The posterior ...
Source: Dr.S.Venkatesan MD - August 24, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Cardiology - Clinical Anatomy of the heart inferior vs posterior surface of heart posterior stemi posterior wall of heart what is the posterior surface of heart Source Type: blogs
An unusual clinical encounter : Gastric “ Bradycardia ” unmasked by Transthoracic Echo !
A 50-year-old man was referred for dizziness, bradycardia and dysphagia .He was very clear in describing his symptoms and landed up in Gastro- enterology OPD , from there was referred to my clinic for cardiac work up . His ECG showed a sinus bradycardia HR of 48 /mt.
Echocardiogram revealed a structurally normal heart as we expected , but was surprised to spot suspicious shadow in para-sternal long axis view , beneath left atrium.
A well demarcated large mass compressing left atrium. Trans Thoracic Echocardiography may not be looking at the heart alone ,(Its technically Thoracic Ultrasound though we may ref...
Source: Dr.S.Venkatesan MD - July 8, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology-Arrhythmias Cardiology-Echocardiography Echo library and gallery Interesting case study achalasia of cardia andleft atrial compression cardiac mass dysphagia and echocardiography extra cardiac mass compressing left atrium revers Source Type: blogs
Ignorance based PCI : Histopathology of “ pinched ” LAD
This article from Circulation Imaging new generation IVUS could reveal histology of pinching
1.Adam J. Brown, Daniel R. Obaid, Charis Costopoulos, Direct Comparison of Virtual-Histology Intravascular Ultrasound and Optical Coherence Tomography Imaging for Identification of Thin-Cap Fibroatheroma Circulation: Cardiovascular Imaging. 2015;8:e003487
Source: Dr.S.Venkatesan MD - June 28, 2017 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Interventional -PCI Cardiology -unresolved questions coronary pinching haziness in side stent intra coronary lysis streptokinase malapposition plaque prolapse post pci shadows post pci thrombosis thr Source Type: blogs
