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Source: Dr.S.Venkatesan MD

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Coronary Incompetence : Thrombolysis “ Incapable ” cardiac care units should be closed immediately !
Professional competence is defined as doing things, always in the Interest of patients. It’s generally believed small hospitals are not competent enough to treat cardiac emergencies . . .Do you agree with that ? No, Its largely a myth . Do you know there is a absolute  lack of proficiency  threatening to plague our country’s coronary care system. ? It’s the professional  Incompetence by the space age, star hospitals (mis)managed by masters of the noble business. None (am I right ?) of this hospitals either monitor or publish the outcome of their treatment. Backed by pseudo scientific data , amplified b...
Source: Dr.S.Venkatesan MD - June 25, 2017 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Criteria Cardiology -guidelines cardiology -Therapeutics Cardiology Outcome analysis Cardiology Risk assesment cardiology wisdom cardiology- coronary care Cardiology-Coronary artery disese cardiology-e Source Type: blogs

Functional CT coronary Angiogram :Live coronary traffic Info on the go !
Technology is a great equalizer.Never in my dreams, I would  have thought as I drive through the dense Nilgiris forest , a satellite  located 36000 Km up in the sky would guide  me through  every turn and bend most accurately. The curvy roads are coded with  live traffic  flow in Red ,orange & green . That’s “Google map”  for you. (By the way, proud to note Google runs with an Indian CEO who hails from my city Chennai !) Now , coming to academics , . .Some one thought,  if the traffic in the entire globe can be monitored with few clicks,  How about  adding live traffic data to the other...
Source: Dr.S.Venkatesan MD - May 28, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Mature cardiologists should never trust BMS !
This study done with over 9000 patients  concluded  like this  . . . The DES industry was (is) so powerful it could easily shrug  the challenge of truth that came out briefly  in early 2000s when DES got hit with increased  acute complications. Now, in 2016 NORSTENT study again showed us BMS is as good as DES in all walks of CAD.  Let us see what happens , still  its very unlikely mature cardiologists do not trust BMS. *I have a belief  (Paranoid or not time will tell !) one of the reasons  DES are strongly promoted  is to sustain DAPT market alive and kicking for a long haul ! Scenerio  in India is frighteni...
Source: Dr.S.Venkatesan MD - April 22, 2017 Category: Cardiology Authors: dr s venkatesan Tags: cost effectiveness in cardiology Ethics in Medicine innovations in cardiology Newer hardwares in cardiology Technology Emerging bms vs des malapposition of stent norstent Source Type: blogs

When do you use a tapering coronary stent ? Which company makes it ?
Coronary artery lumen has unique character . Its well-known  LAD diameter is not constant , it tapers in its distal course.(Unlike RCA which is more tubular ) It is estimated LAD looses 15 % of its diameter for every 30mm length.Fortunately LCX has no such long course to make tapering a visible threat. (Though it may still be an Issue !) Is there a hemodyanmic purpose for this tapering in LAD ? Should be, God never designs anatomy without a physiological purpose.We have to find it  out.(Can it be meant for  flow acceleration as the flow is entriely diastolic in LAD while in RCA its both in systole ...
Source: Dr.S.Venkatesan MD - April 2, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Technology Cardiology Innovations Cath lab Hardware Uncategorized biomime morph long tapering coronary stent lad coronary diameter tapers rca long stent tapering meril morph overlapping vs tapering stent rate of tapering of cor Source Type: blogs

What is the difference between “ under-expansion & mal-apposition ” of coronary stent ?
Improper or technically deficient stent deployment is a major factor for post stent events .Few terminologies are used in assessing stent deployment. Under expanded stent (UES)  A stent is not fully  expanded to the desired or to its specified diameter. This is often due to inadequate balloon pressure during inflation . Many times its technical and It requires post dilatation. Under-deployed stent is  often  due to a struts hitting a  hard surface or calcium . What is mal-apposed stent  ? (MPS) It’s a fine gap between the vessel wall and the stent. It can be observed immediate or late. Immediate is usually due...
Source: Dr.S.Venkatesan MD - March 31, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions cath lab tips and tricks malapposition vs stent underexpansion stent malapposition stent undersizing tips and tricks in pci Source Type: blogs

STEMI management is Indeed funny !
Here is an Interaction between  a ER physician  and a cardiologist !   “I am happy for the cartoon cardiologist , It atleast thinks and verifies the ECG . . . resists entry for this dubious STEMI to cath lab ”  
Source: Dr.S.Venkatesan MD - March 5, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Primary -PCI cartoons in cardiology funny cardiology Primary PCI for STEMI Source Type: blogs

Cathlab misadventures : ” Protected left main ” and . . , unprotected patient !
It has become fashionable for many current generation cardiologists to stent the LAD   with proximal end  liberally extending into left main shaft  in Medina 0, 1, 0 or (1,1,1 )lesions involving distal left main often  jailing the LCX . This concept came into vogue as it helped bail  out few  hemo-dynamically  unstable patients with true left main bifurcation lesions during primary PCI .Of course , it’s potentially useful strategy in  emergency , if  extended into routine situations (like all stable proximal LAD/Bifurcation ) we are bound to create few problems. Rapidly p...
Source: Dr.S.Venkatesan MD - February 26, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Left main disease Left main stenting -Tips and tricks Tips and tricks in cath lab left main pci left main stenting for lad disease safety issues in left main Tips and tricks in left main disease Source Type: blogs

Stunning Innovations in cardiology : Learning from “ Swiss watch ” . . . and pacemakers will soon go battery less!
Artificial pacemaker is one of the major discoveries in cardiology that has given new lease of life to patients suffering from serious bradycardia and heart blocks . Now, the technology has grown beyond pacing , for delivering shock ,defibrillate , resynchronise failing heart etc. For accomplishing  all these tasks we need electrical power . . . non stop on board ! Though , the energy required for sustaining an electric pacemaker is miniscule (About 40 micro watts) still, the lithium ion battery can last only around  10 years with the available technology.Various alternate sources for power* are being  explored. One gr...
Source: Dr.S.Venkatesan MD - February 2, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD Cardiology -Technology future of cardiology Futuristic cardiology innovations in cardiology newer advances in pacemaker energetics pacmekr life battery lithium ion self powered pacemakers Source Type: blogs

Stunning Innovations in cardiology : “ Swiss watch ” has just taught an Incredible trick to human heart . . . and pacemakers will soon go battery less!
Artificial pacemaker is one of the major discoveries in cardiology that has given new lease of life to patients suffering from serious bradycardia and heart blocks . Now, the technology has grown beyond pacing , for delivering shock ,defibrillate , resynchronise failing heart etc. For accomplishing  all these tasks we need electrical power . . . non stop on board ! Though , the energy required for sustaining an electric pacemaker is miniscule (About 40 micro watts) still, the lithium ion battery can last only around  10 years with the available technology.Various alternate sources for power* are being  explored. One gr...
Source: Dr.S.Venkatesan MD - February 2, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD Cardiology -Technology future of cardiology Futuristic cardiology innovations in cardiology newer advances in pacemaker energetics pacmekr life battery lithium ion self powered pacemakers Source Type: blogs

Unexplained dyspnea post primary PCI : Never blame Ticagrelor !
Knowledge can be a dangerous asset sometimes . A modern day cardiologist reassured a patient  who had an unusual dyspnea after a muti-vessel stenting for a not so complex lesions following an anterior MI.The doctor  was not mystified when the patient uttered this complaint. In fact he was so cool , reassured the patient since he was taking  Ticagrelor ,and it’s well recognised to cause dyspnea in some patients. Few days later patient  called  again and informed that the  dyspnea is getting more intense  and ultimately he was rushed to hospital only to diagnose  subacute stent occlusion and a fresh ACS. What...
Source: Dr.S.Venkatesan MD - January 31, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized drug Induced dyspnea how does ticagrelor cause dyspnea mechanism of dyspnea with ticagrelor unusual causes of dyspnea Source Type: blogs

Optical defibrillation : An exciting possibility !
Cardiac arrhythmias  are tackled by drugs, devices, electricity etc. How about using the light energy ? It would be sort of revolution if we could tame dangerous cardiac arrhythmias  by optical energy.Exciting new developments are happening at Jhon Hopkins.The emerging field is optogenetics.Preliminary mouse  and human MRI models suggest  red light has a unique property to interrupt electrical  signals in cardiac tissues.(Tissue level induction of light sensitive protein?).It has been shown to revert ventricular arrhytmias. Reference https://www.eurekalert.org/pub_releases/2016-09/uob-tol090816.php A preview Curious...
Source: Dr.S.Venkatesan MD - January 15, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Venkat quotes future of cardiology light electricity interaction optical defibrillation Source Type: blogs

What ails cardiology literature ? Watch out . . . Guidelines may easily misguide you !
If you think , the  various appropriate use guidelines for cardiology practice are collection of great scientiifc truths , beware . . .many  of them hide behind semantics.  (After all , English is an unique language one can play  with it !) Is it not funny , to note a  recommendation  that goes with a caption “may be appropriate” conveys exactly the same meaning as “may not be appropriate” as well . Here is a rare article which tries to expose the importance of  linguistic Interventions in cath lab that can Impact the patient outcome for good or bad. http://www.inv...
Source: Dr.S.Venkatesan MD - November 21, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Classic papers in cardiology : I think , this is probably one of the most Important publication and concept in STEMI ever published !
How do you evaluate the success of thrombolysis or primary PCI  ? If you say its coronary angiogram and the final snapshot  of  TIMI flow , you need to read further. If you thought its actually the quantum of ECG ST regression . . . great ,  you can exit this page  with credits. CAG  may not be the gold standard in defining PCI success , it just tells you whether IRA is patent or not .Instead , the good old ECG tells you about whether  the myocardium is successfully reperfused or not .  TIMI flows are simply not good enough to identify  adequacy of  myocardial reperfusion . By the way , who is telling this nons...
Source: Dr.S.Venkatesan MD - October 23, 2016 Category: Cardiology Authors: dr s venkatesan Tags: STEMI STEMI -Managment STEMI-Primary PCI Wintage cardiology assessment of reperfusion stemi ecg gold standard ira patency vs ecg st regression thrombolysis vs primary pci Source Type: blogs

What ails modern medicine ? When “ Nonsense ” masquerade as scientific data . . . Does “ Sense ” has to leave quietly by the back door !
Bedside wisdom We have been  using unfractioned Heparin for long , and its  is better than any other anticoagulants  in ACS . . .  Our observation shows that Streptokinase has distinct advanatge over Tenektepelase as it works longer duration  . . . My experience  says Diuretic and beta blockers  are still good as first line therapy for Hypertension  . . . Mind you , there are infinite  number of such wisdom in every sub specialty of medical field. However , the typical response from any  modern scientific intellect would be . . . Stop it . . . Its old  stuff folk  , What does the current data say ? Common u...
Source: Dr.S.Venkatesan MD - October 16, 2016 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology quotes Cardiology research topics Cardiology Risk assesment medical quotes Two line sermons in cardiology Lown Institute medical ethics what is scientific data Source Type: blogs

What ails modern medicine ? When “ Nonsense ” masquerade as scientific data . . . should “ sense ” has to leave quietly by back door ?!
Bedside wisdom We have been  using unfractioned Heparin for long , and its  is better than any other anticoagulants  in ACS . . .  Our observation shows that Streptokinase has distinct advanatge over Tenektepelase as it works longer duration  . . . My experience  says Diuretic and beta blockers  are still good as first line therapy for Hypertension  . . . Mind you , there are infinite  number of such wisdom in every sub specialty of medical field. However , the typical response from any  modern scientific intellect would be . . . Stop it . . . Its old  stuff folk  , What does the current data say ? Common u...
Source: Dr.S.Venkatesan MD - October 16, 2016 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology quotes Cardiology research topics Cardiology Risk assesment medical quotes Two line sermons in cardiology Lown Institute medical ethics what is scientific data Source Type: blogs