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Source: Dr.S.Venkatesan MD
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Cardiology classics : Bernard Lown . . . The cardiologist who won Nobel “ peace ” prize !
Great men dream , but they just do not sit idle. They do what they are passionate about .History just follows them or they create it.Here is a brief story of an ordinary man born in a small European country Lithuania in 1921 ,lived much of his life in the east coast of USA ,transformed into a brilliant cardiologist based in Brigham Hospital , Boston.
He is Dr Bernard Lown , best known as a founder of what is used in every coronary care unit and cardiac surgical theaters around the world . Yes, the DC cardioversion was invented by Lown in the year 1961.(Of course, it was an Improvement upon the pioneering work ...
Source: Dr.S.Venkatesan MD - October 2, 2016 Category: Cardiology Authors: dr s venkatesan Tags: history of cardiology Histroy of medicine bernard lown dc cardioversion Source Type: blogs
Three types of cardiac apical Impulse : An Illustration
Read a related article
How do you define apical impulse ?
How do you define apical impulse ?
Source: Dr.S.Venkatesan MD - September 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Pioneers Clinical cardiology cardaic apical impulse lv apical torsion rotation counterclock wise radiological clinical anatomical apex what is true anatomical lv apex Source Type: blogs
Baremetal stents where are you ? , . . we need you desperately !
Its a funny world out there in medical science, more so in the field of cardiology ! A new treatment comes as a revolutionary breakthrough , lives merrily for a while . . . only to blink , few years down the lane . . . and make a sheepish exit !
Here comes some important knowledge from Rome , European society of cardiology conference 2016 .Its the much expected NORSTENT study from Norway,with a largest number (9013 patients comparing one to one BMS vs DES ) with up to 6 year follow up data ,exposing the limitations and the possible false superiority of DES over bare metal stents .It almost concludes there is no meaning...
Source: Dr.S.Venkatesan MD - August 30, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome are DES really superior BMS prevails over des BMS VS DES debate NORSTENT STUDY 2016 NEJM what is the current role for bare metal stents Source Type: blogs
Balloon Aortic valvuloplasty (BAV) will be back with a bang . . . should pose a genuine threat to TAVR !
SomeInterventional Cardiologist’s favorite play time is to get rid of of obstructions across any blood vessel , valve or a conduit . This has been well practiced for over 2 decades in both coronary and valvular obstruction.Now they wanted more and have since started implanting valves percutaneously. (Aortic valve -TAVR in particular )
Why do balloons work in Mitral stenosis but not in Aortic stenosis ?
It remains a mystery at-least to me ,how PTMC (Percutaneous mitral commissurotomy ) became a default strategy for relieving mitral valve stenosis, while BAV (Balloon Aortic valvotomy) was never consid...
Source: Dr.S.Venkatesan MD - August 30, 2016 Category: Cardiology Authors: dr s venkatesan Tags: baloon aortic valvotomy bav vs tavr current status of baloon aortic valvotomy Source Type: blogs
Primary prevention of CVD with Aspirin : The confusion need to stop here . . . but it may not !
Aspirin for primary prevention of CVD is an ongoing controversy for more than 2 decades. Please note, the controversy is not in the competence of Aspirin to prevent cardiovascular event, but in the potential risk of GI bleed and whether that risk is worth taking. Secondary prevention has no such issues as the benefits easily outweigh the potential bleeding risk .
Male vs female
There is a “gender” and “age” difference in the ability of Aspirin to prevent vascular events.Aspirin primarily prevents MI in men(>45) and stroke in women(>55) (Funny it may look, that’s what data says!...
Source: Dr.S.Venkatesan MD - August 2, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Preventive Primary prevention of CAD primary prevention of cad with aspirin Source Type: blogs
Wait. . . New generation TAVR is coming . . . and its called Lotus valve !
The concept of TAVR(Trancutaneous aortic valve replacement ) is trying hard to prevail over surgical aortic valve replacement .Two companies Medtronic and Edwards life have their products (Core and Sapiens) tested and used with varying success.Meanwhile, Boston scientific has come out with a new one , Lotus valve made with stainless steel and bovine pericardium.
Lotus valve seems to have a distinct advantage* (over the Core and Sapiens ) in terms of easy delivery and adjustment (or retrieval ) of valve till final position and efficient adoptive steel technology in preventing para-valvular leak.
* Outcome ...
Source: Dr.S.Venkatesan MD - July 15, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiac surgery Hadwares in cardiology Heart valves TAVR cath lab hardware core edwards sapiens lotus lotus valve Source Type: blogs
Ignorance based STEMI care : What is the optimal gap between “ Pharmaco ” and “ Invasive ” strategy ?
Less than a century ago an easy chair was enough to manage this most important medical emergency of mankind. Of course, at that time mortality of STEMI was estimated to be around 30%.We have since pushed the in-hospital death rate down to less than 10 % and its around 5-8% currently.(*The lifeless chairs were able to save 70 lives is a different story!)
Heparin , thrombolytic agents, critical coronary care has helped us to achieve this , of course It must be admitted primary PCI also played a small role (at best 1 % ) in our fight against this number one killer.
Now, why not combine both lysis and PCI ?
The concept o...
Source: Dr.S.Venkatesan MD - July 2, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Primary PCI Uncategorized failed thrombolysis pharmaco Invasive strategy Source Type: blogs
Ignorance based STEMI care : What is the optimal gap between “Pharmaco” and “Invasive” strategy ?
Less than a century ago an easy chair was enough to manage this most important medical emergency of mankind. Of course, at that time mortality of STEMI was estimated to be around 30%.We have since pushed the in-hospital death rate down to less than 10 % and its around 5-8% currently.(*The lifeless chairs were able to save 70 lives is a different story!)
Heparin , thrombolytic agents, critical coronary care has helped us to achieve this , of course It must be admitted primary PCI also played a small role (at best 1 % ) in our fight against this number one killer.
Now, why not combine both lysis and PCI ?
The concept o...
Source: Dr.S.Venkatesan MD - July 2, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Primary PCI Uncategorized failed thrombolysis pharmaco Invasive strategy Source Type: blogs
My dear physician , don ’ t feel ashamed to prescribe Digoxin for Atrial fibrillation !
It was delicate few minutes in one of my recent visits to a corporate hospital , when I noticed an emergency physician hesitated to follow my advice to prescribe IV Digoxin for a patient with Atrial fibrillation and fast ventricular rate.His fear was, his consultant, a modern day cardiologist wouldn’t like it as Amiodarone has become a default drug for atrial fibrillation in that Institution. I could sense. . .he felt so out of place to take on my suggestion.
I reminded the young physician , the uniqueness of Digoxin and its un-diminished value for this particular indication ,still he was rel...
Source: Dr.S.Venkatesan MD - July 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized bio ethics digoxin drugs for atrial fibrillation how to practice medicine Source Type: blogs
My dear physician , don’t feel ashamed to prescribe Digoxin for Atrial fibrillation !
It was delicate few minutes in one of my recent visits to a corporate hospital , when I noticed an emergency physician hesitated to follow my advice to prescribe IV Digoxin for a patient with Atrial fibrillation and fast ventricular rate.His fear was, his consultant, a modern day cardiologist wouldn’t like it as Amiodarone has become a default drug for atrial fibrillation in that Institution. I could sense. . .he felt so out of place to take on my suggestion.
I reminded the young physician , the uniqueness of Digoxin and its un-diminished value for this particular indication ,still he was rel...
Source: Dr.S.Venkatesan MD - July 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized bio ethics digoxin drugs for atrial fibrillation how to practice medicine Source Type: blogs
Could Ablation for AF Be an Elaborate Placebo?
We know, atrial fibrillation is the commonest clinical cardiac arrhythmia , that is extensively studied , subjected to exotic investigations and state of the art treatment strategies.Interestingly , this arrhythmia also drags the economics of cardiology practice of a community in a big way with heavy influence on drug , device and usage.We know, RF ablation of pulmonary vein is one of the modern ways to manage this arrhythmia.
Iam sharing this article from medscape by an EP specialist Dr. Jhon Mandrola , surprisingly exposes our fundemental ignorance about this arrhythmia and the near futility of certain procedures.
http:...
Source: Dr.S.Venkatesan MD - June 25, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Don ’ t hunt for non-existing culprits in STEMI crime scene !
Scientific cardiology has forced us to believe ACS management must be catheter based and all others are inferior and those who pursue the later , carry a risk of being labelled as unethical in near future. However ,experienced cardiologists will know where the truth lies.
Now,in the interventional cardiology board rooms there is a big debate going on regarding the value of early total revascualrisation in STEMI with multivessel CAD.Suddenly , every lesion looks suspect ( Ex,current or future culprit ! ) and all stentable lesion are stented either in an emergency or semi emergency fashion (The new age post PC...
Source: Dr.S.Venkatesan MD - June 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -unresolved questions Primary PCI diferred pci for non ira ira non ira culprit vessels multivessel pci in stemi Source Type: blogs
Don’t hunt for non-existing culprits in STEMI crime scene !
Scientific cardiology has forced us to believe ACS management must be catheter based and all others are inferior and those who pursue the later , carry a risk of being labelled as unethical in near future. However ,experienced cardiologists will know where the truth lies.
Now,in the interventional cardiology board rooms there is a big debate going on regarding the value of early total revascualrisation in STEMI with multivessel CAD.Suddenly , every lesion looks suspect ( Ex,current or future culprit ! ) and all stentable lesion are stented either in an emergency or semi emergency fashion (The new age post PC...
Source: Dr.S.Venkatesan MD - June 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -unresolved questions Primary PCI diferred pci for non ira ira non ira culprit vessels multivessel pci in stemi Source Type: blogs
Yes, Its official , medical mistakes consume more human lives . . . and threaten to displace cancer and heart disease for the top honor !
We all know to err is human , but most of us probably won’t agree medical mistakes , (bulk of which happen in the name of practicing state of the art of science ! ) could be the dominant theme in modern medical care !
BMJ exposes this well known secret with the help of most authentic data from an apex scientific body CDC , Atlanta .
Reference
http://www.bmj.com/content/353/bmj.i2139#
Source: Dr.S.Venkatesan MD - May 5, 2016 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -guidelines Cardiology -Patient page cardiology -Preventive Cardiology quotes medical quotes Uncategorized Source Type: blogs
Which is the “side branch” for Left main ?
Bifurcation lesions (BFL) remain a true challenge to interventional cardiologists. For over two decades , at least a dozen strategies are being tried to conquer it without true success
. . . if iam allowed to say that.
We often we talk about side branch in BFLs.Ironically , the importance of side branch is largely determined by our cortical linguistic perception of the word “side”
The much famed Medina classification does little to clarify the importance of side branch with reference to left main vs non left main bifurcation lesions.
In true sense , both LAD or LCX can be side branches in left main BFL dependi...
Source: Dr.S.Venkatesan MD - May 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
