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Source: Dr.S.Venkatesan MD

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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 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 depending u...
Source: Dr.S.Venkatesan MD - May 1, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Unlearning cardiology :Diabetes is not CAD equivalent
There can be no debate to call diabetes as major cardiac risk factor . But , how about calling all diabetics to be deemed (Rather doomed ) to suffer from CAD and label them  with a fanciful terminology as CAD equivalent ? This is what happened few years ago.From the beginging it was a controversial concept. The argument in favour of it was , many diabetics will have micro or macro vascular disease  process in coronary or peripheral disease which are sub-clinical .One major   study from Fiinish population  in (NEJM 1998 ;Ref 1 ) suggested this possibility and was dissiminated without proper scrutinty . The same Finni...
Source: Dr.S.Venkatesan MD - April 30, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

Comical concepts in cardiology : Prehospital thrombolysis is great , but its “no good” inside the hospital !
This happened  recently in one of my private ER visits. When I asked my fellow to lyse a patient with STEMI who arrived within 20 minutes after the onset of chest pain to our CCU. He was reluctant and surprised, seemed to suggest  thrombolysis is a banished indication. I asked him , is there any study that showed early , fast pre-hospital thrombolysis is as good as primary PCI ? True sir. . but these studies clearly say it is useful only if its done prehospitally sir, not inside the hospital or coronary care units.  I told him to think CCU as an ambualnce ,consider the patient is  in transit and  lyse him. He was amus...
Source: Dr.S.Venkatesan MD - April 26, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized STREAM Trial Nejm Source Type: blogs

When STEMI dressup like NSTEMI. . .cardiologists can easily be fooled !
The ECG changes in ACS are “as dynamic as”  the occluding thrombus.The initial events include  sudden total occlusion, early lysis , trickle of flow, partial re-occlusion , reflow, no-flow etc. The extent of transmural vs sub-endocardial injury, the competing force of re-perfusing and necrotic  wave front, would define  ECG findings making  the ST segment labile in early hours of ACS.This is also the basis of  some cases of  STEMI evolving into NSTEMI and vice versa. A 65 year old man  presented to with this ECG,   Does this ECG allow you to go ahead for thrombolysis ? It actually looks like NSEACS...
Source: Dr.S.Venkatesan MD - April 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -Therapeutic dilemma ecg in acs ecg in ccu NSTEMI NSTACS STEMI STEACS STEACS AND NSTEACS transformation of nstemi to stemi and stemi to nstemi Source Type: blogs

Sutureless AVR : Surgeons shed the needle . . . to take on TAVR !
With TAVR (Transcutaneous aortic valve replacement ) threatening to take away the Aortic valve surgery atleast in high risk subsets from surgical domain ,a new development is taking place in aortic valve surgery. Minimally Invasive aortic valve replacement and implantation of low profile , bio prosthetic valve placed in aortic root without active suturing .This type of AVR  can be done without traditional  sternotomy  with minimal bypass time , less surgical morbidity and mortality. It has some specific advantages over TAVR, as the native valve is removed , calcium is debrided and hence less stroke and para-valvular lea...
Source: Dr.S.Venkatesan MD - April 16, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Aortic valve replacement cardiac surgery percutaneous aortic valve vs surgical valve replacement should i go for avr or tavi ? tavr vs avr Source Type: blogs

Why we may “never-ever” understand the seriousness of NSVT in HOCM ?
Hypertrophic cardiomyopathy (HCM) is the most common primary cardiac muscle disorder.It is one of the  extensively studied medical  entity in terms of pathology, genetics, electrophysiology and treatment.Though it has dramatic myocardial  phenotypic expression , longevity  can be near normal  except in a minority who are prone for LV dysfunction and SCD due to the indirect electrical instability.These arrhythmia arise due to myocardial disarray , micro vascular disease or fibrosis. NSVT  by definition is runs of VT at a rate of > 100 /mt occurring less than 30 seconds. How common is NSVT in HCM ? On Holter study ...
Source: Dr.S.Venkatesan MD - April 3, 2016 Category: Cardiology Authors: dr s venkatesan Tags: hocm hcm how to manage non sustained vt in hcm hoc hypertrophic cardiomyopathy icd for nsvt managment issues in hocm nsvt in hocm sustained vs nonsustained vt in hocm Source Type: blogs

Critical management issues in CAD : OMG ! . . where is OMT ?
One of my fellows gave a discharge summary  for a 62 year old patient with stable diabetic  CAD  who had Triple vessel disease with a final advice reading as CABG / PCI/or OMT . There was a near fury over his angiogram report in the cath meet. How can be  eligible for all the three Intervention at the same time ?.(PCI -Percutaneous coroanry Inervention ,CABG-Coroanry artery by-pass graft, OMT-Optimal medical therapy ) The lesion in question was , Triple vessel disease(Non critical LAD) and significant LCX and again a non critical RCA .Syntax was less than 22 for sure , however the patient  had class 2 angina (now redu...
Source: Dr.S.Venkatesan MD - March 31, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) cabg vs omt oci vs cabg vs omt pci vs omt ptca vs medical vs cabg what is optimal medical management omt Source Type: blogs

Finally , Junctional tachycardia gets a proper definition
Junctional tachycardia(JT) is often a misunderstood arrhythmia. Technically,  any tachycardia arising from the AV junction could be termed as JT.Even AVNRT was considered as a form of Junctional tachycardia till recently.The crux of the issue is , true anatomical extent and borders of  so called AV junction is  yet to be clearly demarcated .The common perception that  AV node is a discrete  structure is  an anatomical illusion  , rather its collection of  condensed fibers with proximal  nodal approach and distal fanning . Now , we have a  proper definition by the apex scientific bodies  ACC/AHA/HRS 2015) Source ...
Source: Dr.S.Venkatesan MD - March 31, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Definitions Cardiology-Arrhythmias Electro physiology Infrequently asked questions in cardiology (iFAQs) acc aha hrs svt guidelines define junctional tachycardia jt definition of junctional tachycardia Source Type: blogs

Percutaneous balloon pericardiotomy :What is the anatomical track ? Where does the fluid drain ?
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Source: Dr.S.Venkatesan MD - February 24, 2016 Category: Cardiology Authors: dr s venkatesan Tags: cardiac tamponade Cardiology -Therapeutic dilemma Pericardium balloon pericardiotomy percutaneous baloon pericardiocentesis Source Type: blogs

History of cardiology : Great women cardiologist of our times : Jane Somerville
The field of cardiology has seen great men over the centuries. Few women have permanently stamped their presence  in that history .Jane Somerville can be termed mother of pediatric cardiology along with Maude Abbott She has a fascinating life history , having  worked  in Royal Brompton  , Imperial  and Guys London.She was mentored  by  pioneers like  Paul wood , Blalock and others .She is primarily interested in the pediatric cardiology especially congenital heart surgeries .The classification  of pulmonary atresia with VSD  goes with her name. Dr. Jane Somerville : British cardiologist , (b-1933 ) She carries th...
Source: Dr.S.Venkatesan MD - February 7, 2016 Category: Cardiology Authors: dr s venkatesan Tags: congenital heart disease history of cardiology Jane somerville pulmonary atresia jane somerville Source Type: blogs