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Sex differences in Idiotic behaviour , If its true , does this spill over in professional decisions too ?
This article concludes, Yes, men  . . . indeed  tend to take some foolish risks in various life situations that result in potential harm. What is the influence of MIT on medical profession and patient outcome ? Now , Iam compelled to ask  a hypothetical question .Does women medical professionals take  less aggressive stance and low risk taking behavior  and in the process result in less mortality and morbidity to our patients  ? I would think the answer to that question  would be in affirmative .I wish  BMJ or anyone  should design a study on this issue. Reference 1.Harris CR, Jenkins M, Glaser D. Gender differen...
Source: Dr.S.Venkatesan MD - February 7, 2016 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Gender issues in medicine Hippocratic oath history of cardiology Histroy of medicine medical quotes Wintage cardiology medical ethics gender issues Source Type: blogs

How common is syncope in cervical spondylosis ?
Dizzines , giddiness , light headedness , fear of fall or true fall (Syncope) are the  most common symptoms beyond middle  age .They usually end up with consulting physicians , neurologists and cardiologists .Cervical disc is commonly blamed for this.While all these symptoms can be a manifestation of cervical disc , true syncope seems to be rare with cervical spinal disorder. Why true is  syncope rare with  cervical spinal narrowing ? There is a fundamental ignorance here. We are not yet clear  whether giddiness /dizziness is neural or vascular .(Or combinations of both ) in cervical spinal disease. Many of the patie...
Source: Dr.S.Venkatesan MD - January 31, 2016 Category: Cardiology Authors: dr s venkatesan Tags: Syncope cervical vertigo mechansim of syncope in cervical spondylosis syncope evaluation syncope in neck compression Source Type: blogs

Admixture lesions in congenital heart disease : “It’s still difficult” to understand isn’t ? !
What are the mechanisms of cyanosis in  cyanotic heart disease ? Most of my fellows have difficulty in answering this question. (It is not the lack of knowledge though !)  In my view ,cyanosis can occur , by six  different  modes Reduced pulmonary blood flow  with some form of anatomical obstruction in RVOT with a communication between ventricles  (TOF physiology  ) , atria or both Reduced pulmonary flow with obstructive pulmonary vasculature (Eisenmenger physiology ) Wrong way origin ( RV to Aorta/LV to Pulmonary artery ) : Transposition physiology Simple mixing of arterial  and venous  blood channels within the...
Source: Dr.S.Venkatesan MD - January 19, 2016 Category: Cardiology Authors: dr s venkatesan Tags: admixture lesions in cyanotic heart disease cardiology -congenital heart disease Tetrology of Fallot admixture lesions in congenital heart disease can left to right shunt cause cyanosis ? mechansim of cyanosis mechansim of cyanotic heart disea Source Type: blogs

Post-CABG wall motion defects : Mechanism and implication.
Wall motion defect , in patients after CABG is fairly common.These  defects are difficult  to interpret  as the mechanisms can be multiple.Though the commonest wall motion defect appears to  involve the interventricular septum. it can occur anywhere in antero-lateral zone. The mechanism attributed is  the effect of pericardiotomy , which surgeons as we understand leave it open after grafting  .This can cause lack of localised ventricular interdependence and results in a a brisk septal movement (bounce )It is an indirect effect . Note the, wall motion defects are confined to the exposed areas of the heart during cardi...
Source: Dr.S.Venkatesan MD - December 25, 2015 Category: Cardiology Authors: dr s venkatesan Tags: CABG Cardiology -unresolved questions Echocardiography - LV dysfunction echocardiography following cabg paradoxical wall motion defect in ivs septum cabg post cabg wall motion defect Source Type: blogs

Inferior STEMI : Is it RCA or LCX , and why we need to bother ?
Inferior STEMI is as  common as Anterior  STEMI .Unlike the anterior  STMI  which  auto localises  to LAD , inferior STEMI has to be fixed either RCA or LCX. Following ECG features help localize Inferior STEMI  . ST elevation in lead 3 > lead 2  suggest RCA (Not always true ) ST depression in lead V1,V2,V3 strongly suggest LCX. (More objectively the sum of  ST depression in V1, 2 , 3 divided by sum ST elevation in 2,3, AVF ,  if less than 1 indicate LCX.   Or simply ST depression  V3 > Lead 3 indicate LCX.) ST depression in lead 1 indicate RCA ST elevation in lead V6 strongly suggest LCX Finally , an...
Source: Dr.S.Venkatesan MD - December 23, 2015 Category: Cardiology Authors: dr s venkatesan Tags: echocardiography Infrequently asked questions in cardiology (iFAQs) echocardiographic segments in lcx vs rca localising inferior stemi rca vs lcx Source Type: blogs

Aortic dissection : Its all about flaps, false-lumens . . . and fate !
What are the determinants of  dissecting  path   in Aortic dissection ?   Aortic dissection is  taught to us as a dramatic cardiac emergency where the blood  enters one of the planes of aortic wall and travels  in a random way . The wrong way blood instead of flowing within the lumen invades the vessel wall .(Vascular Tsunami ?) It may (or may not) leave the aorta at a distance resulting in various combinations of true and false lumen. Much like a tsumani  its also triggered by an energy releasing  blood pressure spikes hitting on the weakened  aortic wall rupturing the Intima. While acute dissection are o...
Source: Dr.S.Venkatesan MD - November 29, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions aortic dissection plane of aortic dissection tracking arch dissection Source Type: blogs

New hardware in thrombus capture : Megavac appear promising !
If thrombus is the chief culprit in any vascular emergency  there can be  no second thoughts as it needs immediate  arrest without warrant! (STEMI,Acute pulmonary embolism , DVT, Acute limb ischemia etc) Since pharmacological lysis of thrombus is easy and  be done immediately  it will continue to play a major role still , in many clinical situations that critically compromise organ function . However , large  thrombus burden  (or in which medical therapy fails to do a good job )  we must  intervene mechanically  to change the course of event.Though vascular surgery is a definitive option its always better we try ...
Source: Dr.S.Venkatesan MD - November 16, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Hadwares in cardiology Hardware techniques tips Newer hardwares in cardiology Technology Emerging coronary hardware distal protection device Thrombus capture megavac thrombus suction in pulmonary embolism Source Type: blogs

Come on folks . . . lets get confused about Ischemia , Injury and Infarct for a while ?
These are the common ECG terminologies with which clinical cardiology is being practiced over the years .In this era of instant interventions the exact meaning for these terms  may not matter much for many of us.Still , Ischemia could denote a more benign connotation , while injury suggests an emergency (like an accident) .Of course , this is a dangerous way of defining them. Still, there may not be an entity called  “chronic injury”. while chronic ischemia is all too common. Logistically , both  mean the same (except the perception) and related to the intensity of the index reduction in blood supply to the ...
Source: Dr.S.Venkatesan MD - November 8, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Basic sciecne Basic science -Physiology cardiology -ECG Electro physiology Electrocardiology -Basics Ischemia vs Injury in ECG subendocardial vs subepicardial ischemia and injury Source Type: blogs

I believe , this years Noble economic prize is actually for medical common sense !
This year’s Noble prize for economics was conferred  for Dr Angus Deaton  from Princeton,  for an unique revelation, that measurement errors in economic indices such as estimation of poverty and nutrition levels in society  is real and huge . The crux of argument (My version )  could be , data collection errors , planning with that contaminated data , sets in a chain reaction , that sustain a flawed intellect in young researchers , which  ultimately leads to human beings becoming  victim to their own  data . While Deaton addressed this in economic issues,  one can guess how critical these errors could be , w...
Source: Dr.S.Venkatesan MD - October 21, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Awards in medicine Ethics in Medicine Nobel prize Nobel prize for economics and medicine Source Type: blogs

I believe , this year’s Noble economic prize is actually for medical common sense !
This year’s Noble prize for economics was conferred  for Dr Angus Deaton  from Princeton,  for an unique revelation, that measurement errors in economic indices such as estimation of poverty and nutrition levels in society  is real and huge . The crux of argument (My version )  could be , data collection errors , planning with that contaminated data , sets in a chain reaction , that sustain a flawed intellect in young researchers , which  ultimately leads to human beings becoming  victim to their own  data . While Deaton addressed this in economic issues,  one can guess how critical these errors could be , w...
Source: Dr.S.Venkatesan MD - October 21, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Awards in medicine Ethics in Medicine Nobel prize Nobel prize for economics and medicine Source Type: blogs

If CTO is safe , should we allow all PCI ineligible ATO to evolve as CTO ?
Hot debate in STEMI Acute total obstruction (ATO) of coronary artery is an emergency .Opening it  by pharmacological or catheter is the  standard ( logical ) protocol.However, time plays a crucial role in this coronary re-perfusion game.It can either be a sure shot of success or end up in total spoilsport. One more issue as important as time is from the overflowing scientific data  fired  by different regulators  in conflicting directions  (Also called knowledge) . What to do with STEMI coming late ? ATO with cardiogenic shock is an  absolute emergency at any time. Symptomatic ATO  other than CS beyond 24 hrs stil...
Source: Dr.S.Venkatesan MD - October 20, 2015 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome cto chronic total occlusion open artery hypothesis ato vs cto management stemi Source Type: blogs

Anatomical encounters of Aortic valve with bundle of His : An Illustration
Car tyres warrant  replacement  every  20,000 km or so .Its batteries do require periodic attention. Human heart , which runs non stop from womb to tomb . . . deserves how much ? Unfortunately no one (What about your cardiologist?) can  provide  a flawless lifetime maintenance contract to this restless bio-mechanical pump ! Fortunately still, God has  created this wonder organ ,that can with stand the stress of life for nearly 10 decades . . . if we live a proper life ! However ,there are many areas in heart that are prone for mechanical stress even if it’s structurally normal .These are  the zones where the r...
Source: Dr.S.Venkatesan MD - October 17, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Complete heart block anatomy of complete heart bock aortic root valve stress aortic valve calcification aortic valve sclerosis calcific aortic stenosis mechanism of complete heart block tavr stress on his bundle Source Type: blogs

What are the causes and mechanism of diastolic mitral regurgitation ?
Mitral regurgitation is expected to occur only in systole during  left ventricular contraction. In rare pathological states , if   LV pressure exceeds the mean LA pressure at any point in diastole , small  puffs of regurgitation into LA can occur.The genesis of this MR and its  hemodynamic  significance has generated much interest . Causes Aortic regurgitation -Severe . (Occurs mainly in acute AR or chronic AR with decompensated LV ) AV blocks (especially complete AV block ) Any cardiomyopathy with severely elevated LV diastolic pressures Mechanism No single mechanism is  responsible. Common hemodynamic denominat...
Source: Dr.S.Venkatesan MD - October 11, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Aortic regurgitation Hemodynamics Infrequently asked questions in cardiology (iFAQs) Uncategorized austin flint and diastolic mitral regurgitation diastolic murmur in complete heart block reverse diastolic av gradient Source Type: blogs

Mechanism of AV block in common AV canal defect
Failure of  enocardardial  cushions  to separate and reach the  predesignated destination  ie  right and left AV valve is the basic embryological feature in AV canal defect .This brings whole AV ring  down and stretches the distance between  the semi-lunar valve (especially aortic)  with that of LV , thus elongating  the LVOT into a classical  goose neck deformity.The defect  has a profound  impact on how the AV node and its branches penetrate the ill-formed AV junctional tissue and fan out into the ventricle. There are  four basic issues  that are responsible for the various conduction defects in AV canal d...
Source: Dr.S.Venkatesan MD - October 11, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Animations common av cana;l defect conduction system in common av canal defect mechansim of left axis deviation in av canal defect Source Type: blogs

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