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Source: Dr.S.Venkatesan MD
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Recannalised IRA : When God’s hand is natural aspiration catheter . . . better show restraint .
“Oh , it’s a well recannalised IRA and its flowing TIMI 3 as well. Now, what shall we do sir” ?, An apparently worried senior resident queried after a second look at the images from a 8 hour old STMEI .Why you sound unhappy man ? As if recanalisation is an untoward event” ! I teased my resident !
and went on to ask . . .
What we mean by recannalised IRA ? (Recan-IRA)
It is akin to natural or pharmacological angioplasty (or combination of the two )
It can be complete or incomplete from the IRA perspective.
It can either result in partial or fully salvaged myocardium.
It should be unde...
Source: Dr.S.Venkatesan MD - October 2, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Dengue circulatory shock : What is the mechanism ?
Dengue is a global infectious disease caused by Flavivirus (RNA) transmitted by day biting mosquitoes Ades aegypti .It is primarily a tropical or sub tropical disease , India is marked among the epicentre . 75% of dengue infections are asymptomatic. Among the remaining 25 % only 5 % develop severe dengue and a fraction of them go for a dreaded circulatory and bleeding complication leading to a likely fatality.Severe hypotension is the hall-mark in dengue shock .
The mechanism of shock
The sine-qua non of dengue shock is the capillary leak syndrome .This is due to some unknown vascular toxins acting in micro cir...
Source: Dr.S.Venkatesan MD - October 1, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions dengue myocarditis mechanism of dengue shock myocardial involvement in dengue Source Type: blogs
Practical Pacemaker tips: Is mid-septal lead position . . . a fluoroscopic mirage ?
Pacemaker implantation is one of the few high impact interventions done by cardiologists.Traditionally , RV apex was paced for many decades with tined or screwing leads. Serious concern was raised in recent years about the ideal site of pacemaker lead position. .Today, some argue pacing RV from RV apex is a electro-physiological crime (Of-course it appears more of hyped up fear ! )
What is the concern with RV apical pacing ?
RV apical pacing is unphysiological .To mimic physiology we have to move the lead as cranial as possible within RV. (*Obviously pacing anywhere in RV is non-physiological .Best would be a...
Source: Dr.S.Venkatesan MD - September 11, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Pace maker Tips and tricks how to postion pacemekr lead in mid septum ? mid septal lead position pacemaker tips and tricks rao vs lao view for mid septal pacing lead rv apex pacing rvot pacing Source Type: blogs
Why the concept of “Primary prevention” of CAD is Intrinsically flawed ?
CAD is the principle human cardio vascular disease, that God has created in Homo-sapiens to ensure they do not stay more than “allotted life span” and create havoc in this planet.We essentially live in our blood vessels and age in our arteries. Of course , the current generation cardiologists equipped with scientific weapons , have since decided to take the fight directly in the Almighty’s domain .Contrary to the popular medical doctrine, treating an established CAD seems to be easier task than preventing a new onset CAD.
While , arteriosclerosis is a normal aging process, atherosclerosis could be an...
Source: Dr.S.Venkatesan MD - August 15, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Preventive cardiology Primary prevention of CAD Primary prevention study on aspirin primary vs secondary prevention of cad primordail prevention of cad what is priamry prevention of cad ? Source Type: blogs
What is the Impact of Aortic annular dilatation on TAVR ? Does it carry a risk of dislodgement ?
TAVR is the new state of the art Aortic valve replacement procedure done by cardiologists .Nearly 200 thousand implants have been done , and it is
backed up by major trials What keeps the Aortic prosthesis in situ in the aortic root/Annulus ?
The valve is not actively fixed but passively positioned in aortic root by either self expanding or balloon expanded valve system .It retains the position by two different forces acting on the valve in two difffernt directions , but work coherently to keep the valve static .The radial force of the hardware is centrifugal and the elastic force exerted by annulus is centripetal .I...
Source: Dr.S.Venkatesan MD - August 7, 2015 Category: Cardiology Authors: dr s venkatesan Tags: TAVR /TAVI Para valvular leak following TAVR Percutaneous aortic valve replacement tavr tavi TAVR valve dislodgment displacement embolisation migration Source Type: blogs
What is the secret of carvidilol’s superiority in CHF over other beta blockers ?
Beta blockers(BBs) have become key drugs in management of CHF .It helps by blocking toxic effects of inappropriately elevated catecholamine , which is actually a compensatory response(A fight and survival reaction ) from the sympathetic system to a failing heart . This process becomes a liability in the long run as the adrenergic receptors either down regulate or even promote apoptosis and cell death .Along with RASS-ACE it affects every cell in the body promoting neuro- humoral catabolic state.
By trial and error methodology we have found blocking the sympathetic system by BBs confer con...
Source: Dr.S.Venkatesan MD - July 31, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Beta Blocker beta blockers in chf carvidilol vs metoprolol and bisoprolol How carvidilol is superior in chf cardiac failure Source Type: blogs
Why syncope is less common even in severe Mitral stenosis compared to Aortic stenosis ?
Syncope is a classical feature of LVOT obstruction especially with valvular aortic stenosis.The mechanism of exertional syncope in Aortic stenosis is traditionally attributable to the fixed obstruction .This fixed obstruction is not able to cope up with increased cardiac output as demanded by the exercising muscles . But exercise induced reflex as well as local vaso-dilatation mechanism is intact . The consequence is predictable. A critical fall in SVR amidst a obstructed LVOT precipitating a syncope.
However , If the above mechanism is the sole reason for syncope in Aortic stenosis , we have a problem to explain why sy...
Source: Dr.S.Venkatesan MD - July 26, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic stenosis cardinal symptom in cardiology Cardiology -Clinical signs Clinical cardiology Syncope lvit syncope lvot vs lvit syncope Mechanism of syncope in mitral stenosis and aortic stenosis mechanoreceptors in lfet Source Type: blogs
A Radial Trick : Strictly for advanced Interventional cardiologists !
Radial coronary interventions has become a global norm .Even complex procedures are being accomplished with ease adding on to the patient comfort and low risk for access site complications.However !occasionally we need to have multiple access sites to know the detailed real time contra lateral coronary anatomy is desirable .This becomes vital in the retrograde approach for CTO.
Want to have a quick glimpse of RCA flow while one is attempting LAD PCI without additional puncture ?
How about doing a contra-lateral angiogram with the same guiding catheter and wire in-situ within the ipsilateral ostia ? Here is an I...
Source: Dr.S.Venkatesan MD - May 20, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Chronic total occlusion Radial Interventions Tips and tricks in cath lab cath lab tips contralateral coronary angiogram radial tips and tricks radial vs femoral angiogram retrograde appraoch for cto Source Type: blogs
What is the effect of Inspiration on JVP and blood pressure ?
Image modified from http://www.anatomygallery.info
That’s normal . . . what happens during pathological states ?
There are important diseases that restricts entry of blood into right heart chambers. They can occur either in an acute (Tamponade) or in chronic fashion like constrictive pericarditis and restrictive cardiomyopathy.These entities show distinctive impact on JVP and systemic pulse.
The two pathognomonic signs are Kussmaul sign and pulsus paradoxus that go hand in hand in most situations.Inappropriate elevation of JVP with inspiration is termed as Kussmaul sign , while exaggerated fal...
Source: Dr.S.Venkatesan MD - May 10, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Clinical cardiology Jugular venous pulse pericardial disease bernhiem effect effect of inspiration on jvp kusmals sign kusmaul sign kussmal's sign Kussmaul sign pulsus paradoxus Reverse bernheim effect ventricular interdependence Source Type: blogs
Physiological Interventricular de-synchrony : Right ventricle contracts like an Intestine !
Right ventricle,being a venous chamber has distinct anatomical and physiological features to carry out this function.RV has a complex shape, its triangular in long axis and crescent like in short axis , thin (<5mm) more distendable .Contraction of RV begins slightly early but ends later than LV (30ms )
https://www.youtube.com/watch?v=GH5trHYjozI
RV receives blood from RA and ejects in to PA in a sequential manner .The inflow, body and outflow contract somewhat like intestinal peristalsis. This is facilitated by the incremental delay in the electrical depolarization of right ventricle.In physiological condi...
Source: Dr.S.Venkatesan MD - May 5, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Right ventricle best articles on right ventricle cardiac peristalsis physiological inter ventricualr desynchrony Right ventricle anatomy and physiology right ventricular sequential peristaltic contraction Source Type: blogs
Not just two funny quotes . . . but stunning medical truths !
These two quotes on practice of medicine are close to my heart , one from Voltaire , a non medical man (a French poet ) and the other from ,one of the greatest medical professional of our times, William Osler .
It is amazing ,how the thinking pattern of a philosopher and a true scientific professional living centuries apart are almost in sync with a great medical reality !
Source: Dr.S.Venkatesan MD - May 2, 2015 Category: Cardiology Authors: dr s venkatesan Tags: medical quotes Two line sermons in cardiology great medical quotes Source Type: blogs
J waves are not “Jitter” waves . . . they are “Just” another wave in ECG !
J point is a critical point in the ECG when the ventricles hand over the baton in the electrical relay race from depolarization to repolarization .This the time the sodium channels extinguish itself and the potassium current begins its activity from Phase 0 to 1 .
If the potassium channels activate little early and snatch the baton prematurely from sodium , we get early repolarization pattern .When this happens , the J point of ECG show a conspicuous wave called J wave , originally denoting Junctional wave between QRS/ST segment (Now perceived as Jitter waves ?) The other implication of premat...
Source: Dr.S.Venkatesan MD - April 26, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Brugada syndrome cardiology -ECG Cardiology-Arrhythmias early repolarisation syndrome ECG -Basics brugada syndrome and ers pattern overlap Fear of J waves in ECG j point in ecg j wave beingn waves j wave syndrome Jitter waves in ecg Source Type: blogs
J waves are not “Jittery” waves . . . they are “Just” another wave in ECG !
J point is a critical point in the ECG when the ventricles hand over the baton in the electrical relay race from depolarization to repolarization .This the time the sodium channels extinguish itself and the potassium current begins its activity from Phase 0 to 1 .
If the potassium channels activate little early and snatch the baton prematurely from sodium , we get early repolarization pattern .When this happens , the J point of ECG show a conspicuous wave called J wave , originally denoting Junctional wave between QRS/ST segment (Now perceived as Jitter waves ?) The other implication of premat...
Source: Dr.S.Venkatesan MD - April 26, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Brugada syndrome cardiology -ECG Cardiology-Arrhythmias early repolarisation syndrome ECG -Basics brugada syndrome and ers pattern overlap Fear of J waves in ECG j point in ecg j wave beingn waves j wave syndrome Jitter waves in ecg Source Type: blogs
