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Source: Dr.S.Venkatesan MD

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Total 596 results found since Jan 2013.

Learning new lessons from a stressful “ ST segment ”
This is the Incidental ECG of an apparently healthy 50-year-old businessman, recorded while  applying for health insurance How will you describe this ECG? Let me magnify it for you    Why this big fuss about this ECG?  Such ECGs are so common. Looking at the ST segment, we are supposed to think of significant CAD,, LVH, Aortic stenosis or variants of cardiomyopathy, and sometimes electrolytic shifts. The fact that it is recorded at rest, and the patient is absolutely asymptomatic, it is very unlikely there is ongoing ischemia.It could be a myocardial origin or an unk...
Source: Dr.S.Venkatesan MD - April 22, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized non specific st segment Source Type: blogs

Localising WPW : Take it EASY
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself . How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself. One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm Source Type: blogs

Localising WPW : Take it EASY always
If some body is struggling with same problem, say for over three decades , there is something seriously wrong with the way we deal with the problem or there is some problem with the problem itself . How do you localise accessory pathway in WPW syndrome from 12 lead ECG ? is one such entity, This question is asked exclusively in cardiology board exams. Now a 2023 paper from EUROPACE claims, it has come out with a simple algorithm bettering all the previous ones. Please check it for yourself. One thing we can say with conviction is most of these embryological remnant pathways are posteriorly or laterally dragg...
Source: Dr.S.Venkatesan MD - April 15, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized WPW syndrome 12 LEAD ECG LOCLISATION IN WPW SYNDROME arruda scheme easy wpw algorithm Source Type: blogs

Pre-operative cardiac fitness : No, it is not acceptable , you are not authorised to do this !
A 62-year-old man who is being scheduled for prostate surgery with no cardiac risk factors or comorbid status came for surgical clearance. I examined him and took an ECG, everything was fine and gave him clearance for surgery.  I was surprised to spot him the very next day, waiting in the lounge of my office. He said, his anesthetist was not happy with my pre-op-cardiac assessment report, suggested it was incomplete, and sent me back for echocardiography to know the LV ejection fraction. I wanted to clarify with the patient, what exactly happened when he met his anesthesiologist. “I am not sure doctor, the momen...
Source: Dr.S.Venkatesan MD - April 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiac surgery Cardiac fitness for non cardiac surgery preoperative cardiac risk assesment surgical clearance and cardiac fitness Source Type: blogs

ERS pattern in ECG : New-onset “ Iatrogenic panic ” is unwarranted !
This is an ECG of a 25-year-old, recorded in master health check-up.  It was reported as ERS pattern of concern. When he went for an expert opinion, he was suggested to understand, there is a small risk of SCD. That’s it, the panic has set in already, which got amplified in the following conversation.. How small is the risk,?  he wanted to know. Yours’ is possibly an intermediate risk. Intermediate means what?  Do I have any genetic or EP studies to predict the risk accurately? Sorry, we have some gene mapping but all primitive. We aren’t sure. But keep calm, nothing will happen. Do I nee...
Source: Dr.S.Venkatesan MD - March 23, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ers pattern in ecg ERS syndrome Source Type: blogs

ERS pattern in ECG : “ Iatrogenic panic ” is unwarranted !
This is an ECG of a 25-year-old, recorded in master health check-up.   It would be mind-boggling to know the prevalence of such ERS patterns in the general population. One estimate suggests it could be anywhere between 3 to 13  % depending upon the criteria used. Let us assume the mean as 5 %. Then, it would be 30 crores of human beings in our habitat show this ECG pattern. If applied, in my city Chennai alone 5 lakh people could carry this tag. While it is true, some forms of ERS and J wave syndrome can be markers of serious ventricular arrhythmias, either spontaneous or at times of Ischemia. Curr...
Source: Dr.S.Venkatesan MD - March 23, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ers pattern in ecg ERS syndrome Source Type: blogs

Learning targeted IAS puncture in 20 minutes
The main reason for all those jitters, we cardiologists, get every time we puncture the IAS is not due to a lack of expertise and experience perse. There are two more reasons. First and foremost, it is still largely a blind* procedure. (Even in this era, where drones with HD vision shoot one-meter targets from a 1000 KM range )  *TEE and ICE are there, but they rarely give enough confidence.  The second reason is more important and is rectifiable. It is the perception error in our anatomical cognition, that is fed to us from first-year medical school. We are made to believe (at least to people like me ) The right atrium...
Source: Dr.S.Venkatesan MD - March 10, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Uncategorized ias puncture right vs left atrial anatomy Source Type: blogs

P wave spotting in AF is not forbidden
Fibrillation is a continuous, chaotic muscular activity. In AF, atrial muscle is expected to lose all coordinated contractions with fibrillatory waves replacing P waves. Have you ever spotted a suspicious  P wave in a strip of otherwise explicit AF?  If not, this write-up is not for you. An evolving rare theme in Atrial fibrillation  Have a look at this ECG  Here is an ECG, that was reported as AF, multiple APDs, or Possible AF, Pre AF. I suggested the term AF in transition. While few agreed, many said it is a straightforward SR with APDs, making it appear irregular RR.  But, the fact of ...
Source: Dr.S.Venkatesan MD - March 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cardiology research topics for fellows causes of absent p wabes p vs f waves in af p waves in atrial fibrillation research topics in atrial fibrillation Source Type: blogs

LA volume assessment : A critical parameter with a time trouble !
LA dimension and volume have become vital parameters in recent times, especially, with the entity of HFpEF is becoming so common. LA not only acts as a live barometer, reflecting all that happens in LV, but it is also a chronic marker of LV diastolic function. (Funnily referred to as HBA1c of diastolic dysfunction)  What is normal LA dimension & volume ?  Normal left atrial diameter < 4.1 cm in men or < 3.9 cm in women Normal left atrial volume indexed for body surface area (BSA) is 34 ml/m2 for both women and men  Which part of the cardiac cycle do we measure?  Ever since Wiggers intr...
Source: Dr.S.Venkatesan MD - February 8, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology Illustrations cardiology physiology Left atrial enlargement Uncategorized LA end diastolic dimension la end diastolic vs end systolic dimension LA end systolic dimension la pressure volume loop LA volume by mri normal LA dimen Source Type: blogs

Primary PCI and its silent encounter with “ myocardial neutrophilia ”
Myocardial infarction,  a gross pathological entity renamed now as STEMI for clinical purposes, is the most famous medical emergency that triggers a series of calls. Right from 911/First medical contact, the ER, that ends up in CCU or a 24/7 cath lab. The heart, can’t wait for all these external responses when it is challenged with a vascular accident. The moment ATO occurs, two things happen. The endogenous fibrinolytic led by native tissue PA (Tpa) tries to get rid of the thrombotic plug by all its means. It succeeds in 15%. We call it spontaneous lysis or aborted MI. Many lives are lost in the remaining before th...
Source: Dr.S.Venkatesan MD - February 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized myocardial neutrophilia Source Type: blogs

Furore over FOURIER is (un)warranted : Evolocumab is an Innocent molecule !
Welcome back to the big molecular science of PCSK and its antagonist Evolocumab, a monoclonal antibody designed to target and prevent the LDL receptor catabolism inside the lysosomes. Evolocumab was approved by FDA for aggressive lowering of LDL, following a  customary study published in NEJM 2017, that released this double-edged anti-lipid molecule into the human domain with all fanfare. It aimed to reduce the LDL as low as possible in selected patients with familial LDLemia & and those who don’t tolerate statins.  Now, a study was silently released in BMJ open, at the fag end of 2002, which is causing ripp...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: lipid metabolism evolocumab fourier study how low ldl can go inclisiron lipid guidelines acc aha esc csi Source Type: blogs

Take a break from cardiology : How to debate a complex topic in a forum ?
Pardon ,this video is nothing to do with cardiology. It is from the archives of the United nations library .This can teach some important lessons in art of communication , sharing to all folks, especially medical students. It was recorded in 1959 in Newyork, UN head quarters.Four 17 year old school girls & boys were invited for a debate on a complex topic. Does God exist ? How do you pray ? and what is the purpose of different religions ? I keep wondering , how these youngsters accumulated so much wisdom and express it in such a polite manner too. Mind you, this was recorded , when learning happened with ...
Source: Dr.S.Venkatesan MD - January 16, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized evidence based cardiology medical education religion and god medical profession Source Type: blogs

Missing links in IHD : What is the relationship between Ischemia & cardiac arrhythmias ?
The term Ischemic heart disease (IHD) was once very popular, but many abandoned it as it became an academic cliche.  CAD & CAHD are the other terms that are equally popular and prevalent. Stable IHD was in vogue till recently, which was again replaced by “chronic coronary syndrome’ now. Honestly, I feel the original term IHD to be restored however outdated it may look. it encompasses the entire spectrum of clinical cardiac disorders. Manifestation of Ischemia heart disease  Angina Infarction Cardiac failure Arrhythmias  Silent ischemia Sudden cardiac death  The ...
Source: Dr.S.Venkatesan MD - January 5, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions Cardiology-Arrhythmias Relationship between Ischemia and arrhytmias Source Type: blogs

Reviewing top 10 Interventional papers of 2022 : A good lesson on NSTEMI management
Conclusion is pasted for the busy guys. Post-test What is overall NSTEMI in-hospital mortality? (Everyone knows for STEMI it is around 4-8 %, no one seems to be sure about NSTEMI. I think it can’t be estimated accurately, guess it is 1 -2% ) Is there a primary PCI equivalent situation in NSTEMI?  What are they? (Left main UA with AVR ST elevation comes first on the list) Based on the urgency to treat how does the ultimate outcome change? (This is what this meta-analysis by Kite et all proved.It is not a new revelation though . Recall the landmark ICTUS study  of 2010 which was ...
Source: Dr.S.Venkatesan MD - January 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha nstemi nsteacs guidelines Source Type: blogs

Happy new year & memories of 2022 !
Wishing every one of you an Enlightening New year. As we begin a new journey around the sun, yet another time, let us re-dedicate ourself, to use science, for the welfare of our planet & people. Thank you , for visiting this site and make all its worth. Just one memory of 2022, lingers ! Retired and left Madras medical college,Chennai after 3 decades, which grew me up as a Cardiologist.
Source: Dr.S.Venkatesan MD - January 1, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs