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Source: Dr.S.Venkatesan MD

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Total 596 results found since Jan 2013.

It is not Brugada for sure , I am just suspecting it . . . what to do ?
Have you felt like this query any time in your office ? If “Yes” is your answer, then you are not alone .There was a unique  conference  that  took place  in 2010 to answer the same query in Rome , Italy on behalf of Italian cardiology society  , where this entity is researched more than any other place.Its worth going through this. Reference 1.Doubts of the cardiologist regarding an electrocardiogram presenting QRS V1-V2 complexes with positive terminal wave and ST segment elevation. Consensus Conference promoted by the Italian Cardiology Society.Oreto G1, Corrado D, Delise P, Fedele F, Gaita F, Gentile ...
Source: Dr.S.Venkatesan MD - April 26, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Brugada syndrome Cardiology - Electrophysiology -Pacemaker early repolarisation syndrome consensus conference brugada syndrome how to follow up brugada pattern ecg suspected brugada syndrome Source Type: blogs

Expandable sheaths and catheters : Does a python act !
Interventional cardiologists in one way be labelled as intra-cardiac and intra-vascular civil engineers.Their primary  job is to create ,or close vascular tunnels and holes in various locations within the heart.How to deliver the  working hardware  to the  site of action ?. Temporary bridges ? .The vascular access is through long sheaths though which , wires, catheters, and devices , valves  are transported. It’s the key supply line to the ultimate battle field of life , right inside the beating heart.  . So far,the sheaths  and catheters were rigid tubes with a fixed diameter.Innovative sparks come from  str...
Source: Dr.S.Venkatesan MD - March 29, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cath lab Hardware Hardware techniques tips balloon expandable sheath innovations in cathlab hardware Source Type: blogs

How do you shoot a troubled pacemaker ?
We have been taught right from first year cardiology residency  how to trouble shoot a pacemaker .It has been a real complex thing for us. Now looking  back ,all the troubles we took to understand seems to be redundant.Here is a summary of my thought process on the issue. It can be approached  with reference  to time, symptoms and ECG features.  With due respects to all those brainy hardworking   EP experts  , I have taken few academic liberties! Timing Within 24 hours -100% technical or procedural Issues , like lead dislodgement/Screws and nuts. Within 1-2 week – Again technical , Pocket issues , Infectio...
Source: Dr.S.Venkatesan MD - March 22, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker Pace maker Tips and tricks atrial lead issues in ddd pacing best pacemaker tips and tricks capture failure pacemaker dc shock in pacing rhythm ddd vs vvi pacing intermittent pacemaker spikes pacema Source Type: blogs

How much Irregular ventricular tachycardia can be ?
We know , any wide QRS tachycardias  would argue us to make a default diagnosis of VT.But,  one has to be extremely cautious to apply this rule if  wide QRS  tachycardia shows  significant irregularity in RR interval . All classical VTs are a fairly regular tachycardia (Note the  key words , fair and regular) . Small cycle length variations are observed in VT  but they are usually not discernible in surface ECG. There are no practical rules .A well  appreciable  irregularity in RR interval will seriously  question the diagnosis of classical VT. To make an another statement, most of the  irregular wide QRS tachyc...
Source: Dr.S.Venkatesan MD - March 15, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker WPW syndrome wide qrs irregualr tachycardia wide qrs regular vs irregular tachycardia Source Type: blogs

ICD dilemmas : Single or dual chamber ? How to choose ?
ICDs are primarily life saving devices.Whether single or dual chamber  it does this function  effectively.They will also  take care of  bradycardia by  default  back up pacing .For most indications single chamber ICDs are good enough. My professor used to tell us , dual lead  means ,  dual expertise , dual cost , dual caution and  dual set of complication . One should avoid it whenever possible. Make things as simple as  it could be , without compromising the main goal (Here prevention of SCD) . The incidence of inappropriate shocks being lesser with dual chamber ICD  has not been truly  realised in real world ...
Source: Dr.S.Venkatesan MD - March 7, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker ICD dual vs single chamber ICD Indication for ICD Which ICD to choose Source Type: blogs

Essential cath lab hardware : Snares and retrieval of foreign bodies
We are aware  , modern day cardiologists literally live within the patients coronary artery and vascular system .  It ‘s not at all surprising then , man made cardio vascular accidents  are becoming more common  , where pieces of hard ware like guide wires catheters and stents  get trapped . Knowing about the hardware and techniques of retrieval of foreign bodies within vascular system is so important .It would appear  indulging in cath lab work with out proper salvage hardware and expertise is a  near  serious offense.Apart from this , many complex procedures require intentional snaring of wires and gadgets ...
Source: Dr.S.Venkatesan MD - March 4, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Hardware techniques tips coronary snare ev3 covdien medtronic gooseneck snare guidewire retrival how to retrieve a broken stent or guidewire within coroanry artery micor coronary snare Source Type: blogs

A crazy cardiology tweet and a wish !
I was recently asked to suggest a topic for debate on STEMI in  a major Indian cardiology conference. I wished , this is what we  should be mulling  over, with a set of  virtual  guest lectures and special invitees from heaven ! Plenary  session : State of the Art  STEMI care             Time :  11.AM ,  Speaker : Dr Hippocrates Topic : Aren’t  we erring   on either side of the  Noble profession ? Moderator:  Dr. William Osler Chairperson :  Dr .Harvey Cushings, Dr,Sir Thomas Lewis ,Dr Paul Wood , Excerpts : “While , vast number of  our country-men’s  culprit artery doesn...
Source: Dr.S.Venkatesan MD - February 27, 2015 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics cardiology tweet ethics in cardiology stemi care Source Type: blogs

Atrial fibrillation during STEMI : Don’t get alarmed
Atrial fibrillation is the most  common arrhythmia we encounter in clinical cardiology .Ironically it is  uncommon during ACS and extremely rare in association with UA/NSTEMI. Surprisingly , an entity ” Ischemic AF” is not to be found in cardiology literature. The incidence of AF in STEMI is less than 5%. Occurs more often due to factors other than primary ischemia of atrial musculature. Of-course , AF in association with Infero posterio MI and RVMI is an important trigger for AF.LCX disease is more often associated with AF as it gives up a consistent branch to left atrium. Though it is tempting to implicate ...
Source: Dr.S.Venkatesan MD - February 25, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation Infrequently asked questions in cardiology (iFAQs) atrial fibrillation in stemi management of atrial fibrillation during stemi Source Type: blogs

Forward looking IVUS : A catheter with a camera on its leading edge !
Cardiologists do magic inside the human coronary artery , that too in a  live beating heart , unlike the surgeons.Blocks are removed , holes are closed, valves are inserted ,  scars are burnt, new electrical connections  are laid .They do this with relative blind vision with good degree of success. Still, as we aim for more precise interventions we require excellent imaging  modalities to assist us. In the PCI of CTO(Chronic total occlusion)   the critical element to know  is , what  exactly  we borough ?  as we navigate  through complex, often hard shapeless tortuous tissue tunnels  . Our patients will be  sur...
Source: Dr.S.Venkatesan MD - February 22, 2015 Category: Cardiology Authors: dr s venkatesan Tags: cath lab tips and tricks ivus Newer technology cmoc ivus catheter cto intervention forward looking ivus catheter tips and tricks i ivus Source Type: blogs

I am confused sir , what is the hierarchy of medical advisories ?
In this era of synthesized evidence base,  one of my  intellectually aberrant  student asked  How can we indulge in  a popular coronary procedure   with  class 1 indication backed by level C evidence  ?   (As defined by  the seemingly invincible  guideline committee  of various  International cardiology organizations .) I told him , Institutional protocols are to be followed Guidelines are to be respected Recommendations are to be considered Please be reminded  all of the  above can be rejected  outright ! Finally , realise  Individual  decisions based on sound scientific understanding with zero non...
Source: Dr.S.Venkatesan MD - February 21, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines Infrequently asked questions in cardiology (iFAQs) evidence based medicine guidelines vs recommendatios instituional protocols medical ethics Source Type: blogs

Pulse rate in ventricular bi-geminy : A missing link ?
Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='https://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader'));   Answer : Most probably  B . What we feel in peripheral pulse ,  is one weak and the one strong beat in sequence .The later is due to post VPD potentiation. Since there is a compensatory pause , ECG rate (Number of QRS complexes /mt)  and pulse rate are ...
Source: Dr.S.Venkatesan MD - February 17, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Auscultation Cardiology -unresolved questions absent s 2 in pulse deficit effect of vvpd on aortic and mitral valve closure heart rate in bigeminy mechanism of pulse deficit more s1 and less s2 paired pacing and vpds pulse deficitin bigemi Source Type: blogs

Determinants of gradient across coarctation of Aorta
The gradient across coarctation  is not  simply (& solely ) determined by degree of obstruction , as one would believe.Understanding the hemodynamics and various factors that can influence the gradient is essential .Relieveing the  obstruction /gradient by stent or surgery  may not be synonymous with successful treatment as we understand now the entire aorta right from the root to abdomen can influence the gradient ,along with systemic factors.We also know , some of these patients harbor histological abnormalities in the entire stretch of  Aorta  what is  being  referred to as pan aortopathy  , that may influe...
Source: Dr.S.Venkatesan MD - February 16, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases coarctation of aorta Infrequently asked questions in cardiology (iFAQs) collaterals in coarctation cp stent in coarctation effect of bicuspid valve on coarctation gradient effect of ht on gradient in coarctation gradient acro Source Type: blogs

It looks like adult cardiologist should avoid doing pediatric echocardiograms !
A cardiologist  is  a physician who has  trained himself  in a special  way  to deal with any problem of heart.Ironically , it exists only on paper.The field has developed so vast  no one can master everything .There is no such  “Pan or global cardiology expert” .In fact it would be shortly become unethical to try to become one ! Pediatric cardiology  has developed into such a big field , doing a echo in newborn or  infant has become a comprehensive job and  requires  special talent .This unique  and excellent study from Narayana Institute , Bangalore published in the  prestigious Annals of pediat...
Source: Dr.S.Venkatesan MD - February 14, 2015 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Therapeutic dilemma cardiology-ethics adult vs pediatric echo report echocardiography expertise required errors in echo report errors in echocardiography ethical issues in cardiology inadequate echocardiogram incom Source Type: blogs

Where is the run off in Aortic regurgitation ? Is it central or peripheral ?
We know aortic regurgitation causes  a deluge of   hugely popular peripheral signs of aortic run off  , which are taught  right from 2nd year medical school. When the aorta  leaks it reflects in the entire vascular tree .How is that a  leak in the remote aortic valve cause a quincke’s to and fro pulsations in the fingers pulp ? Is the blood in the finger  trying to follow  the regurgitant  jet  that  go back into left ventricle ? Does the to and fro murmur of  Duroziez over the  femoral artery imply  there is reversal of  blood flow in femoral artery ? Things are  little complex than it appears It ...
Source: Dr.S.Venkatesan MD - February 13, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases Aortic regurgitation Cardiology - Clinical arterial pulse in aortic regurgitation diastolic run off in aortic regurgitation mechanism of collapsing pulse in aortic regurgitation peripheral run off peripheral systemic arteriol Source Type: blogs

Ignorance based Electro-physiology : Why chronic RBBB is a benign entity ?
In the last few decades  we have  understood a major concept in the genesis of cardiac arrhythmia.Slowing in the propagation of cardiac impulse is a key  trigger to precipitate a reentry circuit and initiate a tachy- arrhythmia.Still , many conditions like first degree AV block, chronic RBBB or even LBBB are  benign entities  as along as the heart is structurally normal .They seem never increase the incidence or life time risk of  cardiac arrhythmia . Longevity is unaffected.( Or do we assume many things ?) How is this possible ? or is the theory of slow conduction triggering reentry is flawed ? Think again . . . if ...
Source: Dr.S.Venkatesan MD - February 12, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker RBBB/LBBB bundle branch reentry eelctrophysiology ers pattern moes theory rentry mechanism sloe conduction and reentry theories on genesis of cardiac arrhythmias Source Type: blogs