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Dr .K.A.Abraham : India lose a pioneering cardiologist
With deep regret, reporting the demise of Dr. KA Abraham, cardiologist, par excellence in our part of the world(Chennai, Tamil Nadu, India.) He was a man of great knowledge,  wisdom, and integrity and was an inspiration to generations of cardiologists like us. Dr.K.A Abraham 1942-2021 A life, that was fully dedicated to all those heart patients, many of them sick children in his den, the Railway hospital, Chennai for three decades. Though, never had the privilege to be associated with him either directly, nor does he know me, one could feel instantly the greatness and simplicity in him. It’s 1994-95, vividly recal...
Source: Dr.S.Venkatesan MD - October 24, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cmc vellore cardiologist Dr.A K.Abraham great cardiologist of India pioneering cardiologist india tribute to dr k a abraham Source Type: blogs

Paradoxical Low flow-Low gradient- Aortic stenosis: What is the paradox & why does it happen?
Aortic stenosis evaluation was so simple in our early days. Gradients across the valve were the key. Now, we have more parameters to bother about. Dynamic AVOs, flow state, resting LV function, contractile reserves, GLS, dobutamine response, etc. MRI assessment will soon overtake echocardiography.  Hemodynamics of flow across LVOT. MRI 4D volumetric model of normal Aortic stenotic flow in the bicuspid valve (On the left). The more we know, the more we tend to miss! Image courtesy: Northwestern Medicine The current AS algorithms, though scientific, I am afraid, appear much complicated with some frightening terminol...
Source: Dr.S.Venkatesan MD - October 17, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Aortic diseases aortic stenosis amyloidosis in aortic stenosis ASE ACC AHA ESC guidelines for aortic stenosis dobutamine stress in aortic stenosis doppler error in aortic stenosis grading severity of aortic stenosis hypertension and aortic s Source Type: blogs

Issues in diagnosing grade 1 diastolic dysfunction: Pearls and Perils
Doppler E/A ratio reversal is probably the most reported abnormality in clinical echocardiography. We are also pleased to label it as a grade 1 diastolic dysfunction. Making a significant population who come for regular health checks anxious and worried. Sharing a presentation from the Annual conference ECHO INDIA 2019, I participated in a symposium on Diastolic dysfunction. Topic : Issues in diagnosing grade 1 diastolic dysfunction: Pearls and Perils How did we get into this academic trap? Should we continue this practice? The current ASE guidelines 2016 have a clear message. It has taken off the E/A ratio from the Init...
Source: Dr.S.Venkatesan MD - October 7, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology-Echocardiography Diastolic dysfunction Echocardiography-hemodynamics classification of diastolic dysfunction diastolic dysfunction ppt echoindia grade 1 dd HFpEF indian academy of echocardiography what is grae 1 diastolic dysf Source Type: blogs

What is the effect of Atrial fibrillation on blood pressure ?
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing  RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In dysfunctional ventricles or in acute AF* this variation in systolic  BP can be significant. Also realize, If the preload is changing every beat, there is a consider...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs

What is the Impact of Atrial fibrillation on blood pressure ? … It is also irregularly irregular !
Atrial fibrillation has a direct effect on systemic blood pressure as stroke volume swings from beat to beat because of changing  RR Interval ( preload ). The variation in systolic pressure actually reflects not only the changing stroke volume but also the enhanced contractility of the ventricle to the preload( Frank-Starling principle ). The net effect is reflected in the pulse as an irregularly irregular pulse (Both rate and volume /Amplitude).* However, In severely dysfunctional ventricles this variation in systolic  BP can be minimal. Also realize, If the preload is changing every beat, there is a considerable dynami...
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Blood pressure in atrial fibillation cardiology research topic cardiology thesis topic pulse deficit Source Type: blogs

“ Unconquered ” enemy of scientific research in medicine
Is there a solution? As I understand, we don’t have any. Maybe, we can try this.  No way, I can prevent it from appearing ridiculous for the mainstream scientists. Truths often lie silently  buried deep (many times intentionally). They definitely deserve an intellectual resuscitation beyond the dirty world of data and evidence. Further, why should experience be considered as enemy of evidence ?
Source: Dr.S.Venkatesan MD - October 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Ethics in Medicine evidence based cardiology Medcal research Medical education Medical ethics medical quotes medical satistics Two line sermons in cardiology evidence based falsehoods evidence based lies evidence based med Source Type: blogs

Still, trying to get rid of these “ Seven sins in medicine ” !
Dr.Richard Asher,  a British physician from Sussex addressed a group of young passing out medical students way back in 1948 in London. The lecture was titled seven sins of medicine! We should thank the Lancet for having published this brief speech the subsequent year in its journal making it immortal medical teaching! Though he was listing these sins among medical students, it is very relevant to every health professional. 1. Obscurity Asher endorses the use of clear communication and plain language whether writing or speaking. Obscurity may be used to cloak one’s own ignorance, or due to an inability to communi...
Source: Dr.S.Venkatesan MD - September 15, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology-Land mark studies Great men in Medicine Hippocratic oath medical quotes Two line sermons in cardiology Wintage cardiology Source Type: blogs

Which is most important component in any medical research paper ?
There are about 30000 scientific journals and two million papers every year. Of which 5000 are in medicine (Ref : World university news)  Now, take a deep breath and answer this query. What do you think is the most important aspect of any scientific or medical research in the current era ? Final message With due respect to all researchers, What do you think is the most important aspect of any scientific or medical research?  This query is very much relevant today. All components are equally important is an easy way out. But, that’s not the pathway that will take us to the truth. Postambl...
Source: Dr.S.Venkatesan MD - September 11, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Ethics in Medicine evidence based cardiology Medcal research duplicate medical research ebm evidence based medicine finger criteria how to do medical research how to right a scientific paper junk research medical education medical re Source Type: blogs

D-Cube syndrome : DES-Dengue-DAPT
Background A 52-year-old diabetic woman who had undergone recent PCI with a DES developed a febrile illness which was diagnosed as Dengue fever. She has been taking DAPT (Dual antiplatelet) meticulously to maintain her stent. Now, her platelet count has dropped from 1.5 and subsequently to 1 lakh. She is asking now, whether to stop DAPT or not? What is the risk of stent occlusion if she stops?  The D³ cube syndrome  Infectious diseases rarely bother a cardiologist (maybe a few IE,  myocarditis, etc). Now, a unique situation is emerging. *Dengue affects 50-100 million people worldwide every year and one billion are ...
Source: Dr.S.Venkatesan MD - September 9, 2021 Category: Cardiology Authors: dr s venkatesan Tags: anti platelet drug antiplatelet drugs in dengue clopidogrel prasugrel ticagrelol in dengue fever dapt in dengue fever therapeutic issues in dengue and cad warfarin heparin in dengue Source Type: blogs

How did all those calcium entered my father ’ s coronary artery doctor ?
“It was severe double vessel disease &  turned out to be a complex angioplasty in LAD ”  Why doctor? what happened? It was a hard lesion, there was plenty of calcium deposits. It was not clearly visible in the angiogram. I had to do IVUS. Curiously, the calcium was clustered in all the three planes of the vessel ( intima the media and adventitia) and they projected into the lumen blocking the path. Image collage representation purpose Thank you, doctor,  how did you manage to remove it,? It was a real struggle. I had to break the calcium shell before deploying the stent. (What we refer to as...
Source: Dr.S.Venkatesan MD - September 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -unresolved questions calcium supplementation coronary calcification intimal medial adventitial calcium ivl wolverine angiosculpt opn balloon orbitel atherectomy osteoporosis plaque calcium rotoablator serum calcium vs coron Source Type: blogs

Pregnancy in Hypertrophic cardiomyopathy : LSCS or vaginal delivery ?
Hypertrophic cardiomyopathy is a specific genetic disorder of myocyte (myosin and others) within the sarcomere. Though uncommon in pregnancy it raises considerable anxiety to the patient, family, and the obstetrician.  Hemodynamics Though we tend to worry more about dynamic LVOT obstruction, it is actually the restrictive physiology of LV myocardium that might cause more concern. Three key variables operate in this entity namely preload, afterload, and contractility that determine the cardiac hemodynamics and possibly the symptoms. We know the classical consequence of pregnancy is a fall in systemic vascular resistance(...
Source: Dr.S.Venkatesan MD - August 27, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Pregnancy and heart pregnancy and heart disease Uncategorized esc ropac zahara pregnancy heart disease complicating pregnancy indication for lscs in hcm hocm lscs or normal delivery in hocm hcm pregnancy in hocm pregnancy in hypertrophic c Source Type: blogs

How to find which lesion is causing angina in multivessel CAD ?
Yes, it is a triple vessel disease, with one tight lesion and at least two other significant lesions. One of them appears diffuse as well.  Representative Image: Source courtesy DOI: 10.14740/cr548w LicenseCC BY-NC 4.0 “What to do next?. Is he symptomatic?  Yes. Definitely has significant angina” but LV function is normal. “Ok then. If you are daring enough, ask this question”. Which lesion is causing angina? No easy answer at all. Try looking for some clues right from history, ECG, stress ECHO, meticulous assessment of individual lesions. Realize, even sophisticated imaging l...
Source: Dr.S.Venkatesan MD - August 20, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Cardiology -Definitions cardiology- coronary care Ethics in Medicine Uncategorized ACC AHA ESC Guidelines for multivessel cad angina related artery ara vs ira approach to tvd cabg vs pci vs medical maangement ov cad Source Type: blogs

How good is late PCI ? in STEMI : A presentation
Late PCI: This is a tricky topic to discuss on any day. A tight walk on the evidence base and a narrow risk-benefit ratio. The problem starts right from the genesis point of the true-time window, to the host-dependent myocyte response to hypoxia. Finally, we have the ubiquitous open artery hypothesis, that can taunt even the best brain in cardiology.           Late-PCI-Download
Source: Dr.S.Venkatesan MD - August 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Primary -PCI Primary PCI Source Type: blogs

Cardiology Image watch : Its not a stent for sure … then what ?
A 75-year-old male post CABG with severe LV dysfunction and ICD and dual-chamber pacer in situ presented with NSTEMI. An angiogram revealed something, and he got this form of treatment. ? What is it? Image and case courtesy Patel R, Ghadiam H, Patel P, et al. (April 05, 2020) Angina Leading to Metal in the Heart: An Interesting Case of Saphenous Vein Graft Coiling. Cureus 12(4): e7546. doi:10.7759/cureus.7546 Features of SVG venous graft aneurysm Graft aneurysm what are the risks? Thrombosis Recurrent ACS Rupture  Management  Vascular plug Multip...
Source: Dr.S.Venkatesan MD - July 16, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized coil occlusion of coronary aneurysm post cabg coronary aneurysm SVG graft aneurysm Source Type: blogs

“ To be or Not 2B ” : Let us stop fooling around with premature scientific evidence !
Evidence-based medicine (EBM) is being projected as a scientific God’s secret specialty. Physicians who don’t follow EBM are considered unfit non-professionals. Presumably, in pursuit of truth, all those glamorous official bodies in cardiology bring out umpteen number of protocols, guidelines, advisories, and recommendations. The blueprint for EBM We have the famous 3 levels of recommendation backed up by different levels of evidence. Many of us trust these as the jury’s final verdict for most illnesses in cardiology. I would like to bring one particular issue about this hugely popular model of EBM. It i...
Source: Dr.S.Venkatesan MD - July 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: evidence based cardiology health economics Public Health Public health issues Social medicine Uncategorized acc aha scai esc guidelines class 2a vs 2b indication Class 2b Indication Comparative efficacy cost effetiveness dr venkatesa Source Type: blogs

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