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Source: Dr.S.Venkatesan MD

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Why ISCHEMIA trial conclusions often make us nervous ?
Why ISCHEMIA trial conclusions often make us nervous? Because, we know we can’t follow the lessons from it with true intent, as many of us are near slaves to Invisible Interventional forces in some form or other. I would think, ISCHEMIA trial in one sense was a wasted effort. We always knew OMT is superior to any sort of PCI in stable CAD  (Backed up with COURAGE /BARI 2D/and of course the deadly exposure by ORBITA ) Anyway, we did ISCHEMIA for the sake of deniers, with huge public funding to prove the truth as truth. Still, I am sure ISCHEMIA will be looked down, by most elite Intervenionli...
Source: Dr.S.Venkatesan MD - July 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Criteria cardiology -Therapeutics Cardiology -unresolved questions Comparative efficacy acc aha esc csa Chronic stable cad courage orbita bari 2d ISCHEMIA ISCHEMIA trial Source Type: blogs

How to misunderstand health economics ?
Source: Dr.S.Venkatesan MD - June 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -guidelines Ethics in Medicine Social medicine wisdom in cardiology comparative effectiveness cost effectiveness cost ineffectiveness drsvenkatesan evidence based medicine health budget of a country health care indices hea Source Type: blogs

Postprandial syncope : Incidence, mechanism & hemodynamics.
Syncope is one of the common, yet difficult symptoms to evaluate especially in the elderly. Post-prandial syncope is one condition likely to be missed out.As the name suggests It has a distinct relationship with food intake. Mild fall in postprandial BP is an expected response but if it exceeds a  limit* syncope is triggered. (*Highly variable) Hemodynamics of Postprandial state Normally splanchnic circulation demands up to a 25%  increase in blood volume after a moderately large meal.  When this happens there must be compensatory vasoconstriction elsewhere especially in muscles. Lack of this respon...
Source: Dr.S.Venkatesan MD - June 24, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Clinical signs Cardiology -Definitions Cardiology -Hemodynamics Cardiology -Mechnisms of disease Syncope gastrointestinal cause for syncope orthostatic vs postprandial hypotension post prandial hypotension post-prandial hypoten Source Type: blogs

MDM of mitral stenosis is a “ mid diastolic misnomer ”
Nearly a century ago, Carl Wiggers helped us understand the dynamics of cardiac cycle with a historical diagram depicting systole and diastole. We know diastole has 4 phases. They are  IVRT(nil)  early rapid filling,(70%) diastasis,(0-5%) atrial contraction(25%) (Percentage filling within the brackets) What is mid diastole? The easiest way to define mid diastole is to divide diastole into three parts with reference to time and call the mid-third as mid-diastole. (.5 seconds/ divided by 3). But, Physiologically we can’t do that. Even hemodynamically there is no distinct mid diastole as diastole is di...
Source: Dr.S.Venkatesan MD - June 23, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Auscultation Cardiology - Clinical Clinical cardiology Mitral stenosis Uncategorized cardiologist vs physiologist diastole diastasis murmur diastolic time intervals edm in mitral stenosis ivrt vs at os interval mdm in mitral stenosis Source Type: blogs

3-D printing of heart : Moving from the labs to bed side
3D printing technology is growing at a rapid pace. Both cardiologists and cardiac surgeons are expected to benefit a lot.It helps us in understanding deformed anatomy in complex congenital heart disease as well as planning for synthetic cardiac implants.  Currently, the technology is limited only by the chemical material used to print the heart and its components. The American chemical society is working at it to create more realistic heart models. Once we master this,  biological printing with synthetic tissue equivalents is the ultimate aim.  Major Indications Planning cardiac reconstructive surgeries in ...
Source: Dr.S.Venkatesan MD - June 3, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 3D printing in cardiology 3d prototyping evolute r core valve future of cardiology sapien valve edwards tavr mavr Source Type: blogs

Defining Hypertension : Why we remain in “ Status confusious ” despite 50 years of clinical trials ?
Next to the atmospheric pressure, the most curious pressure to understand is stored within human blood. Yes, it is the “blood pressure”, fondly referred to as BP by both physicians and patients. (When worried men & women visit us and say, that they are suffering from BP, please make it a point to clarify, BP is a sign of existence of life, rather than a dreaded pathology )  Why should blood have pressure? BP is lateral pressure exerted by flowing blood on the vessel wall (or is it the propelling pressure head ? It is to be noted, cuff pressure doesn’t measure this !) BP is generated by the heart in...
Source: Dr.S.Venkatesan MD - May 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Hypertension 2013 STEMI AHA ACC Guidelines blood pressure lowering treatment trialist collaboration hypertension and dyslipidemia Hypertension current guidelines jnc 6 7 8 hypertesnion Lancet BP LTT trial LDL vs diastolic BP vs fasting blood Source Type: blogs

Troponin positivity in AVNRT: A panic reaction and its mechanism.
Here is an uncommon story of a patient with palpitation,SVT , Troponin +ve, and suspected ACS. Palpitation in ER ⇒ {Tachycardia +Troponin positive ≠ ACS} Mechanism of troponin elevation following any SVT At high heart rates (>200) myocardium is subjected to non-Ischemic mechanical strain & squeeze. Minute amounts of Troponin is let out like a myocardial juice into the circulation (Like atrial natriuretic peptide release which causes polyuria during AVNRT) Tropinin releases have been shown to correlate with both heart rate and duration of ST depression (Subendocardial strain /AVRT left lateral pathways) Short d...
Source: Dr.S.Venkatesan MD - May 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized avnrt avrt af biomarkers in tachycardia cpk troponin in avrt false positive troponin in avnrt svt troponin t troponin 1 Source Type: blogs

What is an Intermediate coronary lesion & What shall we do with it ?
This question might squeeze the collective coronary knowledge of any cardiologist. (At least, it does for me !) What is an intermediate coronary lesion? (ICL)  Traditionally it is an “angio-ocular reflex” measurement of coronary arterial diameter stenosis that lies between 40 to 70% (Mind you, 70 diameter stenosis is 90% area. So,we must be clear what we really mean in any  revascularisation debate). Above one is the simplest expression of ICL. (* While 70% cutoff is fairly constant, the lower limit 40% is still not a settled issue. It can even be 30 %. I think we haven’t yet named th...
Source: Dr.S.Venkatesan MD - April 25, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized diameter vs area stenosis fame s fame study ffr ifr qfr intermediate coronary lesion minimal cad coronary erosion what is intermediate coronary lesion ? Source Type: blogs

Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(<35mm). The stupendous success of this procedure is attributed to careful pre and Intra-procedural Imaging, new generation hardware and of course the ever-improving expertise among Interventional cardiologists. Still, there is one issue that is bothersome. It is the late complications of this device and the need for follow-up (Unlike surgery where close and forget option seems real and confer lot of comforts) The delayed mechanical complications are now extremely rare still  follow up of these patients is advised. What is the mechanism o...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs

Heart disease in pregnancy: Overview & management
Some of the questions  addressed  in this presentation 1.What happens to fetal blood pressure during maternal hypotension how good is fetal autoregulation? 2.Why is LSCS increasingly preferred mode of delivery in heart disease complicating pregnancy challenging the traditional scientific concept? 3.What is likely hood of patients with moderate mitral stenosis developing pulmonary edema during prolonged 2nd stage of labor? 3.What is the missing link between PIH and PPCM? How prepartum cardiomyopathy differs from postpartum? 4.Is Eisenemneger really an absolute contraindication for pregnancy? 5. How can we continue VKAs wa...
Source: Dr.S.Venkatesan MD - April 2, 2021 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions Pregnancy and heart pregnancy and heart disease cardiac disease in pregnancy esc aha pregnancy heart disease fetal aortic blood Source Type: blogs

Sailing the Osler ’ s ship of medicine in the third millennium
Source: Dr.S.Venkatesan MD - March 31, 2021 Category: Cardiology Authors: dr s venkatesan Tags: bio ethics Cardiology -Patient page cardiology -Therapeutics Clinical cardiology general medicine Medical education Medical ethics medical quotes Two line sermons in cardiology clinical acumen dr venkat quotes ethics in medicine ev Source Type: blogs

Rheumatic fever : Dr Jones would smile if we get rid of the “ supportive criteria ”
Dr. Duckett Jones, the famed American physician, from Good Samaritan hospital, Boston would be a proud man in heaven, to find his criteria still being celebrated all over the globe. He will also be pleased to know his home country USA  is painted green on the world RHD map due to his untiring efforts that began in 1944. Of course, what the rest of the world has done in the last century has left us wanting (including the WHO).   Global RHD map. Note the red and brown shading in south Asia and Africa. It is obvious, RHD is more about economics, equality, and poverty, rather than aggression from an otherwise innocuous...
Source: Dr.S.Venkatesan MD - March 28, 2021 Category: Cardiology Authors: dr s venkatesan Tags: rheumatic heart disease acute rheumatic fever aso titer chronic rheumatic fever dr duckket jones jones criteria primary vs secondory prevention rtpcr for rheumatic fever supportive criteria for acute rheumatic fever essential Source Type: blogs

Coronary collateral circulation : Why many scientific cardiologists Ignore it ?
A consult with a 62-year-old patient in my office  Hi, welcome?  What is your problem? Nothing doctor. I am good.  What brings you here then? I used to have angina before. Now, I am fine doctor but confused after undergoing this angiogram. I need an opinion. How is your exercise capacity? I do walk, work, and able to do almost all regular activities. Why did you do this angiogram then?  Had to undergo this after a doubtful stress test, Now, I am told by at least 2 eminent cardiologists, that I am having just one functional coronary artery, and it is dangerous for the all-important LAD to live at the merc...
Source: Dr.S.Venkatesan MD - February 14, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chronic total occlusion collateral circualtion in cto coronary collateral circulation interventions in cto Source Type: blogs

Why evidence-based medicine continue to have a turbulent course?
Because . . . its current course is not always in the right direction &  not everyone is ready for course correction as well! Reference 1.Hasnain-Wynia R. Is evidence-based medicine patient-centered and is patient-centered care evidence-based? Health Serv Res. 2006;41(1):1-  2. Wyer PC, Silver SA. Where is the wisdom? I—a conceptual history of evidence-based medicine. J Eval Clin Pract. 2009;15(6):891-898.   3.Tonelli MR. The philosophical limits of evidence-based medicine. Acad Med. 1998;73(12):1234-1240.    
Source: Dr.S.Venkatesan MD - February 13, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology quotes cardiology-ethics best medical quotes dr venkatesan quotes ethics in medicine evidence based medicine evidence vs experience based medicine hippocrates ethics limitations of ebm medical education medical ethics quote Source Type: blogs

Why didn ’ t you try ECMO for my dad , doctor ? I feel really guilty !
It is just past midnight: This is a gloomy conversation between a patient’s son and a cardiologist in the silent waiting room, just outside the dim-lit ICU of a popular 4-star hospital in Chennai. “I am sorry to say, Mr. B., your father didn’t make it. Has succumbed to the heart attack. We have been trying to resuscitate him for the past one hour. We have done everything. We have managed to open up IRA, and 2 more critical blocks still it couldn’t help. It was a massive one. Sorry again. “Doctor, I feel very bad. What went wrong, I want to know. Doc, did you try ECMO ?,” the ...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Technology ecmo IABP impella tandem heart ecmo Source Type: blogs