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History of cardiology : Robert F Rushmer, a cardiac scientist par excellence .
Few individual’s works mattered more than others in the field of cardiology. Here was a man born in Utah, studied at Rush university trained in Mayo, settled in Seattle as a pediatrician. But his passion drove him to become a specialist cardiac physiologist with an urge to find the answers to all those lingering queries that arise as a practicing clinical cardiologist.  He built an exclusive animal lab to study the mechanics and physics of circulation and cardiac pumps.   He can be called new age, Harvey. He seemed to always bother, how is it that the 6 liters of blood traverse from he...
Source: Dr.S.Venkatesan MD - February 1, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Basic sciecne Basic science -Physiology Best books in cardiology bio ethics great cardiologists best books in cardiac physiology best cardiology books cardiovascular physiology famous Seattle doctors Great Men in cardiology history of Source Type: blogs

Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology Sinus venosus ASD (also referred to as SVC ASD)  is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between SVC/P...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs

Year end quiz : What is the name of this Investigation ?
Just role over the virtual marker along the coronary lesion to get the underlying flow ratio. Blue is an absolute normal segment. Green is ok, orange and red slow-moving coronary traffic jam zones. it’s just like drawing a google map showing life traffic. No wire, no adenosine FFR comes inbuilt in every angio shot. Looks great Isn’t it? This is called QFR. Quantitative flow ratio derived from routine coronary angiograms. It can also guide us to find the optimal sites of both proximal and distal stent landing zone in the best physiological manner. Which company makes this ? Any studies done with QFR ? FAVOR 2 st...
Source: Dr.S.Venkatesan MD - December 29, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome Tips and tricks in cath lab coronary doppler coronary flow physiology ffr vs ifr vs ct ffr vs qfr ISCHEMIA trial non invasive ffr oct ivus when to intervene a stable cad Source Type: blogs

LA myxoma surgery : Preventing recurrence should be an important goal.
Cardiac myxoma is the most common primary tumor of the heart that presents as mitral inflow obstruction/ regurgitation often with a systemic presentation. It can be either familial, syndromic, or sporadic. Excellent imaging is possible and diagnosis has become straightforward. Surgery is the specific treatment, What information do the Surgeons need?  Size, attachment to surrounding structures is the key. The myxoma origins most often in IAS and defining its attachment is crucial. Mitral leaflet distortion, Injury ( and even attachment) is possible. It is helpful for the surgeons if we let them know the mechanism of mit...
Source: Dr.S.Venkatesan MD - December 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiac myxoma IAS patch closure for myxoma LA myxoma surgery mesenchymal cell tumor myxoma myxoma benign or malignant Source Type: blogs

ASD device closure: “ Mind the gap ” to avoid SA nodal artery compression.
The branching pattern of the human cardio-vascular tree is as unique as one’s fingerprint. One such hugely variable anatomy is the SA nodal blood supply. Certain salient features Variation can be seen in origin, course, and termination. Now it is estimated to arise from RCA in 70% (Moved up from 55% in old studies ) From LCX (25%) Dual SA node supply(5%) Direct from Aorta It is heartening to find this good anatomical review on this topic. A) From the Right Coronary Artery; (B) From the Left Circumflex Artery (proximal); (C) From the Left Circumflex Artery (distal); (D) From the Left Coronary Artery; (E) From the Ao...
Source: Dr.S.Venkatesan MD - November 20, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology research topics cardiology research topics for fellows Uncategorized ASD device closure cardaic lymphatics cardiology reserach topic sa nodal compression during asd device closure Source Type: blogs

Arrhythmia basics: How often we need to know the mechanism of arrhythmia ?
How many times you have treated cardiac arrhythmia in both emergency & non-emergency situations? Infinite times. How many times did you really bother to know the mechanism of a given arrhythmia before ordering medication or shocking? Hmm,.. let me think. (Except for AVNRT/ AVRT, and few VTs, very rarely I have worried about the mechanism  !) Why is it so? because treatment takes priority and we are able to tame the arrhythmia even without knowing the real mechanism. The following slide is a gross summary of the cardiac arrhythmia mechanism Understanding cardiac arrhy...
Source: Dr.S.Venkatesan MD - November 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Basic science -Physiology Brugada syndrome cardiac electrophysiology cardiology -Therapeutics Cardiology-Arrhythmias brady dependent vt eads dads early and late after depolarisation enhanced automaticity vs triggerred activity vs reentry Source Type: blogs

Acute Aortic syndrome : Please mind the Length of “ Ascending Aorta ” as well !
 Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes.  Meanwhile, CT ,  4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and treatment purp...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs

Acute Aortic syndrome : Please mind the length of “ Ascending Aorta ” as well.
 Aorta probably is the most critical structure in the entire circulatory system. (apart from the heart of course !) It is a 1.5 to 2.5 mm thick tube, with a diameter of 2.5 cm/length of 30 -35 cm from the aortic valve to the iliac bifurcation.(Eric Borsero 2011) It handles about 7500 liters of blood every day. Understanding the Aortic pathology has vastly improved at the molecular level with deep gene sequencing that defines fibrillin phenotypes.  Meanwhile, CT ,  4D MRI and 3D prototyping have landed us in a new era where we can feel the exact models of a patient’s virtual aAorta for monitoring and treatment purp...
Source: Dr.S.Venkatesan MD - November 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: aortic aneurysm marfan aortic dissection aorta size new coconcepts in aortic dimension normal aorta size normal aortic root size what is normal length of ascending aorta Source Type: blogs

“ Dialysable LV dysfunction In CKD ” : Myocardial edema clearance plays a role.
In CKD, LVH is a near-constant feature with echo showing thick, bright echoes from IVS. The LV mass increases, partly due to physiological hypertrophy ,also contributed by deposits of uremic middle molecules and fluid collection in the interstitium as myocardial edema.This, is recognised as T 2 weighted MRI signals. Chronic fluid stasis may progress to myocardial fibrosis. (Kidney Blood Press Res 2018;43:134–142 )   Effect of Frusemide on myocardial edema  We know, loop diuretics cause aggressive depletion of ECF volume and to a lesser extent Interstitial fluid. The effect of diuretic on myocardial wate...
Source: Dr.S.Venkatesan MD - October 11, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology research topics for fellows cardiology thesis topics Uncategorized myocardial edema in ckd myocardial edema mri Source Type: blogs

Amiodarone in Ischemic VT : Doesn ’ t work always,.. IRA patency could be the missing link.
Curiously, the management of VT is simple if the patient is unstable. Just, we need to shock. Cardiologists are troubled only with a hemodynamically stable patient with VT. Some of us still think Amiodarone is a universal antidote for any VT. Though It is effective in both ischemic and non -Ischemic VT, the success rate is not uniform. The mechanism of action of the Initial IV bolus is not a class 3 K + blocking action, instead, it is thought to be its beta-blocking action. If amiodarone fails, we may try Lignocaine,  magnesium, Flecainide. .Many times it is the cumulative dose of amiodarone that reverts the VT. In some p...
Source: Dr.S.Venkatesan MD - October 10, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized brugada criteria for vt efficacy of amiodarone localisation of vt magnesiusm for vt research ideas in cardiology research papers in cardiology Source Type: blogs

Newer frontiers in cardiac pacing : Wireless dual-chamber pacing
The field of cardiology is always at the forefront of any technological breakthrough. Cardiac pacing stands tall among all Innovations. While remote monitoring and pacemaker telemetry are well-known concepts. One would have wondered why Intracardiac leads couldn’t communicate with each other wirelessly. Yes, It was just a matter of time, for that to happen.  The leadless pacemaker Micra/Nanostim was Introduced recently but lacked the much needed physiological pacing as they were single chamber based pacing. Though mechanical sensing of atrial activity was possible with Micra TPS software patch  (A  VDD like...
Source: Dr.S.Venkatesan MD - October 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized av micra tps ddd vs dddr pacemaker dual chamber wirless lead less pacemaker micra nanostim paceaker naspe cardiac rhythm society Source Type: blogs

Role of RT-PCR in the diagnosis of Rheumatic fever/RHD
RT-PCR: Real-time polymerase chain reaction, a sophisticated gene sequence-based biochemical test. Thanks to corona, this complex medical investigation has become a household name. Jones proposed his criteria to diagnose acute rheumatic fever  in 1944, we still use it to diagnose with many modifications . Currently, AHA position statement – 2015 by Gewitz et all is  being followed. (Circulation 2015) From Braunwald textbook of cardiology. Apart from this, there is one catch . Even if the child fulfills Jone criteria, there needs to be evidence for preceding streptococcal sore throat, either by culture or antibody. ...
Source: Dr.S.Venkatesan MD - October 1, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acute rheumatic fever aha rhd 2015 rhuematic fever anti dnase streptococcus group a beta hemolytic streptococci rtpcr mirna rtpcr rhd qpcr in rheumatic fever revised jonec criteria 2015 RHD jones criteria role of rtpcr fro Source Type: blogs

If EF% is a most flawed LV functional parameter,.. why we Insist HF to be classified based on it ?
Heart failure has been classified in many ways, with prevailing levels of our knowledge and ignorance. It is based on a variety of factors like rapidity of onset, etiology, chambers involved, hemodynamics, etc.  Forward vs backward failure Acute vs chronic failure RV/LV or Biventicular failure  Systolic vs diastolic heart failure High output vs low out failure Ischemic vs non-ischemic failure  Reversible vs Refractory HF  None of them have really helped at the bedside though it helped us understand the condition. Now, in the last decade, we have crash-landed on our favorite obsession to classify HF ie based...
Source: Dr.S.Venkatesan MD - September 25, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized ase esc acc csi echo cariteria definition of heart failure diastolic heart failure ejection fraction limitation forward vs backward failure hf with normal GLS HFpEF HFrEF rv vs lv failure systolic vs diastolic heart failu Source Type: blogs

History of cardiology : A soulful story of “ Dr.Thomas ” and his BT shunt
History is rarely kind to the original heroes in the scientific world.The classical Blalock-Taussig shunt,(BT shunt) the term we heard for the first time in the early clinical years of MBBS .We know, it as a dramatic cure (Palliative  though)  for the commonest congenital cyanotic heart disease -Tetralogy of Fallot. Now, half a century later, came to know, there is a gripping  story of an oppressed black hero behind this famous cardiac surgery. This post is  all about the  fascinating life of  Vivien Thomas,  a humble carpenter’s son from Nashville. While he dreamed to become a doctor, circumstances and fate h...
Source: Dr.S.Venkatesan MD - September 17, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized baltimore john hopkins BT shunt dr blalock dr helen b taussig history of cardiology modified bt shunt something lord made vivien thomas Source Type: blogs

NSTEMI : Is it the baby of STEMI or a Neo NSTEMI ?
It was April 15th 1912, Titanic, the Invincible, had just sunk into the dark waters of Atlantic coast off Newfoundland. Exactly same time around, Dr. James Herrick, In Chicago,Illinois was busy documenting the first diagnosed case of acute coronary thrombosis. A new disease was born ie Myocardial Infarction. This was also the era of the Noble Prize-winning  Invention of the ECG machine by Waller, Einthoven, and Thomas Lewis & co that sow the seeds for the speciality of electro-cardiology. Though much was studied about MI with pathological specimens in the subsequent decades, there was a lull in the efforts to define t...
Source: Dr.S.Venkatesan MD - September 14, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome herrick james stemi nomenclature issues of acs non q mi NSTEACS nstemi NSTEMI new definition 2020 Source Type: blogs

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