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Source: Dr.S.Venkatesan MD
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Peer reviewed perils: Medical science is still far away from true democracy !
Source: Dr.S.Venkatesan MD - September 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidelines clinical cardiology drsvenkatesan venkat quotes medical editors medical ethics nstemi peer reviewed journal Source Type: blogs
Stable CAD strategies : Why a 90 % LAD lesion needs much attention … while a 100% doesn ’ t ?
Practice of cardiology is simple as long we don’t dwell deep into coronary physiology.
One of my patients asked, why he was told his total occlusion in LAD appears safer now, which was subtotal a few months ago.I told him, it is indeed true. It is the fear of subtotal disease that’s prone to a fresh coronary event. In total occlusion, chances of that happening are less or nil.
How can you say 100% block is safe? Is that always true?
No, it’s not always true. He was surprised when I said it is not 100 %, even 90% lesion can be safe, if it’s not ...
Source: Dr.S.Venkatesan MD - September 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics chronic stable angina chronic total occlusion collateral circulation csi stable angina guidelines cto cto epicardail collaterals euro cto ISCHEMIA trial open vs closed artery hypotheis ORBITA trial Source Type: blogs
Emotional factors in CAD : Anxiety vs depression , which is bad ?
Psychological factors both depression and anxiety do confer a significant risk for CAD. However, a distinction must be made between risk factors and triggers. It is highly likely, depression has more consistent correlation with chronic CAD than anxiety.
Primary anxiety per-se is of less of a risk factor for chronic CAD, while it can still be a trigger for cardiac events. (when it occurs over heightened baseline risk) Primary depression increases the CAD risk many fold by slowing the system making it sedentary and promote endothelial dysfunction, which is the key promotor of atherogenic CAD.
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Source: Dr.S.Venkatesan MD - August 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: emotion and cad Venkatesan -Presentations depression anxiety cad acs trigger drsvenkatesan ppt drvenkatesan presentation My presentations Neuro cardiology ONSET SHEEP TRIM studies trial on emotion and heart psychosocail factors in cad inte Source Type: blogs
Diabetes management in CAD : Who is dictating to whom ?
No one would have Imagined a generally Innocuous entity called Diabetes will emerge into a “single disease sub-speciality” in medicine”. Thanks to the global authorities & pharma Industry for making this speciality a formidable one. The link between diabetes and cardiology is so strong, now with pharmacological strategies looking for overlapping Indications.
Let me share a presentation in one of the cardiology meet in 2017 at Thiruvananthpuram.TAN CSI meet , India.
Click here for a PDF version
The days are gone when anti-diabetic drugs were alleged to increase CVD mortality. New...
Source: Dr.S.Venkatesan MD - August 23, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Diabetes and Heart ada dapa hf Diabetes and cvd risk empaglifozin hba1c sglt in diabetes ukpds Source Type: blogs
PTMC : How to cross a difficult mitral valve ?
This is a PPT presentation taken from archive (Made in 2012)
Please pardon , it lacks audio.
PDF version : Prof SV PTMC mitral valve crossing
Final message
Often times I have seen my Interventional colleagues struggle more at the mitral valve crossing than at IAS puncture during PTMC. Experience prevails over Image assistance. Assessment of LA size , IAS plane , and sub valvular disease seem to be critical. Probably the secret of success which I found out was , smart guys never hesitate to repeat IAS puncture site for optimal trajectory . Over the wire technique is not forbidden.
Unfortunately, TTE guidance is of littl...
Source: Dr.S.Venkatesan MD - August 22, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized dr venkatesan ppt drsvenkatesan ppt inoue vs accura balloon mitral valve crossing ptmc retrograde ptmc Source Type: blogs
Coronary collaterals in STEMI : Incidence, time of appearance , & Impact on outcome.
Coronary collateral circulation is one of the major determinants of symptoms and outcomes in chronic CAD. But, we generally shrug off the value of coronary collateral circulation in acute coronary syndrome. The fact is, it has a myocardial mitigating effect following sudden total occlusion.
When does it appear? We did a small analysis (PDF version)
We found it is noted in 25% of patients. With reference time of appearance, 6% had it within 12hrs and in few, it was noted as early as 6 hrs. One caveat is, we may not know whether its preexisting collateral due to chronic multivessel CAD. I am sorry to note this study did...
Source: Dr.S.Venkatesan MD - August 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome Coronary collateral circulation Uncategorized collaterals in stemi importance of coronary collaterals in acs nstemi research ideas in cardiology research topics in cardiology Source Type: blogs
Hypoxia and LV dysfunction: Let us learn more from “ COPD, COVID-19 and Tetralogy of Fallot ”
Superficially, tissue hypoxia might look similar to Ischemia but differs in one important aspect. Though the hypoxic myocardium is short of oxygen, the respiratory excreta from cells ie Co2, lactic acid, and free radicles are promptly cleared and flushed as blood flow is normal. Hence, generally acute Ischemia of tissues is more cell threatening than regional hypoxia at any organ level. How do you classify hypoxia? we need to go to physiology classes again.There are 4 types. Ischemic -Hypoxia, systemic hypoxia, Anemic hypoxia, Histo-toxic hypoxia.A good reference to read (Ošt’ádal B., Kolář F. (1999) Myocardial Hy...
Source: Dr.S.Venkatesan MD - August 9, 2020 Category: Cardiology Authors: dr s venkatesan Tags: metabolic support of heart failure anerobic cardiac metabolism copd and lv dysfunction covid heart disease hypoxia and covid lv dysfunction hypoxia vs iscehmia ketone bodies ato heart lv dysfunction in congenital cyanotic heart disease met Source Type: blogs
What is the relationship between BMI and blood cholesterol ?
Caution: Please don’t expect much scientific content in this post. I Hope, you can spare a minute to answer this hypothetical question.
What will be the shape of the curve, If you plot BMI in the X-axis and LDL/ total cholesterol in Y-axis from a thousand normal adult populations?
It will be linear for sure.
Maybe a little curvilinear.
Its likely J shaped with age
I think it is U shaped
No, it is Inverted U
Sorry, I don’t know.
No one knows.
Answer: Though linear relation is the one we expect, all sorts of shapes are reported in various correlation studies, making the resp...
Source: Dr.S.Venkatesan MD - August 3, 2020 Category: Cardiology Authors: dr s venkatesan Tags: clinical lipidology lipids lipid metabolism obesity acc aha esc csi lpi guidelies on lipids ada dyslipidemia inverted u j u curve bmi vs ldl lipids ldl lvels in obesity whats the relation missing link between obesity and cholesterol what i Source Type: blogs
What ’ s the relationship between JVP and PCWP/LVEDP?
This study elegantly shows a correlation (or lack of it) in different subsets of heart failure. It tells us very clearly If JVP(RAP) is not correlating or disproportionate to PCWP, it implies RV dysfunction.
2. This paper suggests a really useful scheme to classify heart failure as concordant and discordant with reference to right and left heart.
It throws some interesting facts. I guess it will help us guide diuretic management and prognosticate chronic heart failure.
Source: Dr.S.Venkatesan MD - August 2, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Clinical Jugular venous pulse JVP -Jugualr venous pulse diastolic stress testing jjvp in hfref jvp cvp pcwp lvedp jvp in acute mr jvp in asd lutembacher syndrome jvp in bernheom effect jvp in isolated lv failure jvp in jfp Source Type: blogs
One more cause for acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Please add, one more cause for Acquired VSD : His bundle pacing
His bundle pacing is the new kid in EP lab. It involves exploration of few 3-dimensional cubic areas of His bundle (4-6mm³ ? ) in the crest of the IVS looking for optimal His pacing site. It aims to provide better recruitment of His Purkinje and hence more synchronous pacing. Still, the modality is in the early stages and has few key limitations. They are, requirement of very specialised leads,(Select Secure 3830 , Medtronic) lead instability (Susceptible to RV ejectile forces*), high threshold, and lower battery life and finally uncertainty of distal bundle disease. A need for temporary RV back up the leads in some cente...
Source: Dr.S.Venkatesan MD - July 26, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Pacemakers and ICD best pacemaker modality best review article in lbbb his bundle pacing\ ddd vs his bundle lbbb pacing select secure lead medtronic 3830 vvi vs ddd vs his vs lbbb pacing vvi vs his bundle pacing Source Type: blogs
Planned PCI in high bleeding risk patient: Three forbidden options
Though two stents Onyx one (Medtronic) and Biofreedom(Biosensors) appear promising with rapid endothelisation and hence short DAPT. There are three more options. available in this situation.
Option 1
Avoid the endothelium unfriendly DES and use BMS* and use MAPT (Mono or minimal antiplatelet therapy). For the sake of the young generation cardiologists, let me expand BMS,ie Bare metal stents.
BMS in 2020 ! What nonsense are you talking about? (For those who ask this question, please try to go through the following study with a conscience)
(NORSTENT 2016 -One of the most underrated, deliberately concealed landmark paper in...
Source: Dr.S.Venkatesan MD - June 13, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized biofreedom vs onyxone bms for high bleeding risk BMS VS DES IN 2020 NORSTENT BASKET PROVE NEJM POBA DEB to reduce bleeding risk Source Type: blogs
Why should the three antiplatelet siblings Tica ,Prasu & Clopi fight perennially?
Anti-platelet drugs find a place virtually in every prescription written by a cardiologist for CAD.No doubt, it sits right on top among the highest prescribed medication in the world. They are used in all forms of CAD/ ACS. It becomes mandatory in post PCI as a stent maintenance protocol. Cardiologists (at least me) are exhausted with so many studies with these drugs. When we thought we are relaxing for a while, the current issue of circulation release a big meta-analysis with 50,000 patient data.It tries to draw fresh battle lines between the three friendly P2Y12 inhibitors.
https://doi.org/10.1161/CIRCULATI...
Source: Dr.S.Venkatesan MD - June 12, 2020 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome anti platelet drug bms vs des isar react 5 themis stents for high bleeding risk biofreedom onyxone ticagrelor vs prasugrel vs clopidogrel Source Type: blogs
What exactly is the relationship between Hypertension and Corona ?
The mainstream (& the sidestream) medical media have already named one culprit ie hypertension (HT) as a significant comorbid entity in the current Corona pandemic. But, If we ask one direct question, how Corona and HT are linked ? , the answer is not forthcoming fluently.
.
Some of the thought process about the Issue.
1. Does Coronavirus relish high blood pressure on its journey to attack lungs ?
Funny question you may think. The virus primarily lives and tracts through the respiratory tract to reach lungs. Viral load in bloodstream is nil or miniscule till late stages. BP is nothing to do with what is hap...
Source: Dr.S.Venkatesan MD - May 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized what is the link between hypertension and corona outcome Source Type: blogs
Link between LV dysfunction & VPDs … Is it a cause or bcoz ?
We know, LV dysfunction of any etiology can cause VPDs.This must be differentiated from VPDs induced LV dysfunction. Mind you, this is not an easy job at all.
When do you suspect excess VPDs are the cause (or might cause) of LV dysfunction?In young, otherwise healthy persons with “VPDs and LV dysfunction” would suggest chronic abnormal electrical activity is the cause for subsequent LV dysfunction. (An expression of electromechanical remodeling)
Monomorphic VPDs more often suggest primary electrical pathology(Like OTVT, Fascicular VT)VPD count more than >10000 in 24 hrs in Holter will probably I...
Source: Dr.S.Venkatesan MD - May 28, 2020 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized av desynchrony due to vpd influence of vpd on crt PVC induced cardiomyopathy tachycardic cardiomyopathy what is the relation between LV dysfunction and VPD vpc pvc Source Type: blogs
