Over-diagnosing MI is not* as negligent as missing it!
As the medical literature expands exponentially, the quality and intent of the research questions sound awry. There are only a handful of journals like JAMA that are bold enough to ask some tough and pragmatic questions in this glitzy world of medical extravaganza.
The current issue wants to set the pace for an important debate, on a topic that is rarely discussed.
The question is
Link to the article
Check whether your answers concur with this crucial query from Harvard Medical School and Massachusetts General Hospital. Three questions this article wishes to address.
1.What is the reason it is happening?...
Source: Dr.S.Venkatesan MD - April 25, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acc aha esc guidlines dilemma in cardiology drsvenkatesan ethics in medicine high senstivity troponins jama network nstemi pci Source Type: blogs
A Pacemaker quiz and a new concept.
This image comes with courtesy of the Journal of SCAI Jai Parekh, Vikram Sharma, Jared Robl,et al Journal of the Society for Cardiovascular Angiography & Interventions 3 (2024) 101310
What is your diagnosis ?
I thought, it was pacemaker extrusion. It was indeed a close answer, still terribly wrong. It is an intentional exterior placement of a permanent pacemaker generator mimicking an extrusion due to pocket infection. Here is a patient, where a permanent pacemaker was kept temporarily for a few weeks or a month in high-risk reversible complete heart block situations. This typically occurs after an inferior post...
Source: Dr.S.Venkatesan MD - April 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized chb after tavi chb risk with tavi core valve vs sapien how to use a permanent pacemaker as temporary ? how to use a ppm as tpm? mechansim of chb after tavi TAVR Source Type: blogs
Forbidden quotes in medicine
(Source: Dr.S.Venkatesan MD)
Source: Dr.S.Venkatesan MD - April 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized best quote on medical ethics bio ethics british journal of medical ethics ethical dysfunction future of noble profession Hippocratic oath indian journal of medical ethics Lown Institute medical education modified hippocra Source Type: blogs
Corvia atrial shunt system: Mean LA pressure reduction device in HFpEF
Lowering the raised LA mean pressure is a major therapeutic goal in any severely symptomatic left heart disease, whether it is valvular or myocardial disease. It is prudent to understand, that even in systolic LV failure; it is the raised LVEDP that causes the symptoms and marks the limits of exercise capacity. Drugs like inotropes, pre-load , afterload modulators like diuretics and vasodilators can take care to a certain extent.
When symptoms are refractory and the underlying condition has no primary correction , we need to intervene with some extreme procedures. We know a small ASD decompresses mitral stenosis, and th...
Source: Dr.S.Venkatesan MD - April 18, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized acquired asd in hfpef atrial flow regulator corvia atrial shunt system decompression of left atrium hhpef lutembacher syndrome Source Type: blogs
Does the “ Non -IRA ” lesion status confuse you often ?..Try a blind primary PCI !
Primary PCI of IRA , continues to be a clinically & statisticaly validated (Inspite of some ifs & buts) coronary reperfusion strategy.
What to do, if we happen to detect, a significant or borderline lesion in non- IRA territory ?
There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is prac...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Does non -IRA lesion status confuse you : Try a blind primary PCI !
Primary PCI of IRA is a legally, & globally validated (of course with lots of ifs & buts) coronary reperfusion strategy.
What to do, if we happen to detect, a significant or borderline lesion in non- IRA territory ?
There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is practiced by s...
Source: Dr.S.Venkatesan MD - April 13, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
Ballooning an obstructed prosthetic Aortic valve : Can be a real tense procedure!
A 76-year-old woman with a history of double valve replacement (Aortic and mitral valves) for rheumatic heart disease, presented with acute dyspnea after a switch from Warfarin to LMWH before a planned bone marrow biopsy.
The investigations revealed a stuck aortic prosthetic valve ,that showed a prohibitive gradient of more than 50 mmhg. Since, she refused further surgery, a rare and risky effort was made to balloon dilate the prosthetic valve leaflet, though it is not a standard approved modality. It was decided to dilate the supero-lateral orifice and the central orifices by simultaneous kissing balloon. The results w...
Source: Dr.S.Venkatesan MD - April 10, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Mitral prosthetic valve-Surgical tips and techniques prosthetic valve dysfunction prosthetic valves prosthetic valves -Technical issues Uncategorized balloon dilatation of prosthetic valve best review article on prosthetic valve obstruction Source Type: blogs
How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs
An anxious approach to a benign arrhythmia in Holter recording
A 32-year-old high-profile businessman was advised Holter monitoring for a few ectopic beats during routine screening ECG. The 72-hour extended Holter monitoring picked up a single short pause with a blocked P wave and reported as doubtful Mobitz type 2 AV block.
The cardiologist in-charge, told the patient that findings are significant, and he would need further investigation. He was referred to their associate center for an EP study. After hearing about the procedure ,the patient was freighted about inserting multiple catheters inside his heart.
This was the time he consulted me with Holter report. It was i...
Source: Dr.S.Venkatesan MD - March 19, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized 2:1 av block a pilot with av block approach to av block in holter asymptomatic mobitz type 2 block ep study esc pacemaker guideline europace heart rhythm society holter monitoring hv interval mobitz type 2 av block we Source Type: blogs
What is the risk of ACS after PCI in a CTO related artery ?
CTOs are opened primarily for four reasons
Angina which is refractory to drugs
Stress test positivity with or without angina
Anxiety of having a blocked coronary artery in a self educated patient
Cardiologist’s clandestine pride & pursuit*
* Personal experience included
Some evidence based observation
Most of the studies as on today do not give survival advantage of opening a CTO.(DECISION-CTO,EURO-CTO,EXPLORE,IMPACTOR)
Opening a CTO, for reasons other than angina (i.e. for relief of dyspnea or improving functional capacity) is largely conjectural and based on randomly accrued data back...
Source: Dr.S.Venkatesan MD - March 16, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cto cto hardware cto trials jcto score open artery hypothesisacc esc aha guidelines Source Type: blogs
Next frontier in radiation free Cath lab : Fibro-optic guided Catheterization
It is a 120-year challenge. Can anyone replace Rontgen’s X-ray discovered in 1895 for medical imaging? The Nobel winning Invention redefined the way we looked at our body and management of diseases for over a century. However, the fact remained it is an invasive and injuring investigation. What is the alternative for the X-radiation ?
CT scan was a great invention, but it turned out to be a gigantic 360-degree clone of X-ray machine. Today’s cath lab, however sophisticated , is like spending hours together inside a hot Chernobyl coffee shop. MRI was a true game changer. With zero radiation, MRI came close i...
Source: Dr.S.Venkatesan MD - March 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized FORS cardiac catheterisation ice intra cardiac echocardiography ivus mri oct proton mri imaging radiation saftety ultrasound imaging Source Type: blogs
No, we can ’ t call OMT, as a re-vascularisation procedure.
Hi, welcome Mr George, I just reviewed your records. You have three blocks in your arteries supplying the heart.
Are they serious Doctor ?
Not really, but one of them appear tight
What should I do Doctor ? But, I am comfortable Doctor.
You may be. But I am not .You need to undergo some re-vascularisation procedure .
What do you mean by that Doctor ?
It means either a percutaneous coronary intervention with a stent or CABG.
Can I get my heart re-vascularised by drugs alone Doctor ?
No we can’t . Hmmm , wait, we do have something called OMT/GDMT. Can you put on hold for some time Mr George, ...
Source: Dr.S.Venkatesan MD - February 25, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
When medical conferences become an “ Edutainment Industry ” the speciality of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe.
Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period
if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
When medical conferences become an “ Edutainment Industry ” the specialty of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe.
Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period
if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
When conferences become an “ Edutainment Industry ” the specialty of Cardiology leads from front !
Recently , I received two e-mail invite for two major conferences one in India other in Europe.
Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period
if you look closely into the above menu card, Indian tariffs would te...
Source: Dr.S.Venkatesan MD - February 22, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
