Let me see how many find sense in this Nonsense !
Posts Tagged ‘cardiology’
What happens to the vegetation after successful treatment of infective edocarditis ?
Posted in Cardiology - Clinical, infective endocarditis, Infrequently asked questions in cardiology (iFAQs), tagged bacterial vegetation, cardiology, drsvenkatesan, healed vegetation, infective endocarditis, mitral valve, vancomycin on August 19, 2012| Leave a Comment »
When do you call a infected heart as healed ?
Should the vegetation disappear to call it a cure ?
Vegetation’s rarely disappear following treatment . Very small vegetation may dissolve – 20% . Many times it regress in size .
Often our aim should be restricted to sterilise the vegetation. This invariably happens in most of the patients who receive complete course of antibiotic. But healing and sterilizing is not enough in many vulnerable patients.If the vegetation is large the embolic risk is still there even with a healed vegetation.
So if there is a relatively large (>1.5cm) vegetation it is always better to remove by surgery.
Interventional techniques may soon allow capturing these vegetation by basket catheters .When technology is there to retrieve small bits of a thrombus inside a coronary artery it should be possible to remove a large vegetation with temporary aortic filters in place.
Also read
What happens to HDL level following Intensive statin therapy ?
Posted in cardiology -Therapeutics, Cardiology lipids /dyslipidemia, tagged atorvastatin, cardiology, cholesterol, coronary artery disese, drsvenkatesan, dyslipidemia, effect of statin on HDL, hdl, hyperlipidemia, ldl, lipids, simvastain, statin on August 4, 2012| 2 Comments »
Statins have revolutionised the treatment of coronary artery disease .Intensive lipid lowering is the fundamental prerequisite in the management of both acute and chronic coronary syndromes. One question is always difficult to answer , ( rather reluctant to find the answer ) “The effect of statins on the HDL cholesterol”. Logic and the mechanisms of action would suggest HDL is not much affected , but in reality I believe , in a given patient statins do reduce the HDL by at-least 10-20 % .This might have some significance. However , the marked reduction in LDL may nullify the adverse effects of lowering HDL. Does this happen in all
What does the scientific evidence say ?
It says the opposite . It seems HDL is raised by statins that too significantly . The following paper also suggests mechanism of HDL elevation by statins .It is Independent to that of LDL reduction , I believe .
This JAMA article adds more evidence
http://jama.jamanetwork.com/data/Journals/JAMA/5100/jpc70001_499_508.pdf
This paper from the premier Journal of Lipid research agrees to the mechanism of HDL reduction by statin is a complex process but still it vouches for it .
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035518/?report=printable
In spite of all these evidence . . . it remains a huge suspect . . . from my personal point of view ( My patients are my evidence ! )
Coming soon
The above articles also raise an important concept of dysfunctional HDL. Simple raise in HDL is not suffice . . .it should be functional as well !
Learning cardiac surgery : Free entry to some of best cardiac surgery theatres !
Posted in cardiac surgery, tagged cardiac surgery, cardiology, crsnet.org, mmcts, mulimedia manual of cardio thoracic surgery on November 2, 2010| Leave a Comment »
Internet has revolutionsed the way we learn . Now, you can watch experts perfoming complex cardiac surgries sitting at any where in the globe !
The credit not only goes to the broad-band internet , but also the greatness of European association of cardiothoracic surgery which has made it available free of cost .
Let us welcome this . . . A forum for cardiac safety !
Posted in bio ethics, cardiology -Therapeutics, cardiology-ethics, Uncategorized, tagged cardiac safety research consortium, cardiology, csrc, dcri, drsvenkatesan, duke university, ethics in cardiology, fda on June 20, 2010| Leave a Comment »
There are thousands of forums for medical science.
Most are aimed at research. Few are available to scrutinize research.
“Cardiac safety research consortium “
This one from Duke university , is a great beginning in collaboration with FDA .
Let us welcome , this whole heartedly and wish all success in it’s motto !
Namely , exposing all safety issues in the modern cardiac therapeutics .
Six “spheres of knowledge” in cardiology . . .
Posted in Uncategorized, tagged cardiology, comon sense based cardiology, ethics in cardiology, evidence based cariology, evidence based medicine, experience based cardiology, ignorance based cardiology, knowledge disease on June 14, 2010| Leave a Comment »
Many believe modern science is pure and uncontaminated.
I wish it to be true , But reality mirror tells a different story !
The following “spheres of knowledge” collectively form the cardiology literature .
How much ? each sphere , contribute is any body’s guess !
The same rule might apply in all medical specialties.
Readers are argued to add more spheres of knowledge.
The seventh sphere may be Eg : “Commerce based cardiology “
The most important journal in cardiology !
Posted in bio ethics, cardiology -Therapeutics, cardiology journal club, cardiology journals, tagged ahj, cardiology, circulation cardiovascualr quality and outcomes, evidence based cardiology, great cardiology journal, jacc, nejm, top cardiology journals on April 17, 2010| Leave a Comment »
Which you think is the most important journal in cardiology ?
- JACC ?
- Circulation ?
- American journal of cardiology ?
- American heart journal ?
- Heart rhythm ?
- European heart journal ?
- The Heart ?
- Journal of invasive cardiology ?
- NEJM ?
- Lancet ?
None of the above . . . is the right answer !
Probably, the best journal that is going to have the greatest impact in cardiology practice in the future could be this . . .
Unfortunately most cardiologists are unaware of this journal . The need for this journal , that too from most respected Circulation family , will vouch for its importance in the current era of cardiology that is driven more by the market forces than by the academics.
Click here to reach journal
Journal Highlights
- This journal is 3 year old , and most of the medical colleges do not subscribe to this.
- None of the 100 cardiologists who were questioned , were unaware of such a journal.
- Even those who read this journal often term as boring , academic and not practical !
The Circulation team which started this journal with only one purpose . . .that is , auditing the uncontrolled proliferation of pseudoscientific literature without proper quality assessment and dubious outcomes. Three cheers to the circualtion team for publishing this journal and let us propogate the importance of this publication.
The fine art of converting healthy persons into patients .
Posted in bio ethics, tagged 64 slice ct scan, bio ethics, cardiologist, cardiology, coronary care, ethics in cardiology, fibroid uterus, hippocrates, master health check up, noble profession, non ulcer dyspepsia, osteoporosis, preventive medicine, preventive screening, stemi on February 24, 2010| 1 Comment »
Common sense would indicate medical care is meant for the sick and ill . Relieving the mankind from all those suffering with a healing hand has made the medical profession noble and sacred .Medical science grew with this sole aim many centuries ago .Some times we succeeded and many times we failed and the journey is continuing .
In those days ,scientists were dedicated , inventions were genuine and were driven by a need to conquer a diseases .Some where along the line, (May be in the last 2-3 decades?) our quest for money power exceeded commonsense . Commerce entered every walk of life and medical science became the biggest causality.
The purpose of noble profession was forgotten . Simultaneously public awareness and quality if life vastly improved in many of the developed countries . So the traditional illnesses either disappeared or reduced to a great extent . Then came the life style diseases.The cost of treating an illness spiraled too much especially in the scientifically advanced countries . What was perceived as great health care system became the most ridiculed health system in the planet ?
Why ? The simplest answer to this q is
In the name of science and modernity , medical treatment was glorified beyond the level it deserves , and hence the cost of treatment is kept at artificially & foolishly high (This often involves diagnostic exploration of human body with modern gadgets without any meaningful purpose ) .
ie , In a nutshell of modern medicine is often a medical mirage than a miracle . We know , the chances of success as we try to chase it. If we think the world is waking on this issue .
We are in for a surprise ! Even as every one is asking for outcome analysis in modern health care
more and more countries just imitate the failed ( Scientific and moral failure ) western models of health care .
When major illness are reducing in a society what will the health care providers do ?
Feel happy ? Yes that’s what a sane mind would do . In a capital rich , health conscious , knowledge driven society the opposite happens .
When the patient input into a top hospital reduces , the MBAs in them plan strategies to bring increase the bed occupancy rate and maintain patient parity.
If sufficient patients are not there in a community what shall we do ?
Create more patients
Creating new patients is a too dangerous game , what shall we do ?
In the name of preventive screening let us label normal persons as patients .
How to do it ?
The following examples are personal observation made in huge city of educated elite in a developing country . Excuse me if it offends a few . . .
Define, redefine all criteria that define the disease (There are
- Make, 130/85mmhg of blood pressure as pre hypertension and make them visit our HT clinic every month.
- In the name of risk stratification do CRP, Micro HDL , Apo a etc and catch them for primary risk reduction for a non existing illness
- Let us label all the age related bone loss as deadly osteoporosis and do bone graft.
- Let us call the occasional post dinner stiff stomach as non ulcer dyspepsia and insert a endoscope into the patient tummy .
- Do a 64slice CT in a master health check and convert many of the healthy normals into carriers soft coronary plaques.
- Do a ultra sound scan in every one who takes alcohol and give our brains a temptation to label the normal fatty streaks as infiltrative fat disorder .
- Do routine pelvic scan and detect sub clinical fibroid uterus as potentially malignant and post them for hysterectomy on the next operation day.
- Convert all healthy women as a potential cervical cancer and administer herpes vaccine and help the vaccine company share move up in wall street !
- Finally , screen all our playful kids for learning disability and label them as slow attention deficit disorder and make their life permanently miserable .
The list is endless . . .
Final message
We are in a era , where even a simple illness ( common cold ? ) can be converted into a billion dollar industry . ( Are you aware of H1N1 fiasco , The role of WHO and mystery labeling of pandemic !)
While the above misadventure with scientific excesses goes on merrily , lest we forget , millions of children and adults suffer in misery for want of live saving investigations and drugs in any country .
When a person with a head injury dies due a missed subdural hematoma for want of CT scan in one hospital , ” in the adjacent hospital” a wealthy and healthy man ( who got admitted for master health check up ) undergoes a series of scans all over the body even as he is watching the satellite TV in the comfort of a five star suite !
God will never forgive the noble professionals if they are part of this negative health care forces
Finally ending with a very positive note !
The new initiative by Obama , ” Health care for the uninsured ” is to be welcomed as great move and will do a world of good .
But , our only request to WHO ( or related bodies ) is to create a forum or authority to impeach all fancy diseases from the medical literature !
Lesser known cardiology journals . . . but with excellent content !
Posted in Uncategorized, tagged cardiology, cardiology journals, Scandinavian journal on February 21, 2010| Leave a Comment »
There are many cardiology journals we read , trust , and celebrate . . .
Many of us are not aware of few other excellent journals
This is one is different
It is from Scandinavia & deserves a special status.
In dilated cardiomyopathy which chamber dilates first ?
Posted in cardiology -Therapeutics, Cardiology -unresolved questions, Cardiology-Coronary artery disese, echocardiography, Infrequently asked questions in cardiology (iFAQs), Uncategorized, tagged cardiac failure, cardiology, DCM, dilated cardiomyopathy on February 9, 2010| Leave a Comment »
As the name suggests dilated cardiomyopathy would imply cardiac chambers will dilate , at least some time in the course of the disease .It can be minimal, mild or massive. A new entity called non dilated cardiomyopathy is also gaining wider acceptance . (That will be dealt seperately )
Logic would suggest , the first chamber to dilate in DCM should be the left ventricle because it is facing the direct load of systemic blood. But we also know , whenever LV is stressed , left atrium comes to it’s assistance .
Left atrium does this by total self sacrifice ( by all means!) increases it’s force of contraction, elevating it’s mean pressure or even increasing it’s rate (AF) .
Like most other critical questions in cardiology , the factors that determine LV dilatation in DCM , is also poorly understood !
- Is it the after load ?
- Is it the muscle mass ? or it’s turgid or flabbiness ?
- Is it the interstitial integrity?
- Is it the blood volume ?(LVEDV , LV residual volume )
When the issue is complex , it is usual to make the the unknown genetic defects , the scapegoat !
As of now the most important determinant of LV dilatation could be the behavior of the desmins, the gap junctions and myosins the titins etc
If the LV of a DCM patient refuses or resists dilatation what might happen ? Is it good or bad for the patient ?
Here is a catch . A LV that does not dilate obviously should be be good for the patient is in’t ? Medicine is not that simple.
When LV fails to dilate it means it has become too stiff and rigid and pass on the burden to to LA which faces the music. And in the process it dilates.This is the reason , we observe diastolic dysfunction in vast number of DCM patients.( Currently it is estimated > 75% DCM will have significant diastolic dysfunction )
So , now we can imagine how complex the sequence of hemodynamic stress in DCM that determine the chamber enlargement.( RA, RV dimension in DCM is a separate issue !)
So now answer this question : Which chamber dilates first in DCM ?
- Left ventricle
- Left Atrium
- Any of the above
- Both of the above dilate simultaneously
The answer must be 3 .
Why recognising this sequence of chamber enlargement in DCM is important ?
- It gives us an opportunity to assess the dominant mechanism of LV dysfunction.There are reports , where some DCMs have more diastolic dysfunction than systolic dysfunction .This will have important therapeutic implication.Further , many of the infiltrative disorders of LV can have features of both DCM & RCM .
- When a RCM begins to dilate it is usually a harbinger of terminal heart failure. But, it need not be always true . A small restrictive LV , when dilates , may acquire a slightly improved diastolic properties , as the LV becomes more placid . And , if it happens the LA size may regress.
- The role of LV restriction devices like, Acron mesh, Dor procedure, plication in refractory DCM is not well defined. All these modalities actually adds a small dose of diastolic dysfunction in these patients who have grossly dilated ventricles. This fact is very important , as presence of any preexisting significant diastolic dysfunction in DCM makes the role of LV restrictive devices and surgery a big question mark !