Posted in cardiology journals, Great websites in cardiology, Uncategorized, tagged cardiology journals, great journals in cardiology, hamad medical corporation, heart views journal, heartviews, lesser known journals in cardiology, qatar cardiology journal on November 27, 2010| Leave a Comment »
Great people do not boast . While there are thousands of hyped up publications in cardiology ,
This one form Qatar excels , which I stumbled upon recently contains very useful information about wide ranging issues in cardiology .
Let us congratulate the Hamad medical corporation for their unique academic vision .
Posted in Uncategorized on November 24, 2010| Leave a Comment »
That was a slightly modified title of an article published by the renowned Nephrologist from India Dr.M.K.Mani
Who is also involved in the fight against live kidney bazaar in India.
In this article he shares his experience , how desperately he is trying to correct a major conflict in physician laboratory nexus in India . It is has been an elusive search for the past 15 years.
And the article seems to the conclude , there is no other option , we (And our patients ) have to live with it .
But , what we need to realize is we have our own watch dogs lie within our mind , and it need to bark every time a thief is seen .
Let us awake our self for the benefit of our patient kind .
By the way , how many among us know such an important journal is published from India !
http://www.issuesinmedicalethics.org/044ed105.html
Further reading
No doubt , such kick backs and gifts and ads make medical care artificially high and unaffordable.
The pathetic stories of how modern medical care create new breed of poverty.
the poor can not get even the basic treatment because they are poor , while the rich get costly and inappropriate some times dangerous treatment and become poor .
Link to The WHO article that exposes the Issue
I know there is a book written by Dr M.K Mani , Yamarj’s Brother
I have not read it .I wish i get it soon .That Iam sure will enlighten us
Posted in Cardiology -Interventional -PCI, history of cardiology, tagged accidental inventions in medicine, cag, cardiac cathetrisation, coroanry angiogram, errors as science, forsmann cournand richards, great inventions, great medcial discoveries, henry ford detriot, nobel prize in medicine, scientiifc errors, Sones mason, what is coroanry angiogram on November 21, 2010| 1 Comment »
In any field , errors and mistakes transform into experience in retrospect. (Of course only if we realize our mistakes !) . Many would argue prevention of such errors is the only way to move forward in science , but ,the opposite could also be true.
In Medicine ,
That’s what happened on 1958 , to be precise on October 3oth , 1958 in a lonely laboratory of Henry Ford hospital/Cleveland clinic *
*A correction -This invention actually happened in Cleveland. ( Sones learnt all his techniques in Henry ford)
When Sones along with his assistant were trying to do an Aortogram in a patient with RHD, the entire dye meant for aorta went straight into the right coronary artery.When every one was stunned ,the patient happily survived the injection with a few skipped beats.
The man behind this horrendous medical mistake was Mr . Sones . He was guilty for many days , spent many sleepless nights ( In spite of the patient surviving the episode ). In fact , he was much amused about the patient’s survival . At that point of time, even a spill over of dye into coronary artery was considered forbidden. He pondered over the incident for months .
Had two queries lingering in his mind .
That was the moment , the concept of diagnostic coronary angiogram was born . He published his observation as an abstract in Circulation journal. Later he did many experiments with video engineering at Kodak labs , X ray technology to improve the cine imaging .By 1964 , he devised a perfect protocol for doing selective coronary angiogram. Then along with Rene Favaloro he pioneered CABG surgery in USA.
Final message
Cardiac catheterisation was invented by Forssman , Cournand , and Richards ,(Nobel prize 1956 ). It was Sones who took it into the coronary arteries and thus it was made possible for a whole new specialty of coronary diagnostics and therapeutic PCI which was conceptualized by another extraordinary human life called Gruentzig. Sones along with Gruentzig definitely deserve a Nobel in medicine which i think will happen soon ! They lived a great life constantly thinking, innovating putting patients interest in the fore front .
Mean while , I argue our youngsters to portray the images of these giants in every cath lab they work .You may get their blessings from heaven , provided you do your interventions with integrity and honesty without any conflict of interest in the patient care.
Do not cry foul when some genuine errors happen in cath lab.Few among us (like Sones ) may innovate those mistakes into glory !
Reference
http://en.wikipedia.org/wiki/F._Mason_Sones#cite_note-3
http://www.wired.com/thisdayintech/2009/10/1030first-coronary-angiogram/
Posted in cardiac drugs, Cardiology -unresolved questions, tagged best articles on anticoagulation, heparin substitution during pregnancy is it necessary, how unsafe is lmwh in pregnancy, pregnancy and anticaogulation, top artilcles in cardiology, warfarin and heaprin in pregnancy, warfarin embryopathy, warfarin safty 1st week or second week on November 17, 2010| 1 Comment »
This one is from Cleveland clinic in their CCJM 2009. It answers all those tricky questions when we plan anti – coagulation in pregnant women .
The ultimate reference article
on peri-operative anticoagulation
Posted in cardiac drugs, Cardiology - Clinical, Uncategorized, tagged anticoagulation in pregnancy, low molecular wieght heaprin in pregnancy, switching to heparin, warfarin vs heaprin on November 16, 2010| Leave a Comment »
A simplified animation strictly meant for understanding the concept
Posted in medical quotes, tagged educate the masses not to take medicines, favorite medical quotes, sir william osler, william osler on November 14, 2010| Leave a Comment »
Posted in Cardiology - Electrophysiology -Pacemaker, cardiology -ECG, Uncategorized, tagged biphasic shock, current as a drug, dc shock, defibrillation, electricity as a drug, electricity is a drug, energy levels in dc shock, monophasic vs biphasic dc shock, what is biphasic defibrillation, what is biphasic shock on November 14, 2010| 1 Comment »
No one would have believed a century ago when electricity was first dosvovered for the mankind by Benjamin Franklin with glorious purpose , would now be used as a drug for treating life threatening heart ailments !
Yes , electricity is a drug by definition.
It is administered percutaneously by focusing a beam of current into the heart.
Mechanism of DC shock / Defibrillation *
When heart suddenly behaves abnormally and start generating its own electricity and sends it through abnormal channels other than its natural paths , it becomes a dangerous arrhythmia .This propagation of wave front can occur in multiple directions in a chaotic manner , resulting in VT/VF and imminent death.
Like an air to air missile ,this abnormal wave front can be tackled only by an another electrical wave front . Nothing else will work.
* The difference between DC shock and defibrillation is only technical. If one gives a synchronised shock ( with qrs complex ) it becomes DC shock .If not , it is defibrillation
The success of defibrillation depends on many factors .
The following are most important.
Two shock forms are used
A biphasic DC shock has replaced the traditional mono phasic sine wave shocks in most machines.
What is the fundamental difference between the two ?
Final message
A biphasic shock waveform has a proven advantage . It has greater efficacy ( because it traverses the heart twice ) , requires fewer shocks with low delivered energy and hence less myocardial and dermal injury.
References
Even though there is general acceptance of superiority of bi phasic shocks , it is still considered by some , that there is no great difference in the overall outcome .
http://circ.ahajournals.org/cgi/content/full/94/10/2507
Bi phasic shocks in atrial fibrillation
Posted in cardiology journal club, cardiology journals, tagged cardio vascular engineering, journal of cardiovascualr enginnering, loose cuff hypertension on November 13, 2010| Leave a Comment »
It is often said medical professionals lack engineering sense and vice versa. The filed of bio medical engineering is is not a new one . It is there for over 50 years .The gap is narrowing very fast.
We are in the era of developing hybrid imaging , where a PET and CT come together. Raman spectroscopy is sending live images of tissue histology from the coronary arteries .
A journal exclusively catering to the cardiovascular enginnering is new development . Let us thank to the unique initiative from Purdue university .
Posted in Cardiology - Clinical, Cardiology hypertension, Uncategorized, tagged cuff length, cuff width, fallacies of blood pressure measurement, how to measure blood pressure, korotkoff sounds, loose cuff hypertension, phase 4 vs 5, riva rocci, sphygomanometer, systemic hypertension on November 13, 2010| Leave a Comment »
Blood pressure measurement , probably is the commonest investigation done in our patients in the entire field of medicine . It is such a common thing , both physicians and patients fail to perceive it as an investigation . (It indeed is !)
Even though BP is considered as a clinical sign , measuring it requires a device called sphygmomanometer . The BP apparatus has to be properly calibrated with the mercury , the tubing, the bladder , inflation balloon etc need to be perfect.
The following fallacies are noted in the measurement of blood pressure . Some of them are rampant* !
Patient
Device
Ocular errors
It is surprising , such an important tool has a scale of 2mm markings which is prone for parallax errors of light with mercury column undulating .
Physician factors*
It is not at all surprising to note, two BP readings rarely match , even if it is recorded by the same person with same machine at the same time !
There are many articles that describe in detail , how to record blood pressure properly. But this article from a relatively unknown journal from Purdue university , tells us most scientifically , what has been taken for granted by the medical community for so long .
Loose cuff hypertension (Link to the journal of Cardiovascular engineering )
How much stiffness is to be applied in the arm for optimal pressure recording ?
What is the incidence of hypertension due to loose cuff ?
Final message
The BP apparatus , though appears as an innocuous machine , the readings that emerge from it determines , how millions of our fellow human beings are going to be labeled ! ( High pressured humans , slaves to anti hypertensive drug marketeers for rest of their life ) .
So , realise how important it is , to measure the blood pressure properly ! Never be casual . . . with this machine .
Experience has taught us , while it is very easy to name an individual wrongly as hypertensive , it often needs Herculean efforts to remove this medical tag from their neck . The reasonings are many .( Academic , non academic and patient factors included )
Finally , in this funny planet it is a personal observation ( Or is it an imagination ?) some men and women tend to enjoy , being referred to as high pressured ! Loose cuff or tight cuff , it simply do not bother them !
Posted in Uncategorized, tagged complete cardiologist, great cardiologists, noble o fowler on November 12, 2010| 1 Comment »
Cardiology as a specialty has grown faster than any other field in medicine. From the days of Da -vinci and William Harvey , the urge to understand the intricacies of anatomy and physiology of this organ that sustain the rhythm of life , life was tremendous .
Heart was a gift of life by God to the man kind
One such person , we should all celebrate is Noble O Fowler From Cincinnati USA. This unassuming ,(In contrast to some of the current hyped up achievers !) has kindled thirst in the subject to many youngsters .
His remarkable achievement included
His book cardiac diagnosis was a exclusively authored by him is still considered as unique as his life.
Some how this book never got published beyond the 1980 s.
I personally dedicate this little service to cardiology literature to the legacy of Noble O Fowler.
A tribute by his Collegue Robert J Adokph
Dr.S.Venkatesan MD 
