Dr.S.Venkatesan MD

Archive for April, 2026

Why IVC rim is most important in ASD device closure ?

Posted in Uncategorized, tagged adequate rims in asd for device closure, amplatzer asd device, ASD device closure, asd rims, ivc vs aortic rims in asd device closure, why ivc rim is most important in asd clsoure on April 25, 2026|

The inferior vena cava (IVC) rim is the most critical rim for successful transcatheter ASD device closure due to its role in preventing device embolization and prolapse. Absence or deficiency of the IVC rim is often a contraindication, as it leads to higher rates of procedural failure compared to other rims like the aortic or SVC.

Anatomical Reasons

The IVC rim forms the posteroinferior border of the secundum ASD, measured in the bicaval TEE view as the distance from the defect’s inferior margin to the IVC ostium. Without ≥5 mm of adequate IVC rim, the device’s right atrial disc lacks stable septal anchorage inferiorly, allowing slippage toward the compliant, funnel-shaped IVC-RA junction. This contrasts with superior rims (SVC), where the SVC-RA junction provides firm foundation.

A dislodged device Video source : APCIS 2016 Jae Young Choi (Yonsei University, Korea) 

Physical and hemodynamic forces at IVC:RA junction

High-volume IVC blood flow (2-3 L/min, 60-70% of venous return) directly strikes the inferior septum and device, exerting continuous shear force that can dislodge a poorly anchored disc, causing left disc prolapse into the RA or embolization. SVC flow (1 L/min) is less voluminous and angled favorably, reducing its destabilizing effect.

If there is good rims on all other sides (270 degreees) can we proceed with ASD device ?

Some cardiologst believe so. Some institiosn have reported ASD device closure in deficnet IVC rims as well . That is not respecting the evidence (Ref 4,5) But, the fact seems to be different. The IVC’s perpendicular, high-momentum jet amplifies fluttering of floppy rims. Thus, even ample superior/anterior rims fail to counter this inferior “pull,” as the device pivots around the waist under dyanmic atrial pressures and flow. Hence IVC deficiency uniquely predisposes to instability despite the availablity of 270° of other rims.

One caution : A common mistake done is eustachian valves is taken as false IVC rim and the device is implanted and later facing issuers. So, a meticulous TEE imaging is neccessary .

Reference

1. Amin Z. Considerations for ASD closure. Cardiac Interventions Today. 2014;7(2):1–8.
   Link: https://citoday.com/articles/2014-mar-apr/considerations-for-asd-closure
2. Amedro P, Bayburt S, Assaidi A, Kreitmann B, Habib G, Fouilloux V, Fraisse A. Should transcatheter closure of atrial septal defects with inferior-posterior deficient rim still be attempted? J Thorac Dis. 2019 Mar;11(3):708-716. doi: 10.21037/jtd.2019.02.89. PMID: 31019758; PMCID: PMC6462671.
3. Song J. Comprehensive understanding of atrial septal defects by imaging studies for successful transcatheter closure. Korean J Pediatr. 2014 Jul;57(7):297-303. doi: 10.3345/kjp.2014.57.7.297. Epub 2014 Jul 23. PMID: 25114689; PMCID: PMC4127391.
4. Remadevi KS, Francis E, Kumar RK. Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance. Catheter Cardiovasc Interv. 2009 Jan 1;73(1):90-6. doi: 10.1002/ccd.21756. PMID: 19089959.

Postamble

Can we create a neo IVC rim by some means?, (Ex by agumenting the lower end of the IVC with stent , that can protrude clost ASD and act as a rim . We have strated closing the complex sinus venosus ASD, so , this might also be possible)

Rate this:

Read Full Post »

Mitral valve anatomy : Why AML lacks scallops, while PML has ? What are the clinical implications ?

Posted in Uncategorized, tagged 3d echo tee mitral valve, clincail implications of mitral leflet scallops, does aml has scallops, mechansim of mitral regurgitation, mitra clip, Mitral valve anatomy, mitral vlave replacement, p2 a2 scallop, scallops, tee mitral valve leaflet terminology on April 24, 2026|

When discussing the anatomy of the mitral valve, many of us get a confusion regarding these A 1, 2, 3 , P 1,2,3 stuff . Is the mitral leaflet really has sub-cm clefts or interuptions , that form the popular terminology mitral scallops .If so how long , these clefts go ? If it goes deep. will it not potentially the mitral valve look a tricupid ? Yes, every thing is possible . But ,It is very important to realise AML has no scallops and indentations, while the PML has distinct sub-commisures that make the well defined three scallops. The so called A 1, 2, 3 are just corresponding segments with reference to PML. Current day cardiologists are supposed to specify , segment or scallop orieneted MR jets . 3-D echo makes it possible. Also live, online TEE( with a good interperator) in cath lab has become essential in cath lab during mitra- clip procedure

3D echo showing the well defined scallops in PML, while the AML appears as single sheet.

A brief review on this topic

The PML has scallops because it develops as three distinct segments separated by indentations (subcommissures), with chordae attaching focally at these inter‑scallops to reinforce and stabilize the scalloped architecture, whereas the anterior leaflet (AML) forms as a single, broad, continuous sheet without clefts and is pulled by chordae in a broad, basket‑like pattern that does not create scallops.

In MR the PML’s scallops are prone to malcoaptation when annular dilatation or tethering pulls them apart, often producing focal jets at P1–P2 or P2–P3, while AML‑driven MR tends to be more diffuse when the entire leaflet is involved.

During MitraClip deployment, the PML’s scallops provide a useful roadmap to target graspable segments (e.g., A2–P2), whereas the smooth AML complicates precise alignment and raises the risk of eccentric residual jets if the clip captures non‑opposite segments, making the PML’s segmental architecturea vulnerability.

Final message

Understanding these mitral leaflet segments in TTE, TEE, are crtical if you are doing a mitral valve repair or mitra clip procedure. However, we need not waste much time in delineating these complex mechansims of MR , if you contemplate a definite mitral valve replacement.

Postamble

Can AML have true scallop ?

Yes , but it is abnormal can be observed in 2 to 3 % . (Ref : Muraru D, Cattarina M, Boccalini F, Dal Lin C, Peluso D, Zoppellaro G, Bellu R, Sarais C, Xhyheri B, Iliceto S, Badano LP. Mitral valve anatomy and function: new insights from three-dimensional echocardiography. J Cardiovasc Med (Hagerstown). 2013 Feb;14(2):91-9. )

Rate this:

Read Full Post »

Let us go back to the golden age of simple clinical trials & get rid of    big, motivated RCTs.

Posted in Uncategorized, tagged bmj, clinical trials, evoultion of clinical research, jam network, lancet, medical education, medical ethics, nejm, rct on April 19, 2026|

Very soon, blogs and independent writing will be the only source of unadulterated truths. One such article is shared here written by Adam Kroetsch , formerly in the FDA

A review and comments

The above article compellingly recounts how clinical trials evolved from ad-hoc, investigator-led efforts in the mid-20th century to the bureaucratic behemoths of today. It highlights the “golden age” of the 1980s-1990s, when academic “trialists” pioneered large simple trials like ISIS and GISSI. These mega-trials enrolled tens of thousands with minimal protocols ,one-page forms, no routine monitoring or source data verification (SDV), proper randomization, and focus on clinical hard endpoints and mortality delivering transformative, low-cost evidence on treatments like streptokinase and Aspirin.

The decline followed the rise of Contract Research Organizations (CROs) in the 1990s, global Good clinical practice -GCP guidelines (1996), and FDA missteps. Trials are now industrialized and bureaucratized: extensive on-site monitoring, exhaustive adverse event reporting, data audits, and risk-averse compliance layers inflated the costs (rising 10% annually). Academic and NIH-funded large trials plummeted .Pharma shifted to smaller, often useless biomarker-driven studies instead of clinical outcome. (Eg Drug X reduce NT-pro BNP by this,and it is crowned in glory ). The irony is ,the trialists are crying “foul” at GCP, and call it unscientific as they interupt the industry.

Who is responsible for this chaos?

Primarily commerce and greed in a profit-driven ecosystem .Alos pharma’s risk aversion and demand for speed and volume. Other factors were, heavily empowered CROs, Perverse incentives and Industry balance sheets, dictated the how science should behave. No surprise , true academics and genuine funders retreated amid prohibitive costs.

Final message

GCP  is not a taboo subject,  as some non- academic forces would like to envisage. Let us bring back the golden age of simple trials—even observational ones will bring the truth when done appropriately .Let us stop this big commercialised RCT nonsense  with ultier motives.

Rate this:

Read Full Post »

How Important is LA pumping function in LV filling ?

Posted in Uncategorized, tagged la conduit, la function assessment, LA pressure volume lopp, la pressure volume lopp animation, la resorvoir strain, la strian on April 10, 2026|

LA has three important functions, namely reservoir, conduit, and pumping. Which among the three is the most and least important?

Find out the answer yourself. One clue: Atrial systole is very brief, hardly lasting for 120 ms (equal to P wave duration). The rest of the period, the atria are taking rest. You think so? No, It gets ready to receive and deliver the entire stroke volume meant for the next LV contraction. Note the green path; it is not only long, it has to be less steep. For this, we require an agile LA (technically good compliant LA). If the LA is stiff, the LA struggles to form a good V loop, and it depends more on its pumping function. That is, the A loop contribution is more than the physiological 25%. So, as of now, the most critical function of LA seems to be its reservoir function, which is often measured by LA strain; normal values are -18 (luckily the same value as LV strain, easy to remember).

By the way, coming to the least important functional component .Even a 65-year-old elderly person just walks to your office with AF and a rapid rate. He just complains of some palpitations. Nothing else. His BP is normal. What does this mean? It would mean, most healthy adults do not really depend on the atrial booster pump for hemodynamic stability .The early ssytolic suction force of LV effectively compensates for this lack of atrial pump assistance. This is a very provocative statement and needs clarification from experts. One more piece of evidence comes from the long standing debate over rate vs. rhythm control in AF. With almost equipoise between rate and rhythm control, I wonder when exactly this atrial booster pump matters? Understanding LA pressure volume loop may look complex. When we spend some time, it becomes less fritetning.Think about how, MS, acute and chronic MR or LV dysfucntion modify this loop.

Final message

William Harvey might have discovered the circulatory system, but it is Carl Wiggers, the father of cardiac physiology and hemodynamics, whose wisdom taught us that the heart plays a silent  hemodynamic orchestra called systole and diastole. We, the current generation of cardiologists, are happy to stop with that. Do we need to have a separate cardiac cycle dedicated to the atria? Which would mean we need to know the nuances of the isolated atrial cardiac cycle (atrial systole and diastole) in and out of sync with the LV. Maybe someone who carries the same passion as Wiggers will soon emerge and do it.

Postamble

One point, I am yet to understand fully is, why should the LA pressure goes up during the conduit function (See the the blue line going north) as the LV fills. Maybe LA is restricted and trying to get equilibrated with the rasing slope of LVEDP, as the LV is getting filled rapidly.

Reference

1.Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019 Apr 23;73(15):1961-1977. doi: 10.1016/j.jacc.2019.01.059. PMID: 31000000.

Link 2

Rate this:

Read Full Post »

Forbidden quotes in medicine : Healing shall prevail over harming

Posted in Uncategorized, tagged bmj, british journal of medical ethics, dr s venkatesan, ethics in medicine, famous quotes on medical ethics, Hippocratic oath, indian journal of medical ethics, lancet, madras medical college, medical education, modern medicine, nejm, venkatesan sangareddi, world health organisation on April 9, 2026|

Rate this:

Read Full Post »

Why different cut-offs for diagnosing STEMI in men and women ?

Posted in Uncategorized, tagged stemi gender difference in defintion on April 6, 2026|

In healthy people, some J-point/ST elevation in V2–V3 is normal. This physiologic elevation is greater in men than in women Using the same cutoff for everyone would cause many false-positive STEMI calls in men (over-diagnosis) while missing true ischemia in women (under-diagnosis).

Molecular and Ionic basis

The difference is not because gender based difference in ischemia response . It is because ventricular repolarization differs between men and women due to sex hormones acting on cardiac ion channels. These differences appear at puberty and are belived to be driven by androgenic hormones.

Mechanism

Transient outward potassium current (Ito, carried by K+channels) is higher in male ventricular epicardium than in females. Testosterone up-regulates Ito density and function. In the action potential (AP) of epicardial myocytes higher Ito produces a deeper phase-1 notch This creates a larger transmural voltage gradient (epicardium vs. endocardium during phases 1–2 of the AP. This transaltes in the surface ECG as J-point elevation reflecting early-repolarization voltage gradients. Greater gradient steepr the J-point and higher ST takeoff .This is called the the classic “male-pattern early reppolarization.”Women have a shallow j point.

Image source : Blinova, Ksenia (2020). Sex and Cardiac Electrophysiology Atrial and ventricular tissue electrophysiology.

Why this difference is not seen in limb leads ?

Note : This J point difference is more prounuced in chest leads only because they are unipolar , and very close to epicardium and picks up the difference

Final message

Whenever we have trouble identifying the true mechanism in any gender-related difference, it is easy to blame it on either testosterone or estrogen. As in the atheletic filed , men are naturally a little faster to fly off from the start-boots in the early phase of repolarization. This also has some connection with why women have longer basal QT intervals than men. The whole repolarization process is slow but steady. We can alos realise, in spite of longer QT, women have less incidence of primary ventricular arrhythmias even during ACS, implying better reslience and stress handling. (Ref 2)

Reference

1.Blinova, Ksenia (2020). Sex and Cardiac Electrophysiology || Atrial and ventricular tissue electrophysiology. , (), 39–48. doi:10.1016/B978-0-12-817728-0.00004

2.Weizman O, Marijon E, Narayanan K, et al. Incidence, Characteristics, and Outcomes of Ventricular Fibrillation Complicating Acute Myocardial Infarction in Women Admitted Alive in the Hospital. Journal of the American Heart Association. 2022;11(17):e025959. doi:10.1161/JAHA.122.025959.

Rate this:

Read Full Post »

IVUS says good bye to complex PCI & left main :  Cardiologists, are yet to blink !

Posted in Uncategorized, tagged ivus oct, ivus-chip study on April 6, 2026|

How many conferences, live workshops, where elite cardiologists, thought leaders (rather, academic influncers) , were projecting glittering power points about IVUS guided stent optimization, the sacred MLA’s , high precision POTS.They , sort of seduced us to believe , that these are going to rule the next generation PCIs .

In fact, some them warned us (with the company brand on the background) it’s a crime, to do any left main interventions without imaging.

Now, two back to back papers has come in NEJM* , exposing the futility of routine IVUS (after exhausting the market, and seeing no further scope for this deciet market ) . It simply unserscores the fact , that the good old luminogram  is good enough for most PCIs including the complex ones *

Ironically , we should thank the same old  companies, who for some reason , decided to stop this futility, by funding these studies.

Final message

The message from this study is , we should concentrate on the treatment of the whole burden of atherosclerosis. Let us not waste our resources to optimize the stent with exotic imaging , which can be done by conventional means.

Further, Cardiologists are obliged to apologize to their fellow physicians as well as the patient community for hyping up these unnecessary tools causing financial excess and promoting pseudo-science. They should also take an oath , they will not embrace the future technologies, prematurely and blindly.

Postamble

Waiting for OCT to go the same way as IVUS very soon. *By the way, I want to ask NEJM one question: Do you have any mechanism to identify these futilities earlier? Because you guys only publish and lift up the Iniital hypes.

Rate this:

Read Full Post »

Why Superior Scientists, will never rely on Non-Inferiority trials?

Posted in Uncategorized, tagged bmj, data torturing, fake science, fake stastistics, jama network, lancet, medical stastistics, nejm, non inferiority trials, stastistics, who is superior scientists, why rcts are riggged on April 4, 2026|

Statistics is the most advanced form of mathematics by which predictions about the future can be made with some degree of surety.  It is a vital cog linking biology with  maths. However, since the last few decades, an abnormal man made bio-mathematical mutation is being spotted in the field of medical statistics.

Why superior scientists avoid Non Inferiority (NI)trials?

They avoid relying NI -trials due to fundamental statistical, interpretive, and ethical weaknesses that undermine rigorous evidence and patient benefit.

Superiority trial models , reduce bias  towards the null hypothesis and proactively protect against false claims. NI trials just do the opposite. The same issues dilute differences, biasing toward falsely concluding the new treatment is “not unacceptably worse” than the active control by a pre-specified margin . Without a placebo arm, sensitivity cannot be confirmed, and the assumption remains tentative.

Key vulnerabilities In NI trials include arbitrary, manipulable margins that may permit clinically meaningful inferiority. High success rates (>85–95%, especially industry-sponsored) suggesting bias, and risks ( Biocreep) where successive approvals erode standards. “Non-inferior” does not mean equivalent .It can mask statistically significant inferiority. Reporting often deviates from guidelines, with inconsistent margin justification and analyses (ITT vs. per-protocol).

Ethically, NI designs accept potential efficacy loss for unproven gains (convenience, cost, safety) without direct proof, exposing patients unjustifiably in high-stakes areas. They place disproportionate proof burdens on de-escalation or alternatives while entrenching suboptimal standards.

A Lancet Oncology piece highlights this as “the tyranny of non-inferiority trials”:. The authors propose abandoning superiority/NI distinctions for simple “comparative” trials.

Final message

Superior scientists prefer superiority or hybrid designs, or direct comparisons of net patient-centered outcomes .They never go for the NI shortcuts driven by regulatory or commercial pragmatism.

Reference

1.Tannock IF, Buyse M, De Backer M, et al. The tyranny of non-inferiority trials. Lancet Oncol. 2024;25(10):e520-e525. doi:10.1016/S1470-2045(24)00218-3.

2.Beryl P, Vach W. Is there a danger of “biocreep” with non-inferiority trials? Trials. 2011 Dec 13;12(Suppl 1):A29. doi: 10.1186/1745-6215-12-S1-A29. PMCID: PMC3287743.

Rate this:

Read Full Post »

SMART- DECISION : When big science tries to disrupt our Intellect,what shall we do ?

Posted in Uncategorized, tagged abyss action trial, acc aha esc, beta blckers post mi, comet trial, drsvenkatesan, esc guidlines, euro pcr, GDMT, jama cardiology, jama network, lancet, nejm, non inferiority trial, omt, reboot trial, reduce ami, secondary prevention of cad by beta blockers, smart decision, tct md on April 1, 2026|

Caution: Harsh language & Unscientific truths

It is a pattern out there, rolled out periodically in cardiac- pharma literature . It happened for Digoxin. They have been trying to do this to beta blockers for quite some time. They successfully ditched beta blockers in systemic hypertension with synthesized evidence. Mind you, BBs are the only drug that received a Nobel Prize for its invention, and its role in post-MI protection is well established.

The script is well written. Trying to ring a death knell for cheap and established medical therapeutic norms, citing lack of evidence. It is done based on some non-sensical study designs called Non-Inferiority Trials. (Tannock I, Buyse M, De Backer M et al.The tyranny of non-inferiority trials The Lancet Oncology, 25, e520-e525 Now, powerful cartels want to get rid of BBs in  post-MI ecosystem. REBOOT, REDUCE-AMI, ABYSS all were done with fixed ideas. Of course, ABYSS didn’t follow their agenda. Now, a  the latest trial has come out with a magical name SMART – DECISION.

Read this paper https://www.nejm.org/doi/full/10.1056/NEJMoa2601005

One famous statistician said, non-inferiority study concept is foundationally flawed. Hence, it is generally not worth reviewing them, as most conclusions are deemed to be wrong and not scientifically consumable. Still, looking beyond the trial design, three important flaws are obvious in SMART-DECISION’ trial , which argues for beta-blocker discontinuation after MI.

The study population is highly selected (median 4.7 years 98% revascularized; median LVEF 59%). The study advocated discontinuation among long-term accrued beneficiaries of BBs rather than typical 6–36-month post-ACS patients. Physician-driven HF hospitalization amplifies open-label bias. A wide non-inferiority margin (HR upper CI <1.4) plus low events (132 total) leave it underpowered, unable to exclude modest 15–25% harm (7.2% vs 9.0%).

Final message

In science, we need to be right first … being polite is optional.

When big science tries to corrupt our minds, what should we do? Let us continue with our conscience and follow the instinct and work for the welfare of our patients. We know the healing power of BBs. Let us be cautious and alert. Never allow wayward science to intrude upon our minds to take STUPID DECISIONS and defame the OMT in CAD.

Postamble

A newchallenge to take on

Fact : There is no published RCT that proves diuretics improve mortality and survival in heart failure.

Action requested : Let all evidence-based cardiologists withhold injections of Furosemide or Torsemide when they encounter their next patient with acute heart failure and pulmonary edema.

Rate this:

Read Full Post »

• Search for:

• Categories

  Categories Select Category acute aortic dissection  (1) acute coroanry syndrome  (18) acute coronary syndrome  (24) acute pulmonary embolism  (5) acute rheumatic fever  (5) admixture lesions in cyanotic heart disease  (1) Alcohol and heart disease  (1) Anatomy of heart  (9) angina  (1) anti platelet drug  (4) aortic aneurysm  (1) Aortic diseases  (10) Aortic regurgitation  (3) aortic stenosis  (5) Aortic stent grafing  (2) Aortic valve replacement  (2) ASD device closure  (1) atherosclerosis  (2) Atrial fibrillation  (13) Auscultation  (2) Awards in medicine  (1) baloon aortic valvotomy  (1) Basic sciecne  (2) Basic science -Physiology  (3) bav vs tavr  (2) Best books in cardiology  (6) Beta Blocker  (1) bifurcation pci  (1) bio ethics  (83) Blood pressure  (1) Breakthrough technology  (1) Bronchail arterial and venous circulation  (1) bronchial arterial and venous circulation  (1) Brugada syndrome  (6) CABG  (1) CABG for Ischemic DCM  (1) CABG Indications  (1) CAD in HFpEF  (1) cardaic pharmacology  (1) cardaic physiology  (28) cardiac anatomy  (3) Cardiac biomarkers  (1) cardiac cycle  (1) cardiac drugs  (32) cardiac electrophysiology  (2) cardiac embryology  (2) cardiac failure  (10) Cardiac MRI  (4) Cardiac myxoma  (1) cardiac physiology  (31) cardiac radiology  (3) cardiac resynchronisation  (2) cardiac source of embolism  (1) cardiac surgery  (61) cardiac tamponade  (1) cardiac volume  (2) cardiac X ray  (1) cardinal symptom in cardiology  (2) Cardio Nephrology  (2) cardio pulmonary resucitation  (1) Cardiologt women  (3) Cardiology – Animations  (10) Cardiology – Clinical  (353) Cardiology – Electrophysiology -Pacemaker  (87) Cardiology – Pioneers  (2) Cardiology -Clinical signs  (4) cardiology -congenital heart disease  (40) Cardiology -Coronary collateral circulation  (1) Cardiology -Criteria  (4) Cardiology -Definitions  (3) cardiology -ECG  (147) Cardiology -Emerging technology  (3) Cardiology -Funny events  (1) Cardiology -guidelines  (21) Cardiology -Hemodynamics  (8) Cardiology -Interesting videos  (1) Cardiology -Interventional -PCI  (260) Cardiology -Mechnisms of disease  (15) Cardiology -Non coronary Interventions -PTMC  (2) Cardiology -Pacemakers and ICD  (5) Cardiology -Patient page  (5) cardiology -pregnancy  (2) cardiology -Preventive  (8) cardiology -Sexual health  (2) Cardiology -Technology  (5) Cardiology -Therapeutic dilemma  (34) cardiology -Therapeutics  (308) Cardiology -unresolved questions  (277) Cardiology classics  (5) cardiology congenital heart disese  (23) Cardiology hypertension  (15) Cardiology Illistrations  (1) Cardiology Illustrations  (2) cardiology innovation  (15) Cardiology Innovations  (4) cardiology journal club  (13) Cardiology journal links  (2) cardiology journals  (21) Cardiology lipids /dyslipidemia  (4) Cardiology Outcome analysis  (1) Cardiology Patho physiology  (2) cardiology physiology  (2) Cardiology quotes  (18) Cardiology research topics  (6) cardiology research topics for fellows  (2) Cardiology Risk assesment  (9) Cardiology teaching websites  (4) Cardiology therapeutics  (1) cardiology thesis topics  (1) cardiology wisdom  (6) cardiology women  (3) cardiology- coronary care  (127) cardiology-Anatomy  (32) Cardiology-Arrhythmias  (66) Cardiology-Coronary artery disese  (93) Cardiology-Echocardiography  (4) Cardiology-Electrolytes  (1) cardiology-ethics  (58) Cardiology-Land mark studies  (41) Cardiology-Statistics  (5) cardiomyopathy  (5) carotid interventions  (3) Cath lab Hardware  (3) cath lab tips and tricks  (28) Centre for cardiology unlearninng  (1) cerebral circualtion stroke  (3) cerebral circulation stroke  (3) Chest pain  (1) Chronic total occlusion  (1) chronic total occlusion (CTO)  (1) Clinical cardiology  (58) Clinical cardiology  (7) Clinical cardiology -Cyanosis  (2) Clinical cardiology -JVP  (2) clinical cardiology -Murmurs  (1) clinical lipidology  (1) coarctation of aorta  (1) Comparative efficacy  (1) Complete heart block  (1) congenital heart disease  (3) constrictive pericarditis  (1) constritctive pericarditis  (1) contrast induced nephropathy  (1) Coronary angiogram  (1) Coronary collateral circulation  (1) coronary sinus anatomy and physiology  (1) coronary sinus filling and emptying time drsvenkatesan  (1) coronary veno occlusive disorder  (1) coronary venous circulation  (1) cost effectiveness in cardiology  (2) Criteria and Nomenclature  (1) critical care ccu  (8) cto chronic total occlusion  (5) Diabetes and Heart  (5) Diastolic dysfunction  (3) Dilated cardiomyopathy  (5) Dissection coronary  (1) dr s venkatesan -Personal  (6) dynamic auscultation  (1) dyslipidemia  (3) early repolarisation syndrome  (3) ECG -Basics  (1) Echo library and gallery  (15) echocardiography  (64) Echocardiography – LV dysfunction  (4) Echocardiography -Normal measurement  (2) Echocardiography-hemodynamics  (4) Echocardiography-Limitations of LV EF %  (1) Electro physiology  (4) Electrocardiography-ECG  (1) Electrocardiology -Basics  (1) Electrolyte and Heart  (1) Electrolytes and heart  (1) Embryology : Heart valve development  (2) embryology of heart  (2) emotion and cad  (1) ESC ACC Guidelines  (1) Ethics in Medicine  (16) evidence based cardiology  (4) excercise stress test .EST  (3) fame study ffr  (2) Fracional flow reserve  (2) Future cardiology gadgets  (2) future of cardiology  (1) Futuristic cardiology  (1) Gender issues in medicine  (1) general medicine  (11) great cardiologists  (1) great illustrations in cardiology  (4) Great Men in cardiology  (2) Great men in Medicine  (1) Great websites in cardiology  (13) Hadwares in cardiology  (2) Hardware techniques tips  (9) health economics  (1) Heart failure with preserved LV EF  (1) Heart transplantation  (2) Heart valves  (1) Hemodynamics  (15) Hemodynamics  (1) hemodynamics during Labor  (1) Heparin  (1) HFpEF  (1) HFrEF vs HFpEF  (1) Hippocratic oath  (3) history of cardiology  (23) Histroy of medicine  (6) hocm hcm  (2) hyperlipidemia  (2) Hypertension  (5) hypertrophic cardiomyopathy  (3) ICD  (1) ICD -Tips and Tricks  (2) ICD and Pacemakers  (3) infective endocarditis  (2) Infective endocarditis : Pathology  (1) Infrequently asked questions in cardiology (iFAQs)  (182) innovations in cardiology  (3) Interesting case study  (1) Interventions -Structural heart disease  (1) ischemic cardiomyopathy  (2) ivus  (1) IVUS /OCT/NIR  (1) Jugular venous pulse  (2) JVP -Jugualr venous pulse  (1) Land mark articles in cardiology  (4) Left atrial enlargement  (2) Left main disease  (4) Left main stenting -Tips and tricks  (4) lipid metabolism  (1) lipids lipid metabolism  (3) Long and Short QT syndromes  (1) LSCS for heart disease  (1) LV dilatation is diastolic dysfunction  (1) LV function  (1) Medcal research  (5) Medical education  (12) Medical ethics  (14) medical quotes  (43) medical satistics  (4) metabolic support of heart failure  (1) Mitral annulus -Functional mitral regurgitation  (2) Mitral balloon valvotomy  (1) Mitral prosthetic valve-Surgical tips and techniques  (1) Mitral regurgitation  (3) Mitral stenosis  (2) Morality in medicine  (1) Multimodality Imaging  (1) MVPS  (3) My favorite quote  (1) My presentations  (13) myocardial disease  (25) Neuro cardiology  (1) New hardware  (1) Newer cardiac Imaging  (1) Newer hardwares in cardiology  (2) Newer technology  (1) NSTEMI  (2) obesity  (1) open artery hypothesis  (2) opening snap  (1) oral anticoagulants warfarin acitrom  (1) Pace maker Tips and tricks  (5) Palpation  (1) Pathology-Vulnerable plaque  (1) patient education  (1) PCI PTCA Hardware  (6) pericardial disease  (14) pericardial effusion  (1) Pericardium  (3) perioperative risk assessment: Non cardiac surgery  (1) Permanent pacemaker  (2) platelet function  (1) post dilatation  (1) prasugrel  (1) Pregnancy and heart  (5) pregnancy and heart disease  (7) Preoperative evaluation  (1) Preventive cardiology  (3) Primary -PCI  (10) Primary PCI  (12) Primary prevention of CAD  (3) Primary prevention studies  (1) prosthetic valve dysfunction  (2) prosthetic valves  (2) prosthetic valves -Technical issues  (1) PTMC  (2) PTMC -Tips and tricks  (3) Public Health  (4) Public health issues  (4) Pulmonary arterial hypertension  (4) Pulmonary circulation  (3) pulmonary embolism  (1) pulmonary hypertension  (7) Pulmonary vascular resistance  (1) pulmonary vein ablation  (1) quantitative coronary angiogram  (1) Quotes  (15) radial coronary angiogram PCI  (1) Radial Interventions  (1) RBBB vs RVH  (1) RBBB/LBBB  (1) Reperfusion  (2) rf ablation  (1) rheumatic heart disease  (9) Right atrial appendage  (1) Right ventricle  (3) RIsk factors  (1) Science and Religion  (3) side branch jailing  (1) Social medicine  (7) stains and ldl  (1) STEMI  (9) STEMI -Managment  (8) STEMI-Primary PCI  (20) stress doubtamine echo  (1) stroke  (3) Syncope  (6) systemic hypertension  (1) Systolic decapitation in aortic stenosis  (1) TAVR  (2) TAVR /TAVI  (2) tavr tavi  (2) TAVR VS SAVR  (1) Teaching points  (1) Technology  (3) Technology Emerging  (2) TEE-Transesophageal echocardiography  (1) Tetrology of Fallot  (2) Thesis/Research topics for cardiology fellows  (1) Thrombolysis  (9) Thrombolysis -Tips  (3) Tips and tricks in cath lab  (5) Top ten in cardiology  (7) Tutorial in clinical cardiology  (18) Two line sermons in cardiology  (17) Uncategorized  (827) valvular heart disease  (21) Venkat quotes  (15) Venkatesan -Presentations  (1) Viability assessment  (1) vulnerable plaque  (1) Wintage cardiology  (8) wisdom in cardiology  (6) WPW syndrome  (2) X ray  (3)

• 

• The contents of the this blog is being published as Kindle E book , as per the request of many of the readers. Every article will continue to be open source in this site. Again I shall reiterate the book format is not aimed at any commercial intent. It is only to facilitate learning in a single book format Here is the link to book
  https://amzn.in/d/euhL5vu

  • 

• Archives

  • April 2026 (9)
  • March 2026 (10)
  • February 2026 (8)
  • January 2026 (8)
  • December 2025 (11)
  • November 2025 (7)
  • October 2025 (8)
  • September 2025 (7)
  • August 2025 (9)
  • July 2025 (10)
  • June 2025 (8)
  • May 2025 (9)
  • April 2025 (7)
  • March 2025 (10)
  • February 2025 (4)
  • January 2025 (9)
  • December 2024 (11)
  • November 2024 (8)
  • October 2024 (10)
  • September 2024 (5)
  • August 2024 (5)
  • July 2024 (6)
  • June 2024 (5)
  • May 2024 (4)
  • April 2024 (7)
  • March 2024 (4)
  • February 2024 (8)
  • January 2024 (6)
  • December 2023 (8)
  • November 2023 (13)
  • October 2023 (14)
  • September 2023 (5)
  • August 2023 (6)
  • July 2023 (10)
  • June 2023 (5)
  • May 2023 (5)
  • April 2023 (4)
  • March 2023 (5)
  • February 2023 (2)
  • January 2023 (7)
  • December 2022 (3)
  • November 2022 (5)
  • October 2022 (5)
  • September 2022 (4)
  • August 2022 (3)
  • July 2022 (9)
  • June 2022 (2)
  • May 2022 (1)
  • April 2022 (2)
  • March 2022 (1)
  • February 2022 (3)
  • January 2022 (7)
  • December 2021 (3)
  • November 2021 (5)
  • October 2021 (8)
  • September 2021 (4)
  • August 2021 (6)
  • July 2021 (6)
  • June 2021 (7)
  • May 2021 (5)
  • April 2021 (4)
  • March 2021 (3)
  • February 2021 (6)
  • January 2021 (8)
  • December 2020 (4)
  • November 2020 (5)
  • October 2020 (7)
  • September 2020 (7)
  • August 2020 (10)
  • July 2020 (6)
  • June 2020 (9)
  • May 2020 (9)
  • April 2020 (5)
  • March 2020 (7)
  • February 2020 (3)
  • January 2020 (4)
  • December 2019 (4)
  • November 2019 (6)
  • October 2019 (3)
  • September 2019 (6)
  • August 2019 (3)
  • July 2019 (1)
  • June 2019 (3)
  • May 2019 (2)
  • April 2019 (2)
  • March 2019 (2)
  • February 2019 (4)
  • January 2019 (2)
  • December 2018 (2)
  • November 2018 (2)
  • October 2018 (2)
  • September 2018 (1)
  • August 2018 (2)
  • July 2018 (3)
  • June 2018 (1)
  • May 2018 (3)
  • April 2018 (1)
  • March 2018 (3)
  • February 2018 (3)
  • January 2018 (1)
  • December 2017 (3)
  • November 2017 (3)
  • October 2017 (3)
  • September 2017 (2)
  • August 2017 (2)
  • July 2017 (2)
  • June 2017 (2)
  • May 2017 (4)
  • April 2017 (3)
  • March 2017 (3)
  • February 2017 (5)
  • January 2017 (3)
  • December 2016 (2)
  • November 2016 (5)
  • October 2016 (4)
  • September 2016 (3)
  • August 2016 (5)
  • July 2016 (3)
  • June 2016 (4)
  • May 2016 (3)
  • April 2016 (6)
  • March 2016 (4)
  • February 2016 (3)
  • January 2016 (5)
  • December 2015 (6)
  • November 2015 (5)
  • October 2015 (8)
  • September 2015 (2)
  • August 2015 (5)
  • July 2015 (7)
  • June 2015 (4)
  • May 2015 (6)
  • April 2015 (5)
  • March 2015 (7)
  • February 2015 (15)
  • January 2015 (8)
  • December 2014 (5)
  • November 2014 (9)
  • October 2014 (7)
  • September 2014 (9)
  • August 2014 (5)
  • July 2014 (11)
  • June 2014 (5)
  • May 2014 (4)
  • April 2014 (5)
  • March 2014 (8)
  • February 2014 (8)
  • January 2014 (5)
  • December 2013 (7)
  • November 2013 (7)
  • October 2013 (14)
  • September 2013 (12)
  • August 2013 (15)
  • July 2013 (15)
  • June 2013 (15)
  • May 2013 (15)
  • April 2013 (15)
  • March 2013 (15)
  • February 2013 (15)
  • January 2013 (15)
  • December 2012 (15)
  • November 2012 (15)
  • October 2012 (15)
  • September 2012 (15)
  • August 2012 (15)
  • July 2012 (15)
  • June 2012 (15)
  • May 2012 (15)
  • April 2012 (15)
  • March 2012 (15)
  • February 2012 (15)
  • January 2012 (15)
  • December 2011 (15)
  • November 2011 (17)
  • October 2011 (17)
  • September 2011 (17)
  • August 2011 (21)
  • July 2011 (20)
  • June 2011 (17)
  • May 2011 (15)
  • April 2011 (17)
  • March 2011 (25)
  • February 2011 (20)
  • January 2011 (20)
  • December 2010 (18)
  • November 2010 (21)
  • October 2010 (21)
  • September 2010 (25)
  • August 2010 (20)
  • July 2010 (10)
  • June 2010 (11)
  • May 2010 (19)
  • April 2010 (16)
  • March 2010 (14)
  • February 2010 (22)
  • January 2010 (18)
  • December 2009 (20)
  • November 2009 (20)
  • October 2009 (3)
  • September 2009 (21)
  • August 2009 (19)
  • July 2009 (12)
  • June 2009 (12)
  • May 2009 (11)
  • April 2009 (15)
  • March 2009 (21)
  • February 2009 (4)
  • January 2009 (12)
  • December 2008 (13)
  • November 2008 (9)
  • October 2008 (22)
  • September 2008 (20)
  • August 2008 (16)
  • July 2008 (14)
  • June 2008 (7)

• Blog Stats

  • 6,657,696 hits

• Please give your feed back .

• Click below to see who is watching this website live !

  
• This site will never aim for profit. Still ,this donation link is added at the request of few visitors who wanted to contribute and of-course that will help make it sustainable .

• Please Note

  The author acknowledges all the queries posted by the readers and wishes to answer them .Due to logistic reasons only few could be responded. Inconvenience caused is regretted.