Dr.S.Venkatesan MD

Archive for the ‘Cardiology quotes’ Category

What ails modern medicine ? When “Nonsense” masquerade as scientific data . . . should “sense” has to leave quietly by back door ?!

Posted in bio ethics, Cardiology quotes, Cardiology research topics, Cardiology Risk assesment, medical quotes, Two line sermons in cardiology, tagged Lown Institute, medical ethics, what is scientific data on October 16, 2016| Leave a Comment »

Bedside wisdom

We have been  using unfractioned Heparin for long , and its  is better than any other anticoagulants  in ACS . . . 

Our observation shows that Streptokinase has distinct advanatge over Tenektepelase as it works longer duration  . . .

My experience  says Diuretic and beta blockers  are still good as first line therapy for Hypertension  . . .

Mind you , there are infinite  number of such wisdom in every sub specialty of medical field.

However , the typical response from any  modern scientific intellect would be . . .

Stop it . . . Its old  stuff folk  , What does the current data say ?

Common uttering  in scientific forums,

Is there data backing up your  treatment modality ?

Is there sufficient data ?

Come’on , grow up , don’t talk about experience in a scientific forum . . . come out with data man !

No one seem to care the quality of the data . Every one bothers  about the quality of the Author and Journal instead  .  if its X Y Z its ok If its A B C no its not acceptable data.

Probably , Data is most misused word in medical science.

In scientific world,  “unpublished sense” goes straightway to  dustbin ,while we have so many avenues for the  published nonsense to  be celebrated (Still, bulk of guidelines in cardiology is backed up by Level C evidence which means experience  of experts !)

By the way what do we mean by data ?

Its organised collection of genuine scientific information , that’s post processed ,  follow it up with sound inference and faithful questioning and debate that should ultimately end up as  “clinical  application” in patient domain for consumption.(No prizes for guessing , whats happening in real world !)

OMG, give us back that elusive Common sense . . . which  I  think we  lost some time  at the turn of this millennium  !

Wrong or useless data : Who will recall ?

Once applied to patient , these data is  to be scrutinized and monitored . If we find a study conclusion  and reality does not match , we  need to stall the data from adversely  exploding .Every stake holder should have the power to do it. There have been instances a treatment modality got banished in one country is legally permitted in other country knowing fully well the futility.

Final message 

Modern scientific Data* is not God sent. Its  created , synthesised and disseminated in various mind factories. All you require is , backing up with some pioneering journal publication with huge impact factor.It’s not really blasphemy to question things which doesn’t make sense .Unfortunately , wrong data can be tackled only with further data .(There is no other means I guess !)

When does “good common sense”  become hard data and evidence ?

Its the act of publication , so  please guys whenever you  find some contamination  in so-called scientific data  please post here.  To begin with I am registering a new Journal  “Commonsense journal in cardiology”

*Please note, data is not a bad word as this write-up  seem to suggest.Naturally occurring , epidemiological and  observational data about diseases are the foundations for medical science .The issue become murky when few motivated humans play brutal  games at the sensitive  interface between science and truth.

It should be acknowledged , there is a distinct risk  of  this fight against falsehood end up in blocking  true progress  of science . Still , Homo sapiens  are (believed to be !)  intelligent enough to differentiate good from bad , that’s the reason God gave us the sixth sense !

Link to Lown Institute (Started by Cardiologist and Nobel peace prize  Laurate Dr Lown who strives hard to pursue this goal)

Further reading :  Scientific Reversals in cardiology 

1.Vinay Prasad, Adam Cifu,  John Ioannidis  Reversals of Established Medical PracticesEvidence to Abandon Ship   JAMA. 2012;307(1):37-38. 

2.Vinay Prasad Adam Cifu  Interventions that were tried in vain .  Cardiovasc Diagn Ther. 2013 Dec; 3(4): 228–235.

Rate this:

Read Full Post »

Over-Indulgence in private health care is a backward thinking !

Posted in bio ethics, cardiology -Therapeutics, Cardiology classics, Cardiology quotes, medical quotes, Morality in medicine, Two line sermons in cardiology, tagged edward banfield, modern medicine and banfield theory, moral basis of backward society, private vs public health care on June 15, 2014|

Shall I begin with a provocative quote (My own !)

Inability to think beyond  self , family, private life  reflects a backward and immature  state of human mind

How to eradicate this backwardness  we all suffer from !

I stumbled upon a book which made me wonder , whether  eradication of  backwardness is little to  do with education ! It lies much, much deeper in our cortical thinking influenced by  inheritance , evolution , culture and economy .

The stunning truth was exemplified  by  American political  scientist  Edward C. Banfield  .A must read for every one who have mind for society , community and the humanity !

In this book he introduced a new term to describe this self centered thinking as “Amoral familism”

“Banfield concluded that  human  plight was rooted in the distrust, envy and suspicion displayed by  them in  relations with each other. Fellow citizens would refuse to help one another, except where one’s own personal material gain was at stake. Many attempted to hinder their neighbors from attaining success, believing that others’ good fortune would inevitably harm their own interests”

Banfield theroy  and  “Moral Bankruptcy in Modern medical care”

I am afraid  there is a  compelling link between Banfield’s observation in a remote Italian village  to the current  medical  community   mind set who care only for their patients who pay them and keep them happy !

If you  think  education will eradicate social backwardness ,Why ?  one of the most highly educated community that form the noble profession remain backward in their thinking !

How do you explain  innumerable instances of hospitals ,  doctors shutting doors for  lesser humans  even in dire emergencies ! ?

Why do many of them  join hands with powers that can be detrimental to the overall health of the society ?

The stunning irony is , they do it  unashamed (with pleasure  at times!)  in  violation of the oath they take when they join the Noble profession. Shall we call it  as ” Moral Bankruptcy in medical care ?

Read further

Moral Basis of a Backward Society 

 

Highlights of this book  (Text from Wikipedia)

The Moral Basis of a Backward Society is a book by Edward C. Banfield, a political scientist who visited Montegrano, Italy . He observed a self-interested, family centric society which sacrificed the public good for the sake of nepotism and the immediate family. Banfield as an American was witnessing what was to become infamous as the “mafia” or families that cared only for its own “members” at the expense of their fellow citizens. Banfield postulated that the backwardness of such a society could be explained ‘largely but not entirely’ by ‘the inability of the villagers to act together for their common good or, indeed, for any end transcending the immediate, material interest of the nuclear family’.

 

Link to this book in PDF

 

Rate this:

Read Full Post »

Why 90 % of cardiologists suffer from coronary blindness ?

Posted in cardaic physiology, cardiac physiology, Cardiology -Coronary collateral circulation, Cardiology quotes, tagged coronary angiogram, coronary blindness, coronary collateral circulation, coronary micro circulation on February 12, 2014| Leave a Comment »

Note :This is a copy of  my earlier blog on coronary micro-circulation  published few years ago.Recently this got numerous hits .Hence I have just reposted it with slight modification.

Human coronary circulation stands unique among  others as it is a  life-sustaining circulation.It is indeed a great medical achievement  to visualise  the right and left coronary artery  system by coronary angiogram.  Actually,  what we see is  only a fraction  of  the surface area of coronary circulation .The surface area of  epicardial coronary arteries   constitutes  less than 5 % of entire coronary vascular tree .

And  . . .

An in vitro heart with special catheters showing the true extent of coronary circulation: Courtesy http://eurheartj.oxfordjournals.org/content/28/3/278.full.pdf+html

This  is the reason  normal coronary angiogram can never mean normal  coronary circulation !

This huge gap in our perception is the single important factor  that  explains the vagaries  of modern coronary care .

This also make any clinical coronary  scenario  a  reality .

“A patient with normal coronary angiogram getting a myocardial infarction , the next day and a severe triple vessel disease living comfortably  for  decades with medical management”

So , it is essentially a  false  sense of  scientific accomplishment  by the cardiac scientists  at  least in the  of coronary circulatory physiology.

What determines the extent of these invisible coronary micro circulation ?

There are innumerable channels of micro vessels traversing across the heart, sharing , bridging , branching, penetrating  and  perfusing the muscle mass.They can be anatomically patent , physiologically non patent .They can be recruited by hemodynamic stress .These are never visualized by current imaging modalities..It is also influenzed by  favorable growth milieu and hormonal and neural stimuli.

Ignorance based cardiology

What is the mechanism  of primary VF following acute STEMI ?

The quantum of  coronary micro circulation is like the vast  cerebral neuronal net work .We have every reasons to believe they are have unique genetic imprint.How else you can explain a man with full blown STEMI come 24 hours later comfortably to the OPD while another loses his life with a stormy primary VF before even boarding the ambulance !

Why many cardiologists   do not give due credit  the   coronary collateral  circulation  ?

Right from the days  of  Levine in 1970s( Who made a seminal contribution  about coronary collateral)  the  utility value of  coronary  collateral  circulation  was never able to convince the cardiology professionals .

It has been our traditional  teaching ( without much evidence of course  !) coronary collateral circulation  is not effective to support blood flow during exercise . This fact has been  disproved  many times . Coronary collateral circulation was indeed useful in limiting damage in ACS and  relieve symptoms in stable angina.It helps  in reverse remodeling and provided electrical stabilty as well in post MI population.

Still , the concept  was  alienated  and   made   totally irrelevant  in the interventional  era  . Many   cardiologists  found well-developed collateral’s as an interference to their expertise and ego since it has a potential to alter the indication of PCI.They  continue to have  strong  scientific conviction (Pseudo ?)   that man made collaterals must always been superior to God made collaterals !

Whenever  some credible  reports emerge about  collateral circulation   being   equivalent to  revascularisation procedure , these concepts were  prematurely buried for some reason.

In the last decade there was a concern  about  performing  PCI in patients with well-developed collaterals  .The argument was , they tend to develop early stent occlusion and restenosis . It  was a genuine  query  raised by few thought leaders in the field as  collateralised vessels  suffer from  low flow   after PCI ,   if the pre -existing collateral continue to function.

But  then , few  studies countered this , and PCI was shown to be safe and  in fact may  fare well   in  patients  with  extensive collaterals .

In these  studies  interventionist’s  argument looked  amusing !  as they  seem to  define a  successful  PCI  as  not only to open the occluded vessel  but also  make sure to close  all functioning  collaterals  .(What a  a pity for our natural biological  angiogenic forces which had  worked  and  grown meticulously for months!)

Cardiac science in the current format,  makes   the future look  bleak for coronary a collateral circulation .With  early PCI  becoming a norm we will never ever allow the natural collaterals to  grow  ,  and even the  established collaterals  will have to face a stiff   fight  for survival  with  sophisticated coronary interventions .

Competing interest in the filed of  coronary collateral   research

While the basic scientists want  to  grow collaterals with angiogenesis ,  stem cells etc  interventionists   continue to  indulge in rampant angioplasties which  will suppress  collateral growth.

This implies we will struggle to  establish  the true  importance of  coronary collateral circulation .

Final message

Can it be an  effective form of revascularisation  ? 

My personal  inference  is   coronary collateral  circulation  “would and should”  have  a definite role  in at- least  some of the subsets  with chronic coronary  syndromes. If we think otherwise . . .    it’s against the principle of  natural biological science .

A good  collateral   system with optimal medical management  can save not only our  patient’s  lives but also  their hard earned currencies !

Reference

Here is a rare article in European heart   journal that discuses coronary collateral circulation  . Let us welcome such wonderful  reviews which keep the interest alive on the filed.

http://eurheartj.oxfordjournals.org/content/28/3/278.full.pdf+html

Rate this:

Read Full Post »

Older Posts »

• Search for:

• Categories

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

• Archives

  • 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 (8)
  • 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

  • 5,514,007 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.