We have thousands of medical videos.When I stumbled upon this one ,from you tube which I thought will be immensely useful and is crisply made.
It proposes a 5 simple rules to diagnose diastolic dysfunction .There is also a new concept* discussed in this video .
* What is super normal diastolic function ? How can it be mis- interpreted as a pathological ?
Over to the video clip from (123sonography 0
http://www.youtube.com/watch?v=qdLkbcFe_DI&feature=related
Posted in Echo library and gallery, echocardiography, Uncategorized | Tagged diastolic dysfunction video, super normal diastolic dysfunction, tissue doppler in diastolic dysfunction | Leave a Comment »
Bicuspid aortic valve is probably the commonest congenital heart disease.
Here is a complete review on the topic from the top rated cardiology journal circulation.
Posted in cardiology -congenital heart disease, echocardiography | Tagged bcav, bicuspid aortic valve | Leave a Comment »
Coronary angiogram is probably the commonest invasive cardiac investigation done world wide. It should run into millions every year. The procedure once thought dangerous is now performed in few minutes in day care centers . While doing a coronary angiogram has become a minuscule task to most cardiologists, interpreting it correctly remains a huge task !
Many of the young cardiologists get fascinated in doing a coronary angiogram and hardly spend enough time and mind in interpreting it.
Most of us succumb to the popular occulo coronary reflex and describe a coronary artery lesions as though it is a number game . It is very rarely we use the quantitative angiography tools available in the machine. We need to meticulously analyse the length , morphology , distal flow, thrombus , collaterals etc . (FFR a new avatar tries to do some justice )
Calling atherosclerois by numbers alone, such as 50 % LAD and 70 % diagonal 20 % left main is a huge insult to the deadly & diffuse disease process of atherosclerosis .We are paying the penalty for it .This is the fundamental flaw in our reporting , that makes every coronary intervention redundant.We must first remember we are looking at the lumen not the wall of coronary artery.
Coronary interventions is not about removing obstructions but regression of atherosclerosis load within the coronary artery , prevent progression of it and ultimately reduced cardiac events and improve survival. It is obvious, it can not be achieved by wires and catheters alone . At best they can be adjuncts.One can easily understand why medical therapy scores over wires as it can take care of the overall disease process.
But still , most* of the learned cardiology community considers medical therapy to be an adjunct to coronary intervention , which is a gross ignorance at it’s best !
* This is my perception. If I am proven wrong , I am happy our patients will be benefited !
Final message
Do not reduce the importance of coronary angiogram to a farce number game !
Do not get excited by visualizing your patient’s coronary artery. It may make you richer by few thousands. Realise , what you are seeing in a CAG is a fraction of coronary circulation.
It is estimated coronary circulation we visualize daily in cath lab as epicardial coronary arteries is less than 2 % of entire cross section of coronary circulation.
This means we are 98 % blind ! ( or 2 % wise !) .Spend adequate time and mind to interpret it correctly , so that logical and useful ( non ) interventions can be done .This only can make you a true cardiac professional and your patients will respect you.
//
Posted in Cardiology -Interventional -PCI, cardiology -Therapeutics, Cardiology -unresolved questions, Uncategorized | Tagged contraindication for doing coroanry angiogram, coronary angiogram, drug eluting stent, ectasia, guidelines for doing coronary angiogram, indications for coronary angiogram, pci, ptca, reporting a coronary angiogram, stents | Leave a Comment »
Healthy heart syndrome (HHS) . This is essentially a state of mind , being in constant worry that something will happen to their heart , in spite of having normal parameters.
HHS is a new age medical entity of the mankind . Here the heart suffers because of excessive knowledge , affluence and entry of market forces into health care .
Final message : Let us suffer from disease not from health !
While , many patients with multiple blocks , bye -pass surgeries and half- functioning hearts , lead a near normal life , it is ironical , a substantial number suffer with HHS and inappropriate interventions .
Let us hope , modern medicine which goes deep into Nano medicines and bio Robotics look into this issue also !
Posted in Uncategorized | Tagged healthy heart syndrome, modern medicine, prevention is better than cure, when prevention becomes a disease | Leave a Comment »
A must read for all clinical cardiologists and fellows . A comprehensive review on pericardial diseases.
It also highlights a new diagnostic parameter in cath lab to differentiate constrictive pericarditis from restrictive cardiomyopathy .The area subtended by RV pressure curve and LV pressure curve moves discordantly in constrictive pericarditis while it moves concordantly in restrictive cardiomyopathy
Source : Mayo Clin Proc. 2010;85(6):572-593
Posted in Cardiology - Clinical, pericardial disease, Uncategorized | Tagged constrictive pericarditis, constrictive vs restrictive cardiomyopathy, mayo clinic reviewconstrictive pericarditis | Leave a Comment »
Coronary collateral circulation is probably the most poorly understood circulation than any other.This is ignorance at it’s best , in spite of the life saving potential of this circulation. A popular (mis )perception is coronary collaterals can support only resting blood flow and it would struggle to compensate at times of exertion. This is based on few case studies and not based on large , authentic scientific data.
Does this reasoning mean , coronary collaterals can never / ever be complete ?
If we believe so . . .we are grossly underestimating the power of nature .(In fact , mankind was humiliated by the nature time and again !)
Lessons from a unique patient we have encountered.
Here is an example of total LAD/LCX occlusion with good collateral from RCA. He was having stable angina on medical management . This patient was not only asymptomatic and was also negative for exercise stress test at moderate work load .
There was an intense debate about the management when this angiogram was presented in the cath meeting .
Any answers . . .
He ultimately went on to receive CABG (By popular opinion ) , but the point here is the collaterals were good enough to support exertion.We have documented quiet a few similar patients with collateral circulation supporting exercise.
What happened to the collaterals and (of course ) the patient after surgery ?
I will post you the curious story soon . . .
Final message
Coronary collateral circulation , if well developed can provide hemo-dynamically useful support even at times of exertion *
* The existing literature is biased against this concept. It generalizes all grades of collaterals into a single entity. It is better if we spend more time to understand the nuances of coronary collateral circulation .
This is the message from our observation. Do not ever believe whatever is published as facts in scientific literature. Observe, analyse , create your own inference , and concepts. Mainstream cardiologists would brand it unscientific , Simply ignore it . Many times it is rewarding to our patients.
Posted in cardiac surgery, Cardiology -Interventional -PCI, cardiology -Therapeutics, Infrequently asked questions in cardiology (iFAQs) | Tagged chronic total occlusion, coronary collateral circulation, idoe coronary collaterals support exertion, importance of coronary circualtion | 9 Comments »
It is often said optimism is key to success . From the patient’s and physician’s perspective it is the willpower that has saved many lives. Positive minded patients do not die without fighting. We know self belief can do wonders in medical care !
If self belief is the ultimate healer , trusting the doctor and the hospital are equally important . Patients believe in doctors and doctors believe in science . Science is not sacred .It is man-made .Those men who create science need not be holy either !
Can we trust modern medicine in the current form ?
I am afraid the answer is too tilted towards . . . “No” I am not a pessimist in the strict sense . However , the future looks bleak in most places ! unless some strong remedial measures are under taken.
Statistics suggest , patients are rapidly losing the belief in their physicians , considering the track record of our health care management in recent times . Global trends in the last 5 decades indicate the health care delivery system has gradually been hijacked from the Govt to the private hands.
It is quiet a shocking revelation , the private sector health care has done more damage than the state driven health care . How foolish our expectation can be ! For fulfilling the millennium goal ( Health for all ) most countries have handed over the baton to the greedy corporates .
How on earth , one can expect the private / corporate sector to provide equitable health for all . It would be wealth for all those involved in this flawed medical care system at the cost of poor !
Read this book . . .To understand the nuances of how our health care industry is bulldozing , like an army tank into the population and most of us is a victim or a partner to this .
Click here for the Book review
From The Hindu January 2011
Final message
Entry of capitalism into health sector is probably the worst infliction man kind has suffered , than all those deadly viruses and bacteria over a last few centuries !
Medical science is a phenomenal gift created , nurtured and grown by the sixth sense of our ancestors .Their only aim was to provide relief to the sufferings. Now their dreams, vision and goals lie shattered .
No hospital has a specialty called “humane care” , while many have a separate department to do a neuro metabolic imaging for a depressed man with Alzheimer disease in his nineties and a Bio – Robot driven fuzzy logic lab to predict cardiac events in a soon to die rich man . Absolute waste of resources !
There is no doubt , we have become a sort of salves to science . . . (Irrational science to be precise ! ) It is a man-made monster. Even a most conservative person (including the author ) could be causing some damage as we are forced to follow the unruly scientific publications . Probably . . .yes . . . we can’t eliminate it but identify futility of modern science try to get rid of it . !
A related article
Those were the days . . . When doctors practiced medicine . . .and much more . . .
A wonderful piece of writing by Dr Susikaran Thangasamy from the open pages of India’s national newspaper
‘The Hindu” http://www.thehindu.com/opinion/open-page/article1137935.ece
What is the remedy ?
First of all , every one should answer this question to their conscience
What ails our health care system today ?
Do not be part of it . . . solutions will come automatically !
Posted in bio ethics, medical quotes | Tagged aggressive medicine, arrogant science, conservative management, evidence based medicine, health care, hippocrates, humane care, medical ethics, medical science, modern health care, randomised controlled trial, what ails medical care, why patients suffer | Leave a Comment »
Left main divides into two. Some times into three . Very rarely into 4
Look at this angiogram , This looks like a quadrification, if not quadrification equivalent
Clinical implication
A 4 way division invariably means the OM and diagonal or going to be diminutive.These people are expected to have favorable coronary hemodynamics during ACS , and left main lesions are less likely to occur
Reference
This article is from Singapore medical Journal
Posted in cardiac surgery, Cardiology - Clinical, cardiology-Anatomy, Uncategorized | Tagged coroanry anatomy, left main, trifurcation and quadrification | Leave a Comment »
Life cycle of PTCA : Let us hope it do not become extinct !
Does PTCA , a great Innovation for mankind, is facing a threat of extinction ?
It seems so . . . the stents are losing its shine in most situations. A simple evidence . . . for that . . . can be found in answering the following question
What drives the extensive research in biodegradable stents now ?
The simple answer is , we are fed up with the metals inside the coronary artery. We want to get rid of it !
Too much of knowledge , often blunts our senses . Our track record clearly reveals this fact. We needed a major study INTERHEART to tell the world that ,exercise is good and tobacco is bad for heart ! Now ,we forgot a simplest solution for getting rid of metal inside the coronary artery , which is “not to implant the stent” at all ! (Instead we do billion dollar research for making bio – absorbable stents , which in the first place may not be required in the majority !
Read the related article . Does POBA has a role now ? in my site
The only situation , where PCI may withstand the test of time could be in ACS (Both in STEMI and high risk NSTEMI !) PCI is cosmetic in most of the chronic coronary syndromes .
Final message
Our fight against human atherosclerosis will have to be , by medical means .PCI at best will provide a supportive role in selected patient group. It requires lots of common sense and scientific ignorance to achieve this. Risk reduction , prevention , optimal medical therapy will have to play a dominant role in the next few decades . This is something similar to the environmental issues we face in protecting our planet .No amount of green industry will protect the earth . It requires better social and behavioral ethics from mankind and their rulers !
Posted in bio ethics, Cardiology -Interventional -PCI, cardiology -Therapeutics | Tagged pci, poba, ptca, stents | Leave a Comment »
God creates life with infinite variation . The heart gets bulk of its blood supply from the left coronary artery , which divides into two after a short course. Bifurcation is the rule . Left main becomes left circumflex and LAD in about in 85-90 %.
Note the left main divides into 3 equal caliber vessels.very lucky to have such a branching pattern !Distal left main is unloaded by three large ostia . This makes stasis of blood in left main very unlikely . LAO caudal view
Note : The OMs are small in these people. RAO caudal view
Few men and women are blessed with three branches from LCA . The anatomical and physiological importance of this branching pattern is not well analysed in the literature .There could be few advantages of having a trifurcation instead of bifurcation .
Disadvantage of trifurcation !
* A related blog elsewhere in my site . The explanations offered above are based on personal observation .
Posted in Cardiology - Clinical, Cardiology -Interventional -PCI, cardiology-Anatomy, Uncategorized | Tagged left main coronary artery, ramus intermedius, true trifurcation | Leave a Comment »
Dr.S.Venkatesan MD 
