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 -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 | 1 Comment »
A simplified animation strictly meant for understanding the concept
Posted in cardiac drugs, Cardiology - Clinical, Uncategorized | Tagged anticoagulation in pregnancy, low molecular wieght heaprin in pregnancy, switching to heparin, warfarin vs heaprin | Leave a Comment »
Posted in medical quotes | Tagged educate the masses not to take medicines, favorite medical quotes, sir william osler, william osler | Leave a 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 - 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 | 1 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 journal club, cardiology journals | Tagged cardio vascular engineering, journal of cardiovascualr enginnering, loose cuff hypertension | 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 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 | Leave a 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
Posted in Uncategorized | Tagged complete cardiologist, great cardiologists, noble o fowler | 1 Comment »
Cadiac resynchrnonisation (CRT) therapy , is the most famed as well as ridiculed treatment modality for refractory failure . It is facing a real tough time for survival now .(At least in class 4 CHF.)
Confident and authentic data are emerging now , that CRT should not be used in advanced heart failure .(This is in total contrast with the original concept , when CRT was introduced nearly a decade ago ! more of class 3 and 4 were enrolled ) . Bad outcomes are expected in advanced CHF. This is something similar to whipping the tired horse concept which found inotropes to increase the mortality in severe heart failure .
The article in the current issue of circulation shows no mercy to CRT in advanced CHF
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.110.956011v1
So what is the answer to the ailing CRT industry ?
Go and catch class 1 and class 2 CHF population* .You will get plenty , of course it got ratified by MADIT -CRT trial .
* It is attractively called prevention of cardiac failure
Posted in Cardiology-Coronary artery disese | Tagged cardiac resynchronisation therapy, care chf, circulation crt, class 4 chf and crt, companion, CRT, crt d, crt in calss 4 nyha, knock out punch for crt, madit crt, miracle | Leave a Comment »
For todays cardiologists traveling in time machine may be made as an essential assignment . It seems there is more to learn from history than the core medical science.
How the knowledge evolved ? . How our ancestors toiled ? Where are the good old medical inspirations ?
How can we enjoy the fruits of success without knowing the tree of it’s origin ?
What you are going to leave for the future man kind ?
Learn how a dream heart team led by Christian Barnard created history in the year 1967 in a remote southern hemisphere town ( To be precise Cape town ) , South africa .Click the link or over the image .Courtesey of Life magazine
Groote schuur hospital where Christian Barnard made history
Thanks to the Life magazine for providing these stunning pictures to the present generation
Christian Barnard and team after the historic surgery .Groote schuur hospital .Cape town
Let us salute the men of past .We shall take an oath to strive harder and harder and the least , trivial achievements are not glorified . .
Posted in history of cardiology | Tagged cape town, christian barnard, heart transplantation | 2 Comments »
A female child aged 14 was referred for progressive breathlessness and abdominal distension
Abnormally dilated right atrium with significant pericardial effusion .www.drsvenkatesan.com
Can you guess the diagnosis ?
Apart form RA ,RV dilatation , the RV apex is seen filled with coarse treabeculations.This is believed to be a type of non compaction http://www.drsvenkatesan.com
Still difficult to conclude ? Look at the following Image.
Tricuspid regurgitation is significant . http://www.drsvenkatesan.com
If you have thought . . .
All are acceptable differential diagnosis
But the real diagnosis is none of the above .
Need more time . . . the following Doppler tracing will settle the issue !
Doppler velocity in RVOT at 88mmhg. http://www.drsvenkatean.com
The final diagnosis was . . .
Here , RV functional assessment becomes vital , but it is difficult many times. A simple clue is , as the RV is able to generate 88mmhg pressure it implies , the contractility should be near normal .
RV EF %, RV Dp/Dt , Tricuspid annular motion by tissue Doppler are additional measures. Cine MRI can be a useful investigation prior to intervention.
Final message
Posted in Echo library and gallery, echocardiography, Uncategorized | Tagged dr s venkatesan, drsvenkatesan, echo clippings, echo clips, echo for diagnosis, echo quiz, echo spot diagnosis, echocardiography videos, interesting echo images, non compacted rv, pulmonary balloon valvotomy, ra rv dilatation, rare echo cases, rv dp/dt, rv dysfunction, sever vps, stunning echocardiography, valvular pulmonary stenosis, venkatesan s | 3 Comments »
Dr.S.Venkatesan MD 
