The LV angiogram that stunned me !
See how a heart is encased within the pericardial shell , still fighting hard
Thanks to circulation for it’s greatness to offer such great video free
http://circ.ahajournals.org/content/vol118/issue16/images/data/1685/DC1/CI191060.DSmovie2.AVI
Posted in Cardiology - Clinical, pericardial disease | Tagged constrictive pericarditis, pericardail knock, pericardail shell, pericardial thickness, square root sign | Leave a Comment »
The one and only journal for cardiovascular surgery from the subcontinent. Great to know full text articles are available from year 2003 , free of cost .Every cardiologists from India must read this journal regularly to update about what our surgical colleagues are doing in our country.
Thanks to the National Informatic centre for hosting this journal in their server .
Posted in cardiac surgery, cardiology journals | Tagged cardiology journals, great cardiology journals, ijtcvs, indian heart journal, indian journal of thoracic and cardiovascualr surgery, medical journals from India | 1 Comment »
Which you think is the most important journal in cardiology ?
None of the above . . . is the right answer !
Probably, the best journal that is going to have the greatest impact in cardiology practice in the future could be this . . .
Unfortunately most cardiologists are unaware of this journal . The need for this journal , that too from most respected Circulation family , will vouch for its importance in the current era of cardiology that is driven more by the market forces than by the academics.
Click here to reach journal
Journal Highlights
The Circulation team which started this journal with only one purpose . . .that is , auditing the uncontrolled proliferation of pseudoscientific literature without proper quality assessment and dubious outcomes. Three cheers to the circualtion team for publishing this journal and let us propogate the importance of this publication.
Posted in bio ethics, cardiology -Therapeutics, cardiology journal club, cardiology journals | Tagged ahj, cardiology, circulation cardiovascualr quality and outcomes, evidence based cardiology, great cardiology journal, jacc, nejm, top cardiology journals | Leave a Comment »
LBBB is probably the most important conduction defect of the heart .When we say LBBB , we visualize a strikingly wide bizarre qrs complex .
Left bundle even though is considered a discrete structure , the fascicles make it a diffusely spread structure. Many varieties of LBBB with various degrees of involvement occur.
Talking about the basics of LBBB electrophysiology is out of place for the current generation cardiologists, who have little spare time as they sweat it out inside the cathlabs.
In early 1960s and 70s great articles came from pioneers regarding these defects. If we want get a good insight read this articles from Sodi palleres .Who says LBBB is a dynamic process, where it can occur from mild functional delay to a total block .
The conduction properties of left bundle is very much influenced by heart rate.
Law of statistics would suggest for every complete LBBB at least three to 4 times incidence of incomplete LBBB
Then . . .
Why we are not diagnosing ILBBB often ?
How to diagnose ILBBB?
See Sodi palleres criteria*
What is the relationship between qrs width and completeness of LBBB ?
Surprisingly and contrary to the belief , the width of the qrs has no linear correlation between severity of LBBB. In fact incomplete LBBB can occur with even 150ms qrs !
Then , what exactly determine the completeness of LBBB ?
What matters is , whether the down coming impulse gets blocked and split in the left side of the IVS or not ? This causes the the septal vector to change it’s direction ( ie right to left instead of the normal left to right) It removes the initial small r wave in v1 and q in v6 in complete LBBB. In incomplete LBBB these r and q are often retained .
What is the differential diagnosis of ILBBB ?
Type B WPW may mimic LBBB and vice versa.
LV hypertrophy .
Differences : See table in the Barold’s article linked above .
Unanswered questions
Final message
ILBBB is not that uncommon as one would tend to perceive.
Reference
My humble tributes to Barold, Sodi -palleres , and Leo Schamroth . Probably one of the best article on ILBBB is linked below. Reviewed in 1963 ! Not much data has been added in the next 47 years as on 2010
Posted in Cardiology - Clinical, cardiology -ECG, Cardiology -unresolved questions | Tagged advanced electrocardiography, barold, complete lbbb, ECG, electrophysiology, incomplete lbbb, left bundle branch block, leo schamroth, sodi pallares | 1 Comment »
There are thousands of medical journal published worldover. Dozens are available in the field of cardiology .Only a few are dedicated for pediatric cardiology. Annals of pediatric cardiology is one .
It is all the more creditable , as it comes from India , A country which is lesser known for scientific infrastructure . Full credit to the pediatric cardiologist associataion of India and the medknow publishers for bringing this highly specialised scientific content in this part of the world .
Posted in cardiology -congenital heart disease, cardiology journals | Tagged annals of pediatric cardiology, great journals in cardiology, indian cardiology journal, indian heart journal, indian medical journals, journal for congenital heart disease, pediatric cardiology society of india, pediatric heart journals, top cardiology journals | 2 Comments »
Association of pediatrics of India has done a wonderful job .This may the first of it’s kind to formulate a excellent guidelines for managing CHD in India . This was made possible by the consensus conference on CHD held in AIIMS in 2007.
A must read for every physician, pediatrician and cardiologist
It is recommended , this guideline should be incorporated in every undergraduate curriculum of medicine .This article which was published three years ago , should have been published in the Indian heart journal also.
Thanks to Indian association of pediatrics for providing this article free
Link to article.2007 consenus conference on CHD Newdelhi
Posted in Cardiology - Clinical, cardiology -congenital heart disease | Tagged aiims consensus conference on congenitalheart, asd closure, indian data base on congenital heart disease, indian guiedlines for heart surgery, indian pediatric journal, optimal timing of congenital heart surgery, pda closure, tga timing of arterial switch, tga with vsd when to operate, timing of congenital heart disease, timing of intervention in pediatric cardiology, timing of vsd closure, when to operate vsd, working group on congenital heart disease | Leave a Comment »
Here is one of the very good resource for all those basic questions we often ask in pediatric cardiac catheterisation. Mind you , great books do not come free of cost .
Have a preview . Thanks to Google books
Click on the book to enter , if you are lucky you will get the information you need free . . .
Posted in Best books in cardiology, cardiology -congenital heart disease | Tagged basics of cardiac catheterisation, cardiac catheters, goose neck deformity, mullins, pediatric catheterisation, right heart catheterisation, spider view | Leave a Comment »
The most famous and popular view in clinical echocardiography is para sternal long axis view.It gives us an instant information about the status of left atrium , left ventricle and aorta.Left atrium appears to be seen in full. Still , one should realise it is far from truth.There is a huge blind spot for left atrium in this view .
For a complete imaging of LA one need to do a short axis view at aortic level, and of course a 4 chamber view . All these three views put together , can at best give a 80% exploration of LA .The rest of the 20%( some times vital !) can be seen only be transesophageal echo .
Why para sternal long axis fail to give even glimpse of the 4 pulmonary veins ?
When can pulmonary veins visible in PS- LAX view ?
When PVs take an abnormal course like in TAPVC or when they enter coronary sinus etc .
Rarely , huge LA enlargement may pull or push the PVs and make them visible in LAX view.
See the link
Posted in echocardiography | Tagged echocardiography, pulmonary veins, right upper pulmonary vein | Leave a Comment »
Human body is a collection of trillions of cells. Life is nothing but , a bundle of energy flowing across each of these cells .Every organ has a specailised mode of communication among themselves and others. When a cell is in an excited state , there is a likelihood of spontaneous electrical activity.This can happen in nerve cells, cardiac cells , GI tract, or virtually in any cell which has a porous cell membrane and ionic fluxes across it .
Thus , membrane stabilising action can be termed as “membrane sedating” action
Posted in Cardiology - Clinical, cardiology -Therapeutics, Infrequently asked questions in cardiology (iFAQs) | Tagged action potential, cell membrane, lignocaine, local anesthetics, magnesium, membrane stbillising action, phase 0, resting membrane potential, sodium channel | Leave a Comment »
Common sense would indicate medical care is meant for the sick and ill . Relieving the mankind from all those suffering with a healing hand has made the medical profession noble and sacred .Medical science grew with this sole aim many centuries ago .Some times we succeeded and many times we failed and the journey is continuing .
In those days ,scientists were dedicated , inventions were genuine and were driven by a need to conquer a diseases .Some where along the line, (May be in the last 2-3 decades?) our quest for money power exceeded commonsense . Commerce entered every walk of life and medical science became the biggest causality.
The purpose of noble profession was forgotten . Simultaneously public awareness and quality if life vastly improved in many of the developed countries . So the traditional illnesses either disappeared or reduced to a great extent . Then came the life style diseases.The cost of treating an illness spiraled too much especially in the scientifically advanced countries . What was perceived as great health care system became the most ridiculed health system in the planet ?
Why ? The simplest answer to this q is
In the name of science and modernity , medical treatment was glorified beyond the level it deserves , and hence the cost of treatment is kept at artificially & foolishly high (This often involves diagnostic exploration of human body with modern gadgets without any meaningful purpose ) .
ie , In a nutshell of modern medicine is often a medical mirage than a miracle . We know , the chances of success as we try to chase it. If we think the world is waking on this issue .
We are in for a surprise ! Even as every one is asking for outcome analysis in modern health care
more and more countries just imitate the failed ( Scientific and moral failure ) western models of health care .
When major illness are reducing in a society what will the health care providers do ?
Feel happy ? Yes that’s what a sane mind would do . In a capital rich , health conscious , knowledge driven society the opposite happens .
When the patient input into a top hospital reduces , the MBAs in them plan strategies to bring increase the bed occupancy rate and maintain patient parity.
If sufficient patients are not there in a community what shall we do ?
Create more patients
Creating new patients is a too dangerous game , what shall we do ?
In the name of preventive screening let us label normal persons as patients .
How to do it ?
The following examples are personal observation made in huge city of educated elite in a developing country . Excuse me if it offends a few . . .
Define, redefine all criteria that define the disease (There are
The list is endless . . .
Final message
We are in a era , where even a simple illness ( common cold ? ) can be converted into a billion dollar industry . ( Are you aware of H1N1 fiasco , The role of WHO and mystery labeling of pandemic !)
While the above misadventure with scientific excesses goes on merrily , lest we forget , millions of children and adults suffer in misery for want of live saving investigations and drugs in any country .
When a person with a head injury dies due a missed subdural hematoma for want of CT scan in one hospital , ” in the adjacent hospital” a wealthy and healthy man ( who got admitted for master health check up ) undergoes a series of scans all over the body even as he is watching the satellite TV in the comfort of a five star suite !
God will never forgive the noble professionals if they are part of this negative health care forces
Finally ending with a very positive note !
The new initiative by Obama , ” Health care for the uninsured ” is to be welcomed as great move and will do a world of good .
But , our only request to WHO ( or related bodies ) is to create a forum or authority to impeach all fancy diseases from the medical literature !
Posted in bio ethics | Tagged 64 slice ct scan, bio ethics, cardiologist, cardiology, coronary care, ethics in cardiology, fibroid uterus, hippocrates, master health check up, noble profession, non ulcer dyspepsia, osteoporosis, preventive medicine, preventive screening, stemi | 1 Comment »
Dr.S.Venkatesan MD 
