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Posts Tagged ‘mayo clinic’

What is the most important criteria for doing a PCI in CAD ? The secret 6th criteria !

Posted in Uncategorized, tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on May 4, 2009| 1 Comment »

pci-ptca-ebm-stent

Scientifically ,  the  indication for coronary revascularisation   should be  based on following

  1. Patient’s  symptom ( more specifically angina , dyspnea is less important !)
  2. Prov0kable  ischemia  ( A significantly positive stress test )
  3. Signifcant LV dysfunction with  documented  viable myocardium &  residual ischemia
  4. A revascularisation eligible coronary anatomy * TVD/Left main/Proximal LAD etc ( *Either 1, 2 or 3 should be  present  in addition )
  5. All emergency PCI during STEMI /High risk NSTEMI

Practically ,

A CAD  patient  may fulfill  “Any of the above 5 “ or  “None of the above 5” ,  but ,  if   a coronary obstruction  was  revealed  by coronary angiogram  and if he  fulfils The 6th criteria , he becomes  eligible for  revascualrisation

6th criteria

If the patient has  enough monetary   resources (by self  ) or by  an  insurance company  to take care of PCI /CABG *

*The sixth  criteria overrides all other criteria in many of the cath labs .Of course , there are few genuine ones still  fighting hard , to keep the commerce out ,  from contaminating cardiology !

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Dr.S.Venkatesan.MD.DM(Cardiology)

Posted in dr s venkatesan -Personal, tagged , , , , , , , , , , , , , , , , , on September 28, 2008| 2 Comments »

   Dr. Venkatesan   Sangareddi  

AK 53/1, # 9

Narmada enclave

 7th main road

Anna nagar

Chennai -600 040

Tel:044 26209009

                        

 

Age &  Date of birth

42 ,               25-5 -1964

Experience

1998–2007                  Madras  medical college                      Madras 

Asst. Professor  Of Cardiology

Work involves  intensive coronary care, invasive and non invasive cardiology.  Has special interest in  clinical research in Acute Coronary Syndromes

Has    publications in  various  Journals.

 

1997-1998                   Madras  medical college                       Madras           

Asst. Professor  Of Medicine

Worked  in intensive care medicine and  in

 Medical oncology for 6 months

 

 

1994–1996                    Madras   medical college                        Madras 

Resident   Cardiologist

Selected to resident programme   toping the state   in the super speciality  exam

Presented  papers in national conferences

Experience gained in invasive and non invasive cardiology

 

1991–1994                      Govt.  Health  Centre           Karur.       Tamil nadu

Medical Officer   

Worked in internal medicine  department

Family medicine and community health care.

And   socio economic aspects of health care.

Education

1994–1997              Madras  medical college                               Madras           

Doctorate  in cardiology (DM) 

 

1988-1991              Coimbatore medical college                          Coimbatore

 

Doctor  of Medicine (MD) Dr.M.G.R  Medical university  , Madras

 

Secured  three  gold medals for excellence in cardiology.

 

1987-1988            Coimbatore medical college          Coimbatore  India

 

Junior resident in  Medicine

 

1987                     Coimbatore medical college          Coimbatore

 

House  officer

 

1982-1986            Coimbatore medical college        Coimbatore

 

M B., B S.    Bachelor of Medicine and Bachelor of Surgery

 

                             Madras    University                           Madras     

 

Interests

Electro physiology, expert systems in cardiology., clinical research  in acute coronary  syndromes, preventive cardiology,  bio ethics, outcome analysis ,  logistics in cardiology and publishing  online journals. 

 

List Of  publications

Enclosed

Reference

Prof.V.Jaganathan. MD.,DM

Professor  &  Head of  Department

Institute of Cardiology, Madras Medical College  Chennai

   

 

Address  for   communication

 

Spouse

 

 

 

 

 

 

 Dr.Latha  Venkatesan  MD . Gynecologist,

 Sundaram  Medical  Foundation, Chennai  India.

AK 53/1, Flat no A- 9

TAS Narmada enclave

 7th main road

Anna nagar

Chennai -600 040

Tel:        044 6209009

Mobile : 9840059947

E.mail : drvenkatesans@yahoo.co.in>

 

 

 

 

 

 

 

 

 

List of publications by  S.Venkatesan

 

 

 

1.QTc  Interval  in atrial fibrillation.  The Tamilnadu Dr. M.G.R Medical university doctorate thesis 1991

 

2 .Thrombolysis in hyperacute MI.

 Indian Heart Jr  1999:51: 321

 

3. Circadian  Response To  Thrombolysis  In Acute Myocardial Infarction Indian Heart Jr  1999:51:686

 

4. Left Ventricular Mass in Pregnancy Induced Hypertension.

  Indian Heart Jr.  1999:51

 

5. Dissection of  interventricular septum by unruptured  right  sinus of valsalva    aneurysm  resulting in complete heart block.

Indian Heart Jr  1995 Nov-Dec: 605

 

6.Angiosarcoma  of leftventricle presenting as hemopericardium and  cardiac tamponade. Indian Heart Jr  1995 Nov-Dec:636

 

7.Asymtomatic multivessel disease  following  myocardial infarction

 Indian Heart Jr  1999:51: 686

 

8. Transmitral pulse doppler echo correlates of mitral regurgitation severity Indian Heart Jr  1999:51:636

 

9. Safety and efficacy of intravenous nicorandil  in unstable angina. Indian Heart  Jr  1999:51:704

 

10. Efficacy of nicorandil as monotherapy in ischemic heart disease Indian Heart Jr  1999:51:728

 

11. Left ventricuar function by angiogram in significant LAD disease. Indian Heart Jr  1999:51:687

 

12. Aortic root dimension in isolated rheumatic mitral stenosis

Journal of association of physicians of India abst: 1998

 

13. Serum phosphate in acute myocardial infarction

Indian J Physiol  Pharmacol 2000  44(2):225-8

 

14.Differential  Response  to  right  and  left  coronary  artery  thrombolysis   Indian Heart Jr  2000:52:715

 

 

15. Therapeutic  issues  in  Stable Ventricular  tachycardia: A coronary  care  unit  perspective Indian Heart Jr  2000: 52: 808.

 

 

16.Current   cardiology  practice: evidence  or  experience  based ?    An  analysis of  ACC/AHA  guidelines. World congress of cardiology   2002 sydney  Oral  presentation.(Published in Journal of American college of cardiology)JACC :2001.39:9 Sup.B 462B

 

17.Isolated  Diastolic Hypertension .World congress of cardiology  2002 sydney  poster  presentation..

( Published in Journal of American college of cardiology) JACC :2001.39:9 Sup.B 175B

 

18.Rescue thrombolysis in  acute myocardial infarction

Journal of association of physicians of India abst: 2002

 

19.Canadian   cardiovascular  society  classification of  angina:

 An  angiographic  correlation. Indian Heart Jr Abstract issue 2001

 

20.Non invasive management  of high risk unstable angina

Accepted for oral presentation in cardiological society of India annual scientific session Kolkata  Dec2003

 

21.Non dilated cardiomyopathy

Accepted for oral presentation in cardiological society of India annual scientific session  Kolkata  Dec 2003

 

22.Safety and efficacy of angiotensin-converting enzyme inhibitors in symptomatic severe aortic stenosis: Symptomatic Cardiac Obstruction-Pilot Study of Enalapril in Aortic Stenosis (SCOPE-AS).
Am Heart J. 2004 Apr;147(4):E19

 

23.Rheumatic heart disease occurrence, patterns and clinical correlates in children aged less than five years.J Heart Valve Dis. 2004 Jan;13(1):11-4.

 

24. Estimation of subjective stress in acute myocardial infarction.
J Postgrad Med. 2003 Jul-Sep;49(3):207-10.

 

25. Serum phosphate in acute myocardial infarction.
Indian J Physiol Pharmacol. 2000 Apr;44(2):225-8.

 

26. Canadian Cardiovascular Society classification of effort angina: An angiographic correlation.
Coron Artery Dis. 2004 Mar;15(2):111-4.

 

Coming soon :

 

List of  top ten  leading famous  cardiologist  in india

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What is a normal coronary angiogram & What is a normal coronary artery ? Do they mean the same ?

Posted in Cardiology - Clinical, Cardiology -Interventional -PCI, tagged , , , , , , , , , on August 31, 2008| 1 Comment »

Coronary angiogram is a video graphic  snap shot of coronary arterial lumen which is filled with radio opaque dye. This is some times called as coronary luminogram . It is a paradox , when we say normal coronary angiogram we can only mean  normal coronary lumen. But  generally, this can provide sufficient  information regarding the status of  coronary blood flow.There are three structured layers in coronary artery wall . Coronary angiogram  can not give any information about the status of the intima, media or adventia .

Lesions A to F may be totally missed by conventional coronary angiogram

Lesions A to F may be totally missed by conventional coronary angiogram

A patient with normal coronay angiogram can have diffuse  atheroscelrosis or  localised atherosclerosis within the media of coronary artery .Many times these atherosclerotic plaques grow outward into the adventia and fail to encroach upon the lumen to be detected by coronary angiogram. These plaques , even though has an hemodynamic advantage, in that it doesn’t block blood flow , has a serious risk for sudden rupture and result in an acute coronary syndrome.

So what is the message?

A normal coronary angiogram can never convey a meaning of normal coronary arteries.


A person who has a normal coronary angiogram has no guarantee that he won’t develop a coronary event in the near future.(But the the chances are very low)

If coronary angiogram has serious limitations  what is the next alternative ?

Intra vascular ultra sound imaging(IVUS) can give us an idea of the coronary arterial wall anatomy. This investigation , though available for clinical application is too complex for regular use.So , you  can’t subject every patient with normal CAG  to an IVUS  (Intra vascualar ultra sound) to confirm the normality. The best option is what we follow every day in our practice  .Tell your patients   with normal coronary angiogram , that they are likely to  have  normal coronary arteries  ! don’t add up to their anxiety by saying,  in spite of normal CAG  still they  can carry  gross atherosclerosis in their  arteries. Anxiety can precipitate an coronary event. Too much technical information to the patients  can be counter productive. Instead  advice regular life style modification,  blood pressure ,diabetes, lipid  control  etc .

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