Posted in Uncategorized, tagged drsvenkatesan, www.drsvenkatesan.co.in, www.drsvenkatesan.com, www.drsvenkatesan.wordpress.com, www.onlineheartcare.co.in on January 1, 2013| Leave a Comment »
The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.
Here’s an excerpt:
About 55,000 tourists visit Liechtenstein every year. This blog was viewed about 530,000 times in 2012. If it were Liechtenstein, it would take about 10 years for that many people to see it. Your blog had more visits than a small country in Europe!
Posted in Cardiology -Interventional -PCI, My presentations, Uncategorized, tagged cardiological society of india, csi kolkatta, department of cardiology cardiommc.org, dr s venkatesan, g gnanvelu, madras medical college chennai, primary pci, primary ptca, spontaneous thromolysis, venkatesan sangareddi, www.cardiommc.org, www.drsvenkatesan.com on December 8, 2010| Leave a Comment »
It is well recognised for STEMI to get aborted spontaneously or through intervention.
Can a glamorous procedure like Primary PCI be redundant ?
Yes of course . This paper, is about how a planned Primary PCI can go awry . . . Presented in the Annual scientific sessions of cardiological society of India Kolkatta December 2010.
Down load full presentation in PDF format (primary_pci_)
Summary of the presentation
ABORTED AND ABANDONED PRIMARY PCI
S.Venkatesan G.Gnanavelu.R.Subramanian .Geetha Subramaninan
Madras Medical College. Chennai
Primary PCI has become the standard of care for acute STEMI in all those eligible patients. Apart from the individual & institutional expertise ,the key to success lies in expediting the symptom to balloon time to less than an hour.
Even though STEMI is characterized by acute total obstruction , it is also a fact during this critical time window , a less recognised positive phenomenon takes place within the ill fated coronary artery. Intrinsic fibrinolytic activity gets activiated and begins to take on the thrombus head on .It should be recalled this is the earliest intervention in STEMI by natural forces , with zero time window . The power of this natural lytic process has never been easy to predict and quantiate . But we have often realised such a phenomenon do occur often and is referred by various terminologies like spontaneuous thrombolyis, aboted MI etc .The exact incidence is not estimated .In this era of primary PCI we have found a new opportunity to confirm this concept.
It has been observed during primary PCI , an occasional patient may have either a totally patent IRA or a minimal & insignificant lesion like luminal irregularity .This has subsequently led on to cancellation of the procedure .We report our experience with two patients with this particular situation .One patient with IWMI with a time window of 6hours had a totally patent RCA. Even , the luminal irregularities were difficult to locate .The other patient had anterior MI with ongoing ischemic pain.He was taken up for primary PCI.The initial angiogram showed a total mid LAD obstruction . As soon as the guidewire reached the thrombotic lesion the artery opened up wth a TIMI 3 flow .There was no residual lesion or thrombus noted. Both of the above patients were young , smokers . 2b 3a antagonists were not administered. We infered, both had thrombotic STEMI and presumed to had either spontaneous reperfusion , or reperfusion assisted by dye injection & guidewire manipulation. They were shifted out of cath lab with a new code of aborted primary PCI and were discharged with normal LV function .It need to be realised here, a distinction must me made between aborted PCI and abandoned or failed primary PCI as the later connote a negative outcome. The causes for abandoning primary PCI are due to complex lesions like bifurcation /Trifurcation lesions , triple vessel disease with difficulty in identifying culprit lesions.A Primary PCI is considered failed when the IRA patency is not accomplished or failure to sustain myocardial flow inspite of IRA patency (No-Reflow) . These patients may end up in CABG or occasionally fall back on thrombolysis which was considered a inferior modality just few hours earlier !
. We conclude , in the management of STEMI , primary PCI once contemplated need not always reach it’s logical conclusion. There are situations it can get aborted or abandoned at various levels . Aborted primary PCI due to spontaneous lysis though uncommon , can be a therapeutically and financially rewarding concept for the patient and physician .
Posted in bio ethics, cardiology- coronary care, Cardiology-Coronary artery disese, tagged annals of medicine, cardiologist, coroanry angiogram, cost effectiveness, dr s venkatesan, economics of cardiology, ethics in cardiology, evidence based cardiology, futility in medicine cardiology, inappropriate medicine, interventional cardiologist, jama, madras medical college, nejm, primary pci, ptca, www.drsvenkatesan.com on August 7, 2009| Leave a Comment »
Is he a person who puts a metal coil coated with a synthetic fungus in a incidentally detected block inside a small coronary artery and sends the bill to the Insurance company ?
Is he a person in a cosmopolitan hospital who opens up a chronically closed coronary artery , in an asymptomatic patient and live telecasts his achievement trans continentally ?
Is he a person who checks in by the early morning flight and puts multiple wires in an aged patient with class 3 heart failure and make him walk 20 meters extra at a cost of 1000$ / Meter ?
Is he a person living in Wall street , who looks for variety of holes In the heart and trying to occlude it with exotic devices
Is he the unknown physician who Intervenes in the natural history of Rheumatic heart disease and arrests immune mediated valve damage by giving the monthly injections penicillin in remote parts of our country ?
Is he the person who Intervenes to prevent young persons from smoking and help maintain their coronary endothelium enriched with nitric oxide & arrest the coronary epidemic ?
Is he the small town doctor who Intervenes to treat a breathless cardiac failure patient with digoxin and frusemide and dramatically alleviate the symptoms and prolong the life of our poor country men?
Is she the village health nurse from an inaccessible health centre located in a hilly terrain , Intervening successfully, by pulling out live babies from severely anemic pregnant mothers with failing hearts ?
Posted in Uncategorized, tagged dr s venkatesan, ep lab, ep lab digest, madras medical college, venkatesan, www.drsvenkatesan.com on July 14, 2009| Leave a Comment »
Thanks to wordpress.This blog has caught the attention of some professional sites.
I was interviewed by Jodie Elrod on behalf of EP lab digest July 09 Issue
Posted in dr s venkatesan -Personal, tagged anna nagar, best cardiologist india, boiler plant high school, bphss, cardiological society of india, cardiologist, cardiologist india, cardiologist madras medical college, cardiologist tamilnadu, chennai, chennai cardiologist, coimbatore, coimbatre medical college, consultant cardiologist chennai, dr s venkatesan, dr venkatesan, famous, india, india cardiologist, india venkatesan, india's famous cardiologist, indian cardiologist, interventional cardiologist, kaniyalampatti, latha venkatesan, leading, madras, madras medical college, mani high school, on line heart care, online cardiologist, pudupatti, shreenila venkatesan, top, top indian cardiologist, top ten cardiologist india, venkatesan assistant professor of cardiology, venkatesan india, venkatesan madras, www.drsvenkatesan.com on October 10, 2008| 2 Comments »
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Dr.S.Venkatesan MD 