The gimmickery called routine echocardiography in pre-operative cardiac risk assesment !

Can you  safely rule out  heart disease before  non cardiac surgery without echocardiography  ? Yes  ,  in most situations  .  Experience suggest  If the clinical examination is normal  ,  ECG and  X ray  do not show any abnormality  , significant heart disease is ruled out 95/ 100 times.   Please note  : ECG and X-ray [...]

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An astonishing presentation about “Approach to congenital heart disease in infants ”

I stumbled upon this presentation which deals  how to approach to a problem of  congenital heart disease in a newborn or an infant . It is clearly a master piece .  A life time experience  of a pediatrician  condensed in  130 slides . It is from Kerala .India. Link to the  presentation To  quote an  [...]

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Fine art of thrombus suction in STEMI !

The key word for  successful  primary PCI  is  Suction &  Aspiration of thrombus  with   micro catheters like  export catheters One can do away with a stent during primary PCI but can never do away aspiration Distal protection as concept is rapidly dying out as we aim to remove all the thrombus . Tips for effective [...]

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When every one is blinded . . . who shall awake medical research ?

Blindness  brings  doom to most life situations , paradoxically it is supposed make us wiser in medical research . We are made  to  believe , the shrewdness and the accuracy of  a study is directly related to the  degree of blindness . Is blindness  such a great thing ? The fact that medical research requires  [...]

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Unusual arrhythmias during Excercise stress testing

A young  man  fell  off the tread mill  soon  after complaining of chest pain in the immediate recovery  phase. He had just completed 8 minutes of standard Bruce without any difficulty . Even as the defibrillator was being  moved near him , he was  successfully   shocked with hands  of a hefty nurse !  ( [...]

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How accurate is the TR jet derived Pulmonary artery systolic pressure ?

Measuring TR peak velocity is the most popular  method to assess pulmonary arterial  pressure.It is  universally  believed  TR jet predicts the systolic PA pressure fairly accurately. By all means it is  a wrong perception. At best ,  it has only 40% correlation with cath  derived PAP  . In other words cardiologist are fooled by TR [...]

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What are the mechanisms of “Pulmonary Arterial Hypertension” in Dilated cardiomyopathy ?

Pulmonary  arterial hypertension (PAH ) is  an uncommon manifestation of dilated cardiomyopathy .While pulmonary venous hypertension of some degree is expected in most patients with DCM,  it is rare for these patients to go for severe arterial hypertension. The reason for this may be the  natural history of DCM do not allow these patients to live that longer [...]

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Tough calls in cardiology : How will you manage ventricular tachycardia with a mobile LV clot ?

Clinical cardiac  problems can be very demanding at  times. Here  is a  situation even the toughest will struggle. A 52 year old man comes with a wide qrs tachycardia  with a blood pressure of 90 /70 with class 4 dyspnea .He was restless , trying to sit up because of  orthopnea. The ECG showed  a [...]

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Arruda scheme for rapid localisation of WPW syndrome

Localising  WPW syndrome is a favorite  time pass  for cardiologists in spite of  serious  limitations of surface ECG .Still , it is vital to generate a rough idea about the location of  these pathways ,  so that we can focus  our efforts  on  some sort of ablation procedure . Arruda algorithm is probably a simple [...]

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A forbidden book for doctors !

Doctors would simply hate  this book   because  it tries to  expose them ! I would n’t agree with  the tone and conclusion of  this book . But one should soul search  , why such books are written  in the first place ? The medical professionals  definitely  need to ponder over this  issue . I stumbled [...]

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