Lowering the raised LA mean pressure is a major therapeutic goal in any severely symptomatic left heart disease, whether it is valvular or myocardial disease. It is prudent to understand, that even in systolic LV failure; it is the raised LVEDP that causes the symptoms and marks the limits of exercise capacity. Drugs like inotropes, pre-load , afterload modulators like diuretics and vasodilators can take care to a certain extent. When symptoms are refractory and the underlying condition has no primary correction , we need to intervene with some extreme procedures. We know a small ASD decompres ..read more

A 76-year-old woman with a history of double valve replacement (Aortic and mitral valves) for rheumatic heart disease, presented with acute dyspnea after a switch from Warfarin to LMWH before a planned bone marrow biopsy. The investigations revealed a stuck aortic prosthetic valve ,that showed a prohibitive gradient of more than 50 mmhg. Since, she refused further surgery, a rare and risky effort was made to balloon dilate the prosthetic valve leaflet, though it is not a standard approved modality. It was decided to dilate the supero-lateral orifice and the central orifices by simultaneous kis ..read more

Primary PCI of IRA , continues to be a clinically popular & statistically validated  (In spite of some critical ifs & buts) coronary reperfusion strategy. What to do, if  we happen to detect, a significant or borderline lesion in the Non- IRA territory during pPCI ? There are too many guidelines scattered across cardiology literature to “help or confuse” us on this issue. They argue for either immediate intervention or defer transiently, postpone or just ignore , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently defe ..read more

The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- plac ..read more

A 32-year-old high-profile businessman was advised Holter monitoring for a few ectopic beats during routine screening ECG. The 72-hour extended Holter monitoring picked up a single short pause with a blocked P wave and reported as doubtful Mobitz type 2 AV block. The cardiologist in-charge, told the patient that findings are significant, and he would need further investigation. He was referred to their associate center for an EP study. After hearing about the procedure ,the patient was freighted about inserting multiple catheters inside his heart. This was the time he consulted me with Holte ..read more

CTOs are opened primarily for four reasons Angina which is refractory to drugs Stress test positivity with or without angina Anxiety of having a blocked coronary artery in a self educated patient Cardiologist’s clandestine pride & pursuit* * Personal experience included Some evidence based observation Most of the studies as on today do not give survival advantage of opening a CTO.(DECISION-CTO,EURO-CTO,EXPLORE,IMPACTOR) Opening a CTO, for reasons other than angina (i.e. for relief of dyspnea or improving functional capacity) is largely conjectural and based on randomly accrued data backe ..read more

It is a 120-year challenge. Can anyone replace Rontgen’s X-ray discovered in 1895 for medical imaging? The Nobel winning Invention redefined the way we looked at our body and management of diseases for over a century. However, the fact remained it is an invasive and injuring investigation. What is the alternative for the X-radiation ? CT scan was a great invention, but it turned out to be a gigantic 360-degree clone of X-ray machine. Today’s cath lab, however sophisticated , is like spending hours together inside a hot Chernobyl coffee shop. MRI was a true game changer. With zero radiation, MR ..read more

Recently , I received two e-mail invite for two major conferences one in India other in Europe. Once upon a time, in 1990s we as fellows used to attend these conference for Rs 1000 (15 Euros/Dollors). Now it is 50-75(5000-7500%times increased) Even few years ago it was affordable. I don’t know how many of us can think to attend such conferences. Definitely not me. What prevents these guys to keep the cost nominal. Certainly, Inflation is not the reason. Air tickets and hotel room tariffs has just raised 50-100%.over the same period if you look closely into the above menu card, Indian tariffs ..read more

Once upon a time, long, long ago, cardiologists used to be worried about akinetic segments, scars, dead tissue, and Q waves before attempting revascularization by either PCI or CABG. Now, the concept of myocardial viability has become a cliché ( rather demeaning) at least within the cath labs. Currently ,we follow a self administered whip . Every post-MI patient should be considered for revascularization as a default strategy irrespective of the level of dysfunction or scarring .This can happen either in the IRA territory or non-IRA territory or both. This strategy is now dis-armed with fresh ..read more

If anyone thinks doctors are the only unique and gifted people, who can treat diseases and mitigate human sufferings , realize how incorrect their understanding of the world, humanity & reality. The ICD-11 , the latest code lists nearly 15000 diseases. Have a look at this much celebrated (respected ?) list put up by the world health organization There are so many entities in the list , that are man made and solution is right there in our minds. Zoom your eyes on the red rectangle. Impact of Y-36 Y-36 is a contagious endemic, transmitted by power, pride and foolishness . Y-36 along with v ..read more