(This is supposed to be a poll. Sorry, readers, you can’t select the answer. WordPress is not kind enough and suddenly made the poll service payable extra. I am already paying nearly a $100 fee to maintain this site. I can’t afford any more.) We have been taught Bi-Atrial enlargement is the rule in AF .It is still true in most situations. But, we rarely dispute it , & ask which atrium dilates more in AF ? Let us see few factors. Both atria develop from a combination of the primitive atrium, sinus venous, and pulmonary veins.It is logical to presume there must be a hidden morpho-electric ..read more

As the medical literature expands exponentially, the quality and intent of the research questions sound awry. There are only a handful of journals like JAMA that are bold enough to ask some tough and pragmatic questions in this glitzy world of medical extravaganza. The current issue wants to set the pace for an important debate, on a topic that is rarely discussed. The question is Link to the article Check whether your answers concur with this crucial query from Harvard Medical School and Massachusetts General Hospital. Three questions this article wishes to address. 1.What is the reason it i ..read more

This image comes with courtesy of the Journal of SCAI Jai Parekh, Vikram Sharma, Jared Robl,et al Journal of the Society for Cardiovascular Angiography & Interventions 3 (2024) 101310 What is your diagnosis ? I thought, it was pacemaker extrusion. It was indeed a close answer, still terribly wrong. It is an intentional exterior placement of a permanent pacemaker generator mimicking an extrusion due to pocket infection. Here is a patient, where a permanent pacemaker was kept temporarily for a few weeks or a month in high-risk reversible complete heart block situations. This typically occur ..read more

..read more

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