Sattur Heart Care

*First in Hubli Dharwad*
_*IVL IntraVascular Lithotripsy for calcific 🪨coronary artery lesions *_🫀
The most common cause of angioplasty and stenting failure ❌️ is secondary to severe coronary artery calcification.
Athero-ablative procedures can be used to modify calcium, allowing more optimal stent delivery and expansion in such complex coronary cases. These adjuvant techniques are associated with an increased risk of complications 🚨while at the cost of stent under-expansion, stent damage, or malposition if the calcium modification is not optimal.

What is New 🆕️
Intravascular lithotripsy delivers circumferential, unfocused, and pulsatile energy to disrupt calcium within the target lesion safely with > 90% clinical and angiographic success. The purpose is to fracture the calcified plaque to allow proper expansion with a balloon to gain enough lumen diameter to pass and deploy the DES successfully.

What Are the Clinical 🩺Implications?
Intravascular lithotripsy can offer a significant improvement in the vessel lumen to facilitate coronary stent delivery and deployments in severely calcified coronary arteries.

Presenting a successful IVL and subsequent PTCA with stenting to calcific 95% LAD lesion in an elderly gentleman .

“Dyslipidemia “ 🧈is one of the most important risk factors for cardiovascular disease 🫀(CVD) . The current latest LAI - Lipid Association of India 🇮🇳 guidelines in management of dyslipidemia 2023 🗓️emphasize on adequate control and treatment of dyslipidemia, particularly on LDL-C lowering particularly in high, very high, and extremely high-risk patients . ( Indians 🇮🇳develop CAD a decade earlier than western population 🇺🇸calling for more strict LDL control as writerly suggested by LAI ) Pharmacotherapy 💊with statins is the gold standard in the treatment of hypercholesterolemia and elevated LDL-C; however, some patients do not reach their therapeutic goals 🥅even with the highest tolerated doses of statins thus in them other lipid lowering therapy like Ezetemibe , Bempidoic acid and more effective injectable PCSK9 inhibitors and incliseran should be judiciously used .

In this pursuit , happy 😊 to share that I have been using INCLISERAN INJECTION 🩼 which is a safe and once in 6 months injection which effectively reduces LDL cholesterol .

It was a great pleasure 🎖️to be a CHAIRPERSON in the 17th best of ACC 🫀– American 🇺🇸college of cardiology educational program in india 🇮🇳 . The goal 🎯of which is to provide the latest 📰information that will impact the practice in the next five years ⌛️and to discuss innovations in practice , new techniques and recent findings from research .It was a very interactive program with more then 600 delegates attending the program .
Dr Yehuda Handelsman – who is a pioneer in lipidology delivered a excellent lecture on management of Dyslipidemia which was very much in lines with the LAI – Lipid association of india . Lectures by Dr Raymond Townsend , Dr ralph Brindis , Dr JoAnn Lindenfeld were excellent

Heart 🫀failure Consensus 📖statement, from India 🇮🇳 on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease which is published 🗞️ in the Journal of the Association of Physicians of India (JAPI).

This consensus was drafted to highlight 💡the judicial use of heart failure modifying drugs in patients of HF and CKD with a focus on Indian patients.

Honoured to be part of this prestigious heart failure consensus group of India led by DR H K Chopra sir

Talks This week

Introducing
North Karnataka Sleep Centre (NKSC) 🛌
Revolutionizing Sleep 💤 Health in Hubli. North Karnataka Sleep Centre (NKSC) stands as a beacon of hope and innovation, offering specialized services in sleep medicine. As the first of its kind in North Karnataka, sleep centre (NKSC) is equipped with state-of-the-art facilities, including a fully equipped sleep lab featuring advanced Polysomnography (PSG) machines ⚙️📠and titration facilities. What sets this sleep centre (NKSC) apart is its commitment to providing comprehensive care, with special sensors tailored for pediatric patients and a team of trained technicians ensuring precise diagnosis and treatment. The inception of sleep centre (NKSC) marks a significant milestone for the region, who previously had to travel to Bangalore
Sleep disorders are often overlooked aspects of health, and NKSC addresses this gap by catering to the needs of individuals suffering from various sleep-related issues prevalent in the area.
Obstructive sleep apnea (OSA) is associated with various health conditions, including stroke 🧠, ischemic heart disease (IHD)🫀, resistant hypertension, obesity , dementia, motor vehicle accidents 🚗(MVAs), psychiatric diseases, and metabolic disorders like dyslipidemia.

Right ventricular(RV) apical pacing 🫀has long been a standard 🩺treatment for symptomatic AVblock 😵,it has become clear that in a proportion of patients, right ventricular pacing (RVP) can lead to dyssynchronous⛓️‍💥 left ventricular (LV) contraction and reduced LV EF *ejection fraction and Heart failure🩻. So thus came Cardiac physiologic pacing (CPP)🔗 , defined as any form of cardiac pacing intended to restore or preserve synchrony of ventricular contraction. CPP can be achieved by engaging the conduction system- (which is challenging ) via conduction system pacing which includes His bundle pacing or left bundle branch area pacing)

Presenting the *FIRST🥇 CASE OF LEFT BUNDLE BRANCH AREA PACING .

Happy Ugadi to all

Yet again It’s a privilege 🎖️to author ✍️ a chapter 👨‍💻 : “ Role of Bisoprolol's Survival Benefits in Heart Failure” in Text book📕 of cardiology titled “Advances & Revolutions in Heart Failure (ARHF) “with chief editor 📑being HK Chopra (India) - Navin C Nanda (USA) - Jagat Narula (USA) GS Wander – CN Manjunath - Praveen Chandra (India) Viveka Kumar - CK Ponde - AK Pancholia (India), Published by Jaypee Publications .
Thank K Chopra sir for his guidance .

Dr Ameet G Sattur, interventional Cardiologist, Hubli, Karnataka
On “Lipid clinics”.
Times of India, National edition .
The very concept of “Lipidology “ as an integral part of CV management and that we as Indians, need strategically different Lipid management consensus is now a reality especially for young population of India which is ~ 60% of our population …..will go a looooong way!!!
We at Sattur Medical Care and Heart care do Extended lipid profile
Lp(a) and ApoB also
Heart Care

ISP – International Speaker Program by Dr Prof Renato Lopes
•Professor Renato D. Lopes, MD, MHS, PhD, is a Professor of Medicine within the Division of Cardiology at Duke University Medical Center, Durham, North Carolina, USA, and a Professor of Medicine within the Divisions of Internal Medicine and Cardiology at the Federal University of Sao Paulo, Sao Paulo, Brazil.
•He has an interest in novel antithrombotic therapies and in the discovery of new biomarkers in cardiology.
•Dr Lopes has led several national and international clinical trials and all the major NOAC Apixaban guidelines are based on his RCT trials
Prof Dr Lopes spoke on :
Demystifying anticoagulation practices across specialties:
10 years journey

KLE SUCHIRAYU hospital was selected as one of the spoke hospitals for live interaction with Prof Dr Lopes himself (only 10 -12 centres throughout India ) with me being the moderator .

Excellent scientific discussions and insights on “RIGHT BETA BLOCKER FOR THE RIGHT PATIENT”. Thank you MERCK india for arranging this wonderful Merck’s Expert meeting.

It’s a privilege and an honor 🎖️to author ✍️ a chapter 👨‍💻 : “ Difficult to Control Hypertension (Resistance, Pseudoresistance, and Malignant Hypertension” . in the HYPERTENSION MANUAL textbook 📕 with chief editor 📑being Dr A Muruganathan and Associate Editors being Dr Sadanand Shetty and Dr Bitida Khandelwal , Published by Jaypee Publications .
.

More than 500 people participated in the 'Exercise for strong & healthy heart' workshop held in the Gymkhana Ground at Deshpande Nagar in the City recently.
Asha Diabetic Trust & Research Foundation, Sattur Heartcare, Majethia Founda-tion, Karnataka Gymkhana Association, Indian Medical Association, and Rotary Club organised the workshop to create awareness about the importance of exercise for a better life.

We distributed free handbooks on diabetic for
stress, and bad lifestyle con-
all the 509 participants.
Trustees of ASHA : Shri Sanjay Dronawat , Shri Mahendra Vikamshi , Shri Jitendra Majethia , Shri V S V Prasad , Shri Keshav Desai , Shri Mathad , Shri Keval Lunkar
Guest of honour: Shri Nandkumar , Shri Kamal
Mehta, Shri Arvind Kubsad, Shri Tilak Vikamshi, Shri Prakash Tenginkai, Shri Bharat Khimji, Shri Kashyap Majethia Shri M V Karmari , Shri Mahendra Thakkar Dr Venkatesh Mulimani from IMA , Shri Sankalp Shettar and others were present.
# Sattur Heart Care

There is no difference between saving lives and extending lives, because in both cases we are giving people the chance of more life.

A 70 year old Gentleman 👴K/C/O Diabetes Mellitus , Hypertension --- whose wife 👵was apparently admitted in VIVEKANANDA HOSPITAL GOKUL ICCU 🏥 with Complicated Viral fever , vasculitis and Bronchopneumonia , He was so busy 😰and worried about his wife 👵that he probably forgot 🤦🏻‍♂️to take care of himself and his medications 💊, He suddenly collapsed 🆘‼️in the waiting room 🚪and was rushed to the ICCU 🚨by the bystanders , was found to be unresponsive 💀, Briskly intubated by the intensivist 🩺⚕️ and CPR started . In the mean time EKG showed Severe AV dissociation 🫀with very low heart rate ~20 . With no time to shift the patient to cath lab - Bedside Temporary Pacemaker ❤️ was immediately inserted and his heart was paced . On further evaluation he was found to have very high sugars , Ketosis , 🩸Hyperkalemia K+- 7.0 – which was responsible for his rhythm disturbances . Following correction of his sugars and potassium his condition improved , Rhythm normalized , Extubated and subsequently discharged and was walking home 🏠.

Prompt identification of reversible and treatable cause of collapse is important even in the very elderly .

Happy MAHASHIVRATRI to all 🕉🕉

This is what keeps us going- our patients love and blessings

Participated as a faculty for AF Expert Conclave Meeting
The aim of the meeting was
• To differentiate NOACs among different subgroup of patients with AF.
• To address the practical challenges faced by the physicians while initiating NOACs in patients with AF.

Target Specialty: Cardiologist, Neurologist and Consultant Physicians.

We has a very interactive session and lovely scientific discussion

ELDERLY 👴👵People and Heart Attacks 🫀

Heart 🫀disease is the most frequent condition in older adults and the No.1️⃣cause of death 🪦
Normal aging causes the heart and blood 🩸 vessels to stiffen, which can lead to heart conditions in later years.

Older 👵👴patients with heart attacks should have the same treatment as younger 👦🧒ones
In the field of cardiology⚕️🩺, we have developed some amazing treatments: this includes both procedures and medications that can improve patients’ wellbeing ❤️and prolong their lives. However, as we get older, the risks posed by treatments and adverse side effects to drugs increases. With our elderly patients, it becomes much more difficult to balance the benefits offered by certain treatments with the risks that they present.

Presenting a successful Angioplasty🫀 and stenting procedure done in a 96 year old YOUNG FEMALE👵 !!!!!!!
Photo with permission

It was a pleasure to participate and deliver a lecture on Lipid lowering in Acute coronary syndrome at a CME organised by API Hubli Dharwad chapter to celebrate Physicians Day .
Senior physicians were felicitated for their dedicated service and for guiding junior specialists .

Case 2
A 41 year old male👮‍♂️ was brought to the emergency department of KLE HCG Suchirayu hospital 🚨 with chest pain since 1 day which became intense 🥵 and unbearable for the past 15 min 🕑, even before an EKG could be taken the patient arrested and CPR🆘️ was started The patient was resuscitated and immediately shifted to cath lab for angiography 🫀. As the patient was being shifted the patient had a cardiac arrest again and CPR was continously going on , The patient Angiography showed all 3 vessel disease with left main involvement , With no time 🕑to spare the patient was put on IABP - Intra Aortic balloon🎈 , temporary pacing and PTCA with stenting was done to all 3 vessels ( The patient arrested twice during the procedure) . The patient was shifted to ICU with IABP , high inotropic support , mechanical ventilation with ECMO machine kept ready if at all needed . To our surprise the patient hemodynamics improved , BP picked up and we were able to wean IABP , ventilatory support and inotropes over time . The patient was subsequently discharged - All's well that ends well !!!!!!!

Medical miracles 🪄refer to events that are unanticipated and inexplicable, outside the range of medical ⚕️🏥precedents and the laws of nature as assessed by science.
Here are two cases that posed to be like a challenge to medical science with little hope and lots of disparities. However, the stories turned out to be different than what was predicted. These medical miracle stories will make us believe that miracles do happen, and for the better.
Case 1 :
A young boy 🧍‍♂️ of 17 years with 4-5 day history and fever 🤒and breathing difficulty 🫁 was referred 🏥in view of worsening breathlessness . The patient on arrival to KLE HCG Suchirayu hospital casualty 🚨 had a respiratory arrest and collapsed‼️ , Our emergency team 🆘and Intensivist 🩺immediately resuscitated the patient intubated and shifted to the ICU , After detailed evaluation he was diagnosed as *ARDS with fulminant Myocarditis with heart failure with Multiorgan dysfunction in Shock* . Team of specialists - Cardiologist 🫀 / Pulmonologist 🫁 /Intensivist ⚕️/ Physician 🩺all worked tirelessly to treat and save the patient . Finally after 17 days of struggle the boy went home walking
The Gratification you get on seeing the smile on the mother’s face - unmatched with any materialistic worldly pleasures and motivates us .

Photo with permission

HAPPY REPUBLIC DAY TO ALL !!!!!

Re-Live Life with Heart failure : practical tips and tricks on navigating treatment of heart failure with heart failure disease modifying drugs
Interactive discussion on heart failure management

Rediscovering Sulfonylureas - A new era of SU
Good interactive panel discussion on the role of sulfonylureas in the context of newer anti diabetic agents

HAPPY MAKARA SANKRANTI !!!!

Honoured to be part of Second 🥈Heart 🫀failure Consensus 📖statement, on the Current Place of SGLT2i in the Management of Heart Failure:An Expert Opinion from India' 🇮🇳 which is published 🗞️ in the Journal of the Association of Physicians of India (JAPI).

Sodium-glucose cotransporter-2 inhibitors have been recently added to the treatment milieu of HF in India.🇮🇳 This consensus was drafted to highlight 💡the clinical place of SGLT2i in the management of HF with a focus on Indian patients.

Another day at work !!!

Health talk at Annual conference of chartered accountants of India 🇮🇳-Hubli branch of SIRC of ICAI . Had a good interactive session with all the chartered accountants of Karnataka .