Dr Seshasayee Narasimhan

Dr Seshasayee Narasimhan

Conjoint Senior Lecturer

School of Medicine and Public Health

Career Summary

Biography

Dr. Seshasayee Narasimhan is the current Chair of Manning Hospital Medical Staff Council and the Director of Medicine at Manning Base Hospital. Besides HNEAH in NSW, he is a Visiting Interventional cardiologist at The Gold Coast University Hospital in QLD. He is a Conjoint Senior Lecturer at University of Newcastle and an Adjunct Senior Lecturer at the School of Rural Medicine, UNE. He teaches year 4 & 5 medical students clinical skills and contributes to the Joint Medical Program. In addition to his commitments to students, he is actively involved in training registrars for the FRACP examinations and is a visiting instructor in Interventional Cardiology with the Jillin University in China.

Dr. Narasimhan completed his General Cardiology training at John Hunter Hospital. During his training period, he wrote the orientation manual for the cardiology-advanced training. He consolidated his Rural Cardiology experience at Tamworth Hospital where he helped establish the inpatient Transthoracic Echocardiography Services, Cardiac Rehabilitation and Heart Failure Outreach Clinics. Further to this, he has completed 2 years of invasive cardiology fellowships in both the USA and Canada and has settled with his family in the Taree area. Whilst having a broad interest in general cardiology, Dr. Narasimhan's area of expertise is invasive cardiology which includes complex coronary angioplasty of ischemic heart disease, percutaneous management of adult congenital and structural disease including ASD/PFO closures, assessment and management of valvular heart disease, pulmonary hypertension assessment and management, cardiac transplant work up including right heart catheterization and basic diagnostic and interventional vascular medicine.He lives with his wife Katrina and their children, Zeke and Matilda in Taree.


Qualifications

  • Bachelor of Medicine, Bachelor of Surgery, University of Madras

Fields of Research

Code Description Percentage
110201 Cardiology (incl. Cardiovascular Diseases) 100

Professional Experience

Professional appointment

Dates Title Organisation / Department
21/10/2012 -  Cardiologist Hunter New England Health
Internal Medicine
Australia
1/10/2012 -  Director of Medicine


Hunter New England Health
Internal Medicine
Australia

Teaching appointment

Dates Title Organisation / Department
21/10/2012 -  Conjoint Senior Lecturer Hunter New England Health
Internal Medicine
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (28 outputs)

Year Citation Altmetrics Link
2017 Stawiarski K, Kataria R, Bravo CA, Villablanca P, Mohananey D, Narasimhan S, Ramakrishna H, 'Dual Antiplatelet Therapy Guidelines and Implications for Perioperative Management', Journal of Cardiothoracic and Vascular Anesthesia, (2017)
DOI 10.1053/j.jvca.2017.06.033
2017 Saraswat A, Narasimhan S, 'Lex parsimoniae', Journal of Cardiology Cases, 15 187-189 (2017)

© 2017 Japanese College of Cardiology We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From c... [more]

© 2017 Japanese College of Cardiology We present a noteworthy case of dual pathology in a 62-year-old female with recurrent chest pains and extensive cardiac risk factors. From computed tomography coronary angiography, a left anterior descending artery lesion was identified and successfully revascularized with a drug-eluting stent. Due to persistent chest pain, further investigation revealed a descending aortic dissection, which was conservatively managed. This case highlights the potential challenges of diagnosis in dual pathologies and emphasizes initiating appropriate investigations. < Learning objectives: It is important to consider all differential diagnoses in atypical presentations of possible acute coronary syndrome. As clinical presentations and risk factors may be similar, initiating appropriate diagnostic and management pathways are crucial to avoid misdiagnosis. >

DOI 10.1016/j.jccase.2017.02.001
2016 Baker D, Wilsmore B, Narasimhan S, 'Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation', Internal Medicine Journal, 46 792-797 (2016) [C1]

© 2016 Royal Australasian College of Physicians Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) an... [more]

© 2016 Royal Australasian College of Physicians Background: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. Aims: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. Methods: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013¿2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. Result: Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38¿34%, 22¿20%), and those prescribed no medication declined (17¿8%, P < 0.001). DOAC were prescribed to patients with lower CHA 2 DS 2 VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). Conclusion: DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA 2 DS 2 VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.

DOI 10.1111/imj.13088
Citations Scopus - 6Web of Science - 5
2014 Sebastianski M, Narasimhan S, Graham MM, Toleva O, Shavadia J, Abualnaja S, et al., 'Usefulness of the Ankle-Brachial Index to Predict High Coronary SYNTAX Scores, Myocardium at Risk, and Incomplete Coronary Revascularization', The American Journal of Cardiology, 114 1745-1749 (2014)
DOI 10.1016/j.amjcard.2014.09.010
2014 Jayasinghe R, Narasimhan S, Tran TH, Paskaranandavadivel A, 'Rapid rule out of myocardial infarction with the use of copeptin as a biomarker for cardiac injury', Internal Medicine Journal, 44 921-924 (2014)

© 2014 The Authors. Internal Medicine Journal. © 2014 Royal Australasian College of Physicians. Copeptin is a non-specific marker of an endogenous stress response. A dual biomar... [more]

© 2014 The Authors. Internal Medicine Journal. © 2014 Royal Australasian College of Physicians. Copeptin is a non-specific marker of an endogenous stress response. A dual biomarker marker approach involving the simultaneous use of troponin and copeptin assays may assist early exclusion of acute coronary syndrome in Australian emergency departments. The utility and limitations of this approach are discussed.

DOI 10.1111/imj.12526
Citations Scopus - 5
2013 Narasimhan S, 'Coronary Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention of Chronic Total Occlusion', Case Reports in Vascular Medicine, 2013 1-3 (2013)
DOI 10.1155/2013/706820
2012 Nanna GJ, Nanna MG, Muchnik D, DeRose JJ, Narasimhan S, 'A rare case of isolated congenital right ventricular inflow obstruction: Due to the presence of an intraventricular muscular shelf', Texas Heart Institute Journal, 39 557-559 (2012)

A 56-year-old man presented with anasarca and a 40-lb weight gain that had occurred over the course of 3 to 4 weeks. He had a history of permanent atrial fibrillation and a congen... [more]

A 56-year-old man presented with anasarca and a 40-lb weight gain that had occurred over the course of 3 to 4 weeks. He had a history of permanent atrial fibrillation and a congenital anomaly of the right ventricular inflow tract. This defect consisted of a muscular shelf in the right ventricular inflow tract, which encased the tricuspid subvalvular apparatus in such a manner that it created tricuspid stenosis. The clinical consequences of this anatomic and hemodynamic situation were a massively dilated right atrium, permanent atrial fibrillation, and clinical evidence of right-sided heart failure, including fluid retention and ascites. The patient underwent surgical resection of the muscular shelf, which was followed by progressive resolution of the ascites and fluid retention. © 2012 by the Texas Heart Institute, Houston.

2012 Narasimhan S, Krim NR, Silverman G, Monrad ES, 'Simultaneous very late stent thrombosis in multiple coronary arteries', Texas Heart Institute Journal, 39 630-634 (2012)

We report 2 noteworthy cases of very late stent thrombosis presenting as ST-segmentelevation myocardial infarction, with vastly different manifestations. Both patients were women ... [more]

We report 2 noteworthy cases of very late stent thrombosis presenting as ST-segmentelevation myocardial infarction, with vastly different manifestations. Both patients were women who had histories of multivessel percutaneous coronary intervention with firstgeneration sirolimus-eluting stents, in 2005 and 2006. On the more recent occasions reported here, one underwent successful multivessel primary percutaneous coronary intervention, while the other underwent successful multivessel "plain old balloon angioplasty." Both were discharged from the hospital with advice to stop smoking and to follow a lifelong regimen of aspirin and clopidogrel. On the basis of these two cases and our review of the current literature, we ask whether it is now prudent to recommend lifelong dual antiplatelet therapy after drug-eluting stent deployment. Moreover, in order to account for cases of stent thrombosis that occur =5 years after drug-eluting stent implantation, should we perhaps suggest the addition of "extremely late stent thrombosis" to the existing Academic Research Consortium classification?. © 2012 by the Texas Heart ® Institute.

Citations Scopus - 2
2012 Krim NR, Narasimhan S, Monrad ES, 'Severe multivessel coronary vasospasm presenting as acute ST-segment elevation myocardial infarction', Journal of the American College of Cardiology, 60 1429 (2012)
DOI 10.1016/j.jacc.2012.02.087
Citations Scopus - 5
2012 Narasimhan S, McKay K, Bainey KR, 'Coronary artery disease in South Asians', Cardiology in Review, 20 304-311 (2012)

It is well established that South Asians living in the western world have a higher burden of cardiovascular disease than other ethnicities. Additionally, South Asians develop card... [more]

It is well established that South Asians living in the western world have a higher burden of cardiovascular disease than other ethnicities. Additionally, South Asians develop cardiovascular disease at a younger age, have a more aggressive form of coronary artery disease, and a higher overall mortality. This predilection seems to be multifactorial and includes a combination of traditional and emerging risk factors with an absence of ethnic-specific prevention and control measures. Future direction points toward ongoing research with the aim of discovering technology for earlier detection. Additionally, coronary artery disease in South Asians could be addressed by increasing awareness, modifying health beliefs through health-promotion strategies, and instituting ethnic-specific control measures including appropriate and early pharmacological intervention. Copyright © 2012 by Lippincott Williams & Wilkins.

DOI 10.1097/CRD.0b013e3182532286
2012 McKay KA, Narasimhan S, 'Bridging the gap between doctors and nurses', Journal of Nursing Education and Practice, 2 (2012)
DOI 10.5430/jnep.v2n4p52
2012 Narasimhan S, 'A Rare Case of Isolated Congenital Right Ventricular Inflow Obstruction', Texas Heart Institute Journal, 39 558-560 (2012)
2011 Narasimhan S, Gabriel PP, 'Location, location, location: Is the star really close?', Journal of Invasive Cardiology, 23 200-201 (2011)
2011 Narasimhan S, Srinivas VS, Derose JJ, 'Hybrid coronary revascularization: A review', Cardiology in Review, 19 101-107 (2011)

The long-term benefits of a left internal mammary artery bypass graft compared to the left anterior descending artery have been well described. The use of drug-eluting stents has ... [more]

The long-term benefits of a left internal mammary artery bypass graft compared to the left anterior descending artery have been well described. The use of drug-eluting stents has minimized the morbidity of revascularization. Hybrid coronary revascularization is the planned use of minimally invasive surgical techniques for left internal mammary artery-left anterior descending artery grafting and the use of percutaneous coronary intervention for nonleft anterior descending coronary artery target revascularization. The optimal timing and order of revascularization in hybrid coronary revascularization remains unclear. © 2011 by Lippincott Williams & Wilkins.

DOI 10.1097/CRD.0b013e3182140330
Citations Scopus - 19
2011 Srinivas VS, Narasimhan S, 'Coronary artery surgery for multivessel coronary artery disease reduces 10-year risk of myocardial infarction compared with medical treatment or percutaneous coronary intervention', Evidence-Based Medicine, 16 50-51 (2011)
DOI 10.1136/ebm1162
2010 Hiew C, Williams T, Hatton R, Narasimhan S, O'Connor S, Baker F, et al., 'Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial infarction', Journal of Invasive Cardiology, 22 273-277 (2010) [C1]
Citations Scopus - 8Web of Science - 7
Co-authors John Attia, Patrick Mcelduff
2009 Haddard R, Narasimhan S, Williams T, Savage L, 'Chest Pain Management in a Rural Hospital', Heart, Lung and Circulation, 18 S110-S110 (2009)
DOI 10.1016/j.hlc.2009.05.249
2009 Narasimhan S, McKay K, Attia JR, 'Staff perspectives of a cardiac short stay unit', Australian Journal of Advanced Nursing, 26 23-28 (2009) [C1]
Citations Scopus - 1Web of Science - 1
Co-authors John Attia
2009 Narasimhan S, Clausen D, 'Heterophile antibodies and troponin results: Implications in rural setting', New Zealand Medical Journal, 122 130-132 (2009)
Citations Scopus - 3
2008 Narasimhan S, McKay K, Savage L, Attia J, Bellamy G, 'The Usefulness of a Short Stay Unit in Cardiology', Heart, Lung and Circulation, 17 S74-S75 (2008)
DOI 10.1016/j.hlc.2008.05.175
2008 Scott IA, Thomson PL, Narasimhan S, 'Comparing risk-prediction methods using administrative or clinical data in assessing excess in-hospital mortality in patients with acute myocardial infarction', Medical Journal of Australia, 188 332-336 (2008)

Objectives: To compare results of statistical process-control analyses of in-hospital deaths of patients with acute myocardial infarction by using either administrative or clinica... [more]

Objectives: To compare results of statistical process-control analyses of in-hospital deaths of patients with acute myocardial infarction by using either administrative or clinical data sources and prediction models, and to assess variation in results according to selected patient characteristics. Design: Retrospective, cross-sectional study comparing variable life-adjusted display (VLAD) curves derived by using administrative or clinical prediction models applied to a single patient sample. Participants and setting: Data from 467 consecutive patients admitted to a tertiary hospital in Queensland, between 1 July 2003 and 31 March 2006, with a coded discharge diagnosis of acute myocardial infarction. Main outcome measure: Statistical estimates of cumulative lives gained or lost in excess of those predicted at the end of the study period. Results: The two prediction models, when applied to all patients, generated almost identical VLAD curves, showing a steadily increasing excess mortality over the study period, culminating in an estimated 11 excess deaths. Risk estimates for individual patients from each model were significantly correlated (r=0.46, P < 0.001). After exclusion of misclassified cases, out-of-hospital cardiac arrests and deaths within 30 minutes of presentation, replotting the curves reversed the mortality trend and yielded, depending on the model, a net gain of three or seven lives. After further exclusion of transfers in from other hospitals and patients whose care had a palliative or conservative intent, the net gain increased to seven or 10 lives. Conclusion: Appropriate patient selection is more important than choice of dataset or risk-prediction model when statistical process-control methods are used to flag unfavourable mortality trends suggestive of suboptimal hospital care.

Citations Scopus - 8
2008 Narasimhan S, 'Electroconvulsive therapy and electrocardiograph changes', JOURNAL OF POSTGRADUATE MEDICINE, 54 228-229 (2008)
DOI 10.4103/0022-3859.41810
Citations Scopus - 1Web of Science - 2
2007 Robinson G, Narasimhan S, Weatherall M, Beasley R, 'Hemochromatosis gene mutations, liver function tests and iron status in alcohol-dependent patients admitted for detoxification', Journal of Gastroenterology and Hepatology (Australia), 22 852-854 (2007)

Background: Screening of target populations for hemochromatosis (HFE) gene allele status has been recommended. Alcoholic liver disease may be associated with iron overload and the... [more]

Background: Screening of target populations for hemochromatosis (HFE) gene allele status has been recommended. Alcoholic liver disease may be associated with iron overload and there is evidence of excessive alcohol consumption among patients with hereditary hemochromatosis. This study determined the HFE gene allele status in alcohol-dependent patients and explored the associations between iron status, liver enzymes, and HFE status. Methods: A total of 151 consecutive patients admitted for alcohol detoxification were tested for HFE mutations, iron status, and liver function tests. The prevalence data were compared with those from a New Zealand population. manova was used to compare liver function tests and iron status for subjects with different HFE mutations. Results: Three compound heterozygotes, one homozygote for C282Y, and one homozygote for H63D were found among the 151 patients. For the remaining 146 patients, there was no difference in the distribution of heterozygote status by allele, compared to the general New Zealand population. No HFE mutation: general population 64.4%, alcohol-dependent patients 64.4%; H63D: general population 23.6%, alcohol-dependent patients 28.1%; C282Y: general population 11.9%, alcohol-dependent patients 7.5% (P = 0.20). There was no relationship between liver function tests or iron status and HFE mutation status among the study group. Conclusions: No evidence has been found in the present that HFE allele status prevalence is different from the general population or associated with different liver function or iron status among alcohol-dependent patients. The cause of altered iron status among alcohol-dependent patients does not appear to be related to HFE status. © 2006 The Authors.

DOI 10.1111/j.1440-1746.2006.04519.x
Citations Scopus - 7
2006 Narasimhan S, Ranchord A, Weatherall M, 'International medical graduates' training needs: Perceptions of New Zealand hospital staff', New Zealand Medical Journal, 119 (2006)

Objective: To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. Design: A ... [more]

Objective: To determine the opinion of New Zealand doctors and nurses on the possible training needs of international medical graduates (IMGS) in New Zealand hospitals. Design: A postal questionnaire sent to hospital doctors and nurses. Methods: All doctors working at Wellington, Kenepuru, and Hutt Hospitals in the greater Wellington region, and nurses working in acute medical wards at the same hospitals, were asked to complete a questionnaire based on the Northern Clinical Training Network and Capital Coast District Health Board resident medical officer assessment forms regarding an overseas-trained doctor they had worked with in the last year. Results: The response rate for the doctor's questionnaires was 68/174 (39.1%), with 51 of these from New Zealand doctors. rating an international medical graduate. The response rate for the nurses was 58/ 60 (96.7%). Areas where the median score of the questionnaire was unsatisfactory (less than three out of five on ordinal scale rating performance) were clinical documentation; communication with patients, families, and other health professionals; knowledge of hospital policies and procedures, and medicolegal matters; and some aspects of patient management. There was no difference in median ratings between doctors and nurses. Conclusions: More specific training may improve the performance of overseas-trained doctors in the New Zealand health system. A further study of the perceived needs of the overseas-trained doctors themselves may be useful. ©NZMA.

Citations Scopus - 11
2006 Burgess C, Blaikie A, Ingham T, Robinson G, Narasimhan S, 'Monitoring the use of amiodarone: Compliance with guidelines', Internal Medicine Journal, 36 289-293 (2006)

Aim: Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at o... [more]

Aim: Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at our hospitals with the current international guidelines for the use of this drug. Methods: A retrospective audit was carried out on all patients aged 15 years or older, with a primary discharge diagnosis of tachyarrhythmia and who were commenced and discharged alive on amiodarone between 1 January 2000 and 30 June 2002 from Wellington and Kenepuru Hospitals, Capital and Coast District Health Board, Wellington, New Zealand. The medical records were examined for baseline measurements of renal, liver, thyroid and pulmonary function, the electrocardiogram and chest X-ray. Follow-up arrangements were sought postdischarge. A questionnaire was sent to the general practitioner requesting information on follow-up testing. Results: During the trial period, 743 patients were admitted with a primary diagnosis of tachyarrhythmia. Eighty-six patients satisfied the entry criteria, and of these 58 were followed for at least 1 year postdischarge. Baseline testing of the electrocardiogram, full blood count and renal function testing was excellent (95-100%). Chest X-rays were carried out in 80% of patients. Baseline testing of thyroid (61%) and liver (44%) function was suboptimal. Two percent of patients had pulmonary function testing and no patient had a formal eye examination. At 6 months, only 32% had thyroid function tests and 41% had liver function tests. At 1 year, of those still on treatment, 35% had both liver and thyroid function tests. Conclusion: Monitoring of thyroid, liver and pulmonary function tests in patients on amiodarone is less than ideal. This is probably because of lack of awareness of current guidelines. © 2006 Royal Australasian College of Physicians.

DOI 10.1111/j.1445-5994.2006.01068.x
Citations Scopus - 15
2005 Robinson GM, Narasimhan S, Weatherall M, Beasley R, 'Raised plasma homocysteine levels in alcoholism: Increasing the risk of heart disease and dementia?', New Zealand Medical Journal, 118 (2005)

Background: Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in ... [more]

Background: Raised plasma homocysteine levels, which may contribute to the increased risk of cardiovascular disease and dementia associated with alcoholism, have been observed in alcohol-dependent male subjects. Methods: In this study, we measured plasma homocysteine levels in 20 female and 31 male alcoholic subjects admitted to hospital for detoxification. Nutritional status and clinical factors that might predict plasma homocysteine levels were assessed by measurement of red cell folate, vitamin B 12 , blood alcohol, and liver function tests. Results: The median (interquartile range) plasma homocysteine level on admission was 15.4 µmol/L (11.1 to 19.7), with 27 (53%) subjects having a raised homocysteine level, greater than 15 µmol/L. There was no difference in admission plasma homocysteine levels between the male and female subjects (difference, male versus female 1.9 µmol/L, 95% CI=2.4 to 6.0, p=0.4). Red cell folate, vitamin B 12 levels, and blood alcohol level on admission were not significant predictors of admission homocysteine level. Conclusion: Severe alcohol dependence is associated with markedly raised plasma homocysteine levels in both females and males. The common condition of alcohol dependence may be an under-recognised risk factor contributing to raised plasma homocysteine levels and the associated risk of vascular and intellectual impairment. © NZMA.

Citations Scopus - 7
2004 Narasimhan S, Robinson GM, 'Wellens syndrome: A combined variant', Journal of Postgraduate Medicine, 50 73-74 (2004)
Citations Scopus - 3
2004 Narasimhan S, 'Spontaneous coronary artery dissection (SCAD)', Indian Journal of Thoracic and Cardiovascular Surgery, 20 189-191 (2004)
DOI 10.1007/s12055-004-0084-x
Citations Scopus - 3
Show 25 more journal articles

Conference (1 outputs)

Year Citation Altmetrics Link
2016 Lim J, Sarwar G, Narasimhan S, 'Characterising Heart Failure with Reduced Ejection Fraction and its Management in Regional New South Wales', Heart, Lung and Circulation (2016)
DOI 10.1016/j.hlc.2016.06.242
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Dr Seshasayee Narasimhan

Position

Conjoint Senior Lecturer
School of Medicine and Public Health
Faculty of Health and Medicine

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