Cardiology
echocardiograms, stress test | |
Specialist | Cardiologist |
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Glossary | Glossary of medicine |
Occupation | |
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Names |
|
Occupation type | Specialty |
Activity sectors | Medicine, Surgery |
Description | |
Education required |
|
Fields of employment | Hospitals, Clinics |
Cardiology (from
Specializations
All cardiologists in the branch of medicine study the disorders of the heart, but the study of adult and child heart disorders each require different training pathways. Therefore, an adult cardiologist (often simply called "cardiologist") is inadequately trained to take care of children, and pediatric cardiologists are not trained to treat adult heart disease. Surgical aspects outside of cardiac rhythm device implant are not included in cardiology and are in the domain of cardiothoracic surgery. For example, coronary artery bypass surgery (CABG), cardiopulmonary bypass and valve replacement are surgical procedures performed by surgeons, not cardiologists. However, some invasive procedures such as cardiac catheterization and pacemaker implantation are performed by cardiologists.
Adult cardiology
Cardiology is a specialty of internal medicine.
To become a cardiologist in the
In India, a three-year residency in General Medicine or Pediatrics after
Per Doximity, adult cardiologists earn an average of $436,849 per year in the U.S.[3]
Cardiac electrophysiology
Cardiac electrophysiology is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to describe studies of such phenomena by invasive (intracardiac)
Other therapeutic modalities employed in this field include
The cardiac electrophysiology study typically measures the response of the injured or cardiomyopathic myocardium to PES on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in the future. Sometimes a series of electrophysiology-study drug trials must be conducted to enable the cardiologist to select the one regimen for long-term treatment that best prevents or slows the development of VT or VF following PES. Such studies may also be conducted in the presence of a newly implanted or newly replaced cardiac pacemaker or AICD.[4]
Clinical cardiac electrophysiology
Clinical cardiac electrophysiology is a branch of the medical specialty of cardiology and is concerned with the study and treatment of rhythm disorders of the heart. Cardiologists with expertise in this area are usually referred to as electrophysiologists. Electrophysiologists are trained in the mechanism, function, and performance of the electrical activities of the heart. Electrophysiologists work closely with other cardiologists and cardiac surgeons to assist or guide therapy for heart rhythm disturbances (arrhythmias). They are trained to perform interventional and surgical procedures to treat cardiac arrhythmia.[6]
The training required to become an electrophysiologist is long and requires eight years after medical school (within the U.S.). Three years of internal medicine residency, three years of cardiology fellowship, and two years of clinical cardiac electrophysiology.[7]
Cardiogeriatrics
Cardiogeriatrics, or geriatric cardiology, is the branch of cardiology and geriatric medicine that deals with the cardiovascular disorders in elderly people.
Cardiac disorders such as
Imaging
Cardiac imaging includes echocardiography (echo), cardiac magnetic resonance imaging (CMR), and computed tomography of the heart. Those who specialize in cardiac imaging may undergo more training in all imaging modes or focus on a single imaging modality.
Echocardiography (or "echo") uses standard two-dimensional, three-dimensional, and
Cardiac MRI utilizes special protocols to image heart structure and function with specific sequences for certain diseases such as
Cardiac CT utilizes special protocols to image heart structure and function with particular emphasis on coronary arteries.
Interventional cardiology
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases.[12] A large number of procedures can be performed on the heart by catheterization, including angiogram, angioplasty, atherectomy, and stent implantation. These procedures all involve insertion of a sheath into the femoral artery or radial artery (but, in practice, any large peripheral artery or vein) and cannulating the heart under X-ray visualization (most commonly fluoroscopy). This cannulation allows indirect access to the heart, bypassing the trauma caused by surgical opening of the chest.
The main advantages of using the interventional cardiology or radiology approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary angioplasty is now the gold standard of care for an acute myocardial infarction. This procedure can also be done proactively, when areas of the vascular system become occluded from atherosclerosis. The Cardiologist will thread this sheath through the vascular system to access the heart. This sheath has a balloon and a tiny wire mesh tube wrapped around it, and if the cardiologist finds a blockage or stenosis, they can inflate the balloon at the occlusion site in the vascular system to flatten or compress the plaque against the vascular wall. Once that is complete a stent is placed as a type of scaffold to hold the vasculature open permanently.
Cardiomyopathy/heart failure
A relatively newer specialization of cardiology is in the field of heart failure and heart transplant. Specialization of general cardiology to just that of the
Cardiooncology
A recent specialization of cardiology is that of cardiooncology. This area specializes in the cardiac management in those with cancer and in particular those with plans for chemotherapy or those who have experienced cardiac complications of chemotherapy.
Preventive cardiology and cardiac rehabilitation
In recent times, the focus is gradually shifting to preventive cardiology due to increased cardiovascular disease burden at an early age. According to the WHO, 37% of all premature deaths are due to cardiovascular diseases and out of this, 82% are in low and middle income countries.[13] Clinical cardiology is the sub specialty of cardiology which looks after preventive cardiology and cardiac rehabilitation. Preventive cardiology also deals with routine preventive checkup though noninvasive tests, specifically electrocardiography, fasegraphy, stress tests, lipid profile and general physical examination to detect any cardiovascular diseases at an early age, while cardiac rehabilitation is the upcoming branch of cardiology which helps a person regain their overall strength and live a normal life after a cardiovascular event. A subspecialty of preventive cardiology is sports cardiology. Because heart disease is the leading cause of death in the world including United States (cdc.gov), national health campaigns and randomized control research has developed to improve heart health.
Pediatric cardiology
Adult congenital heart disease
As more children with congenital heart disease are surviving into adulthood, a hybrid of adult & pediatric cardiology has emerged called adult congenital heart disease (ACHD). This field can be entered as either adult or pediatric cardiology. ACHD specializes in congenital diseases in the setting of adult diseases (e.g., coronary artery disease, COPD, diabetes) that is, otherwise, atypical for adult or pediatric cardiology.
The heart
As the center focus of cardiology, the heart has numerous anatomical features (e.g.,
Disorders of the heart lead to
The primary responsibility of the heart is to pump blood throughout the body. It pumps blood from the body — called the
The heart is a muscle that squeezes blood and functions like a pump. The heart's systems can be classified as either electrical or mechanical, and both of these systems are susceptible to failure or dysfunction.
The electrical system of the heart is centered on the periodic contraction (squeezing) of the
The mechanical system of the heart is centered on the fluidic movement of blood and the functionality of the heart as a pump. The mechanical part is ultimately the purpose of the heart and many of the disorders of the heart disrupt the ability to move blood. Heart failure is one condition in which the mechanical properties of the heart have failed or are failing, which means insufficient blood is being circulated. Failure to move a sufficient amount of blood through the body can cause damage or failure of other organs and may result in death if severe.[17]
Coronary circulation
Coronary circulation is the circulation of blood in the
As the left and right coronary arteries run on the surface of the heart, they can be called epicardial coronary arteries. These arteries, when healthy, are capable of autoregulation to maintain coronary blood flow at levels appropriate to the needs of the heart muscle. These relatively narrow vessels are commonly affected by
The coronary arteries are classified as "end circulation", since they represent the only source of blood supply to the myocardium; there is very little redundant blood supply, which is why blockage of these vessels can be so critical.
Cardiac examination
The cardiac examination (also called the "precordial exam"), is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination.[citation needed]
Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation.[citation needed]
Heart disorders
Cardiology is concerned with the normal functionality of the heart and the deviation from a healthy heart. Many disorders involve the heart itself, but some are outside of the heart and in the vascular system. Collectively, the two are jointly termed the cardiovascular system, and diseases of one part tend to affect the other.[18]
Coronary artery disease
Coronary artery disease, also known as "ischemic heart disease",
Risk factors include:
Prevention is by eating a healthy diet, regular exercise, maintaining a healthy weight and not smoking.
In 2013 CAD was the
Cardiomyopathy
This section needs expansion. You can help by adding to it. (November 2021) |
Heart failure or formally cardiomyopathy, is the impaired function of the heart and there are numerous causes and forms of heart failure.
Cardiac arrhythmia
Cardiac arrhythmia, also known as "cardiac dysrhythmia" or "irregular heartbeat", is a group of conditions in which the
There are four main types of arrhythmia:
Most arrhythmias can be effectively treated.
Arrhythmia affects millions of people.
Cardiac arrest
Cardiac arrest is a sudden stop in effective blood flow due to the failure of the heart to contract effectively.[46] Symptoms include loss of consciousness and abnormal or absent breathing.[47][48] Some people may have chest pain, shortness of breath, or nausea before this occurs.[48] If not treated within minutes, death usually occurs.[46]
The most common cause of cardiac arrest is coronary artery disease. Less common causes include major blood loss, lack of oxygen, very low potassium, heart failure, and intense physical exercise. A number of inherited disorders may also increase the risk including long QT syndrome. The initial heart rhythm is most often ventricular fibrillation.[49] The diagnosis is confirmed by finding no pulse.[47] While a cardiac arrest may be caused by heart attack or heart failure these are not the same.[46]
Prevention includes not smoking, physical activity, and maintaining a healthy weight.
In the United States, cardiac arrest outside of hospital occurs in about 13 per 10,000 people per year (326,000 cases). In hospital cardiac arrest occurs in an additional 209,000[53] Cardiac arrest becomes more common with age. It affects males more often than females.[54] The percentage of people who survive with treatment is about 8%. Many who survive have significant disability. Many U.S. television shows, however, have portrayed unrealistically high survival rates of 67%.[55]
Hypertension
Lifestyle factors can increase the risk of hypertension. These include excess salt in the diet, excess body weight, smoking, and alcohol consumption.[57][60] Hypertension can also be caused by other diseases, or occur as a side-effect of drugs.[61]
Blood pressure is expressed by two measurements, the
Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications.
Essential vs Secondary hypertension
Essential hypertension is the form of
, and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension. Hypertension can increase the risk ofComplications of hypertension
Congenital heart defects
A congenital heart defect, also known as a "congenital heart anomaly" or "congenital heart disease", is a problem in the structure of the heart that is present at birth.[92] Signs and symptoms depend on the specific type of problem.[93] Symptoms can vary from none to life-threatening.[92] When present they may include rapid breathing, bluish skin, poor weight gain, and feeling tired.[94] It does not cause chest pain.[94] Most congenital heart problems do not occur with other diseases.[93] Complications that can result from heart defects include heart failure.[94]
The cause of a congenital heart defect is often unknown.
Congenital heart defects are partly preventable through
Heart defects are the most common birth defect.[93][99] In 2013 they were present in 34.3 million people globally.[99] They affect between 4 and 75 per 1,000 live births depending upon how they are diagnosed.[93][97] About 6 to 19 per 1,000 cause a moderate to severe degree of problems.[97] Congenital heart defects are the leading cause of birth defect-related deaths.[93] In 2013 they resulted in 323,000 deaths down from 366,000 deaths in 1990.[21]
Tetralogy of Fallot
Pulmonary atresia
Pulmonary atresia happens in 7–8 per 100,000 births and is characterized by the aorta branching out of the right ventricle. This causes the deoxygenated blood to bypass the lungs and enter the circulatory system. Surgeries can fix this by redirecting the aorta and fixing the right ventricle and pulmonary artery connection.
There are two types of pulmonary atresia, classified by whether or not the baby also has a ventricular septal defect.[100][101]
- Pulmonary atresia with an intact ventricular septum: This type of pulmonary atresia is associated with complete and intact septum between the ventricles.[101]
- Pulmonary atresia with a ventricular septal defect: This type of pulmonary atresia happens when a ventricular septal defect allows blood to flow into and out of the right ventricle.[101]
Double outlet right ventricle
Double outlet right ventricle (DORV) is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. There is usually a VSD in different particular places depending on the variations of DORV, typically 50% are subaortic and 30%. The surgeries that can be done to fix this defect can vary due to the different physiology and blood flow in the defected heart. One way it can be cured is by a VSD closure and placing conduits to restart the blood flow between the left ventricle and the aorta and between the right ventricle and the pulmonary artery. Another way is systemic-to-pulmonary artery shunt in cases associated with pulmonary stenosis. Also, a balloon atrial septostomy can be done to relieve hypoxemia caused by DORV with the Taussig-Bing anomaly while surgical correction is awaited.[102]
Transposition of great arteries
There are two different types of transposition of the great arteries, Dextro-transposition of the great arteries and Levo-transposition of the great arteries, depending on where the chambers and vessels connect. Dextro-transposition happens in about 1 in 4,000 newborns and is when the right ventricle pumps blood into the aorta and deoxygenated blood enters the bloodstream. The temporary procedure is to create an atrial septal defect. A permanent fix is more complicated and involves redirecting the pulmonary return to the right atrium and the systemic return to the left atrium, which is known as the Senning procedure. The Rastelli procedure can also be done by rerouting the left ventricular outflow, dividing the pulmonary trunk, and placing a conduit in between the right ventricle and pulmonary trunk. Levo-transposition happens in about 1 in 13,000 newborns and is characterized by the left ventricle pumping blood into the lungs and the right ventricle pumping the blood into the aorta. This may not produce problems at the beginning, but will eventually due to the different pressures each ventricle uses to pump blood. Switching the left ventricle to be the systemic ventricle and the right ventricle to pump blood into the pulmonary artery can repair levo-transposition.[citation needed]
Persistent truncus arteriosus
Persistent truncus arteriosus is when the truncus arteriosus fails to split into the aorta and pulmonary trunk. This occurs in about 1 in 11,000 live births and allows both oxygenated and deoxygenated blood into the body. The repair consists of a VSD closure and the Rastelli procedure.[103][104]
Ebstein anomaly
Ebstein's anomaly is characterized by a right atrium that is significantly enlarged and a heart that is shaped like a box. This is very rare and happens in less than 1% of congenital heart disease cases. The surgical repair varies depending on the severity of the disease.[105]
Pediatric cardiology is a sub-specialty of pediatrics. To become a pediatric cardiologist in the U.S., one must complete a three-year residency in pediatrics, followed by a three-year fellowship in pediatric cardiology. Per doximity, pediatric cardiologists make an average of $303,917 in the U.S.[3]
Diagnostic tests in cardiology
Trials
Cardiology is known for randomized controlled trials that guide clinical treatment of cardiac diseases. While dozens are published every year, there are landmark trials that shift treatment significantly. Trials often have an acronym of the trial name, and this acronym is used to reference the trial and its results. Some of these landmark trials include:
- V-HeFT (1986) — use of vasodilators (hydralazine & isosorbide dinitrate) in heart failure
- ISIS-2 (1988) — use of aspirin in myocardial infarction
- CASE I (1991) — use of antiarrhythmic agents after a heart attack increases mortality
- SOLVD (1991) — use of ACE inhibitors in heart failure
- 4S (1994) — statins reduce risk of heart disease
- CURE (1991) — use of NSTEMI
- MIRACLE (2002) — use of cardiac resynchronization therapy in heart failure
- SCD-HeFT (2005) — the use of implantable cardioverter-defibrillator in heart failure
- RELY (2009), ROCKET-AF (2011), ARISTOTLE (2011) — use of DOACs in atrial fibrillationinstead of warfarin
- PARADIGM-HF (2014) — use of angiotensin-neprilysin inhibitor in heart failure
- ISCHEMIA (2020) — medical therapy is as good as coronary stents in stable heart disease
- EMPEROR-Preserved (2021) — SGLT2 receptors in heart failure
Cardiology community
Associations
- American College of Cardiology
- American Heart Association
- European Society of Cardiology
- Heart Rhythm Society
- Canadian Cardiovascular Society
- Indian Heart Association
- National Heart Foundation of Australia
- Cardiology Society of India
Journals
- Acta Cardiologica
- American Journal of Cardiology
- Annals of Cardiac Anaesthesia
- Current Research: Cardiology
- Cardiology in Review
- Circulation
- Circulation Research
- Clinical and Experimental Hypertension
- Clinical Cardiology
- EP – Europace
- European Heart Journal
- Heart
- Heart Rhythm
- International Journal of Cardiology
- Journal of the American College of Cardiology
- Pacing and Clinical Electrophysiology
- Indian Heart Journal
Cardiologists
Occupation | |
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Names | Doctor, Medical Specialist |
Occupation type | Specialty |
Activity sectors | Medicine |
Description | |
Education required |
|
Fields of employment | Hospitals, Clinics |
- Robert Atkins (1930–2003), known for the Atkins diet
- Eugene Braunwald (born 1929), editor of Braunwald's Heart Disease and 1000+ publications
- Wallace Brigden (1916–2008), identified cardiomyopathy
- Manoj Durairaj (1971– ), cardiologist from Pune, India who received Pro Ecclesia et Pontifice
- Willem Einthoven (1860–1927), a physiologist who built the first practical ECG and won the 1924 Nobel Prize in Physiology or Medicine ("for the discovery of the mechanism of the electrocardiogram")
- Berliner Charité Hospital, quitting cardiology as a speciality, and then winning the 1956 Nobel Prize in Physiology or Medicine("for their discoveries concerning heart catheterization and pathological changes in the circulatory system")
- Andreas Gruentzig (1939–1985), first developed balloon angioplasty
- William Harvey (1578–1657), wrote Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus that first described the closed circulatory system and whom Forssmann described as founding cardiology in his Nobel lecture
- Murray S. Hoffman (1924–2018) As president of the Colorado Heart Association, he initiated one of the first jogging programs promoting cardiac health
- Max Holzmann (1899–1994), co-founder of the Swiss Society of Cardiology, president from 1952 to 1955
- heart murmurs, known as the Levine scale
- Henry Joseph Llewellyn "Barney" Marriott (1917–2007), ECG interpretation and Practical Electrocardiography[106]
- Bernard Lown (1921–2021), original developer of the defibrillator
- Woldemar Mobitz (1889–1951), described and classified the two types of second-degree atrioventricular block often called "Mobitz Type I" and "Mobitz Type II"
- Jacqueline Noonan (1928–2020), discoverer of Noonan syndrome that is the top syndromic cause of congenital heart disease
- John Parkinson (1885–1976), known for Wolff–Parkinson–White syndrome
- Helen B. Taussig (1898–1986), founder of pediatric cardiology and extensively worked on blue baby syndrome
- Paul Dudley White (1886–1973), known for Wolff–Parkinson–White syndrome
- Fredrick Arthur Willius (1888–1972), founder of the cardiology department at the Mayo Clinic and an early pioneer of electrocardiography
- Louis Wolff (1898–1972), known for Wolff–Parkinson–White syndrome
- Karel Frederik Wenckebach (1864–1940), first described what is now called type I second-degree atrioventricular block in 1898
See also
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