Cardiology


Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system, and it is a sub-specialty of internal medicine. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

Specializations

All cardiologists in the branch of medicine study the disorders of the heart, but the study of adult and child heart disorders each requires different training pathways. Therefore, an adult 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 and surgical valve replacement are surgical procedures performed by surgeons, not cardiologists. Typically, a cardiologist would first identify who is in need of cardiac surgery and refer them to a cardiac surgeon for the procedure. However, an increasing number of structural interventions can be performed less invasively by cardiologists; these include coronary procedures such as cardiac catheterization and percutaneous coronary intervention; structural valve procedures such as transcatheter aortic valve implantation and MitraClip; and procedures for heart rhythm disorders such as pacemaker implantation, Implantable cardioverter-defibrillator insertion, and ablation.

Adult cardiology

Cardiology is a specialty of internal medicine.
To become a cardiologist in the United States, a three-year residency in internal medicine is followed by a three-year fellowship in cardiology. It is possible to specialize further in a sub-specialty. Recognized sub-specialties in the U.S. by the Accreditation Council for Graduate Medical Education are clinical cardiac electrophysiology, interventional cardiology, adult congenital heart disease, and advanced heart failure and transplant cardiology. Cardiologists may further become certified in echocardiography by the National Board of Echocardiography, in nuclear cardiology by the Certification Board of Nuclear Cardiology, in cardiovascular computed tomography by the Certification Board of Cardiovascular Computed Tomography in cardiovascular MRI by the Certification Board of Cardiovascular Magnetic Resonance. Recognized subspecialties in the U.S. by the American Osteopathic Association Bureau of Osteopathic Specialists include clinical cardiac electrophysiology and interventional cardiology.
In the United Kingdom, following completion of two years of foundation training and three years of internal medicine training, doctors may commence the five-year cardiology specialty training programme. As cardiologists are physicians, all prospective cardiologists must complete the Membership of the Royal Colleges of Physicians of the United Kingdom diploma, prior to commencing cardiology specialty training. It is possible to specialise in a recognised sub-specialty; the core sub-specialties are interventional cardiology, electrophysiology, cardiac imaging, heart failure, and adult congenital heart disease. All cardiologists must complete a core curriculum in cardiology, and may undertake further training and additional qualifications and certifications necessary for their chosen sub-specialty, before being awarded the Certificate of Completion of Training in cardiology.
In India, the full process of becoming a cardiologist after graduating high school takes around 11.5 years. After completing Class 12th, students appear for the Medical Entrance Exam conducted at the National level, and then the National Eligibility cum Entrance Test , which allows students to take MBBS/BDS courses. The MBBS course takes 5.5 years to complete. Upon completing this, the student becomes a qualified doctor. To pursue a specialization in cardiology, students must appear for either the NEET-PG or INI-CET exam. Once passed, the students get to study MD in General Medicine, which takes 3 years. Finally, to pursue a super-specialty in cardiology, a 3 year DM in cardiology course is required.
Per Doximity, adult cardiologists earn an average of $436,849 per year in the U.S.

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 catheter recording of spontaneous activity as well as of cardiac responses to programmed electrical stimulation. These studies are performed to assess complex arrhythmias, elucidate symptoms, evaluate abnormal electrocardiograms, assess the risk of developing arrhythmias in the future, and design treatment. These procedures increasingly include therapeutic methods in addition to diagnostic and prognostic procedures.
Other therapeutic modalities employed in this field include antiarrhythmic drug therapy and implantation of pacemakers and automatic implantable cardioverter-defibrillators.
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 or ventricular fibrillation 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.

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 to assist or guide therapy for heart rhythm disturbances. They are trained to perform interventional and surgical procedures to treat cardiac arrhythmia.
The training required to become an electrophysiologist is long and requires eight years after medical school. Three years of internal medicine residency, three years of cardiology fellowship, and two years of clinical cardiac electrophysiology.

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 coronary heart disease, including myocardial infarction, heart failure, cardiomyopathy, and arrhythmias such as atrial fibrillation, are common and are a major cause of mortality in elderly people. Vascular disorders such as atherosclerosis and peripheral arterial disease cause significant morbidity and mortality in aged people.

Imaging

Cardiac imaging includes echocardiography, cardiac magnetic resonance imaging, 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 uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart. It is used to evaluate and quantify cardiac size and function, valvular function, and can assist with diagnosis and treatment of conditions including heart failure, heart attack, valvular heart disease, congenital heart defects, pericardial disease, and aortic disease.
Those who specialize in echo may spend a significant amount of their clinical time reading echos and performing transesophageal echo, in particular using the latter during procedures such as insertion of a left atrial appendage occlusion device. Transesophageal echo provides higher spatial resolution than trans thoracic echocardiography and because the probe is located in the esophagus, it is not limited by attenuation due to anterior chest structures such as the ribs, chest wall, breasts, lungs that can hinder the quality of trans thoracic echocardiography. It is generally indicated for a variety of indications including: when the standard transthoracic echocardiogram is non diagnostic, for detailed evaluation of abnormalities that are typically in the far field, such as the aorta, left atrial appendage, evaluation of native or prosthetic heart valves, evaluation of cardiac masses, evaluation of endocarditis, valvular abscesses, or for the evaluation of cardiac source of embolus. It is frequently used in the setting of atrial fibrillation or atrial flutter to facilitate the clinical decision with regard to anticoagulation, cardioversion and/or radio frequency ablation.
Cardiac MRI utilizes special protocols to image heart structure and function with specific sequences for certain diseases such as hemochromatosis and amyloidosis.
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. 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 and cannulating the heart under visualization. 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.