Cardiologist are medical doctors who specializes in Cardiology. Cardiologist have expertise in treatment of the diseases of heart and blood vessels. Cardiologist is a Heart Specialist and not a heart surgeon. Cardiology is a sub specialty of Medicine dealing with diseases, conditions of heart, arteries and vascular system of the body.
How does a doctor become a cardiologist?
After graduating from medical school, doctors complete three-year training in Internal or General Medicine. After finishing Internal medicine training, some doctors spend another 3-4 years in training for cardiology. Some cardiologist chooses to specialise further with spending another 1-2 years in training.
What are the common diseases treated by Cardiologist?
The common problems treated by cardiologist include:
Coronary heart disease (blockage of heart arteries)
It includes problems like CAD, Heart Attack, Myocardial Infarction, Stable Angina, Unstable Angina, STEMI. CHD occurs when the coronary arteries that are responsible for bringing oxygenated blood to the heart are blocked or clogged. Blocking of arteries takes place when cholesterol deposits, also referred to as plaques, build up inside the arteries. The plaque eventually ruptures leading to a blood clot which, if it becomes large enough, blocks blood from flowing to the heart. If not treated promptly, portions of the heart begin to die, and scar tissue replaces healthy heart tissue.
Congestive Heart Failure
It is inability of heart to pump enough blood to meet body needs due to muscle weakness or muscle stiffness. Heart failure is NOT heart attack.
Valvular Heart Disease
Heart has 4 chambers and each is separated from one another by valves (consider these as doors for each heart chamber). Heart valves can be damaged due to age, rheumatic fever, infection, heart attack.
Heart has inbuilt electrical system which makes heart muscles pump to send blood to the body. There can be damage to electrical system leading to slow heart rate requiring pacemakers. There can be extra electrical signals in the heart causing skipped beats, palpitations, fast heart rate like Supraventricular tachycardia and ventricular tachycardia.
Congenital Heart Disease
It is a defect in the heart present from birth. Heart defects are the most common birth defects. It can cause problems as early as newborns but sometimes they are diagnosed later in the life. It includes problems like hole in the heart (PFO, ASD, VSD), Tetralogy of Fallot, Bicuspid Aortic valve, Persistent Truncus Arteriosus. The risk factors for congenital heart disease include exposure of pregnant women to alcohol, smoking, infections like Rubella, certain medications. Some birth defects may not need treatment, but some may need repair with catheterization based procedure or open heart surgery
It is a condition in which there is high Blood pressure in the arteries of the body. It is a risk factor for several problems like coronary heart disease, congestive heart failure, stroke, kidney failure.
When do you need to see a cardiologist?
- Chest pain with or without radiation to jaw, shoulders
- Heart murmur
- Shortness of breath
- Palpitations or irregular pulse
- Syncope or passing out
- Leg swelling or edema
- Leg pain
- High Blood Pressure
- High Cholesterol
- Family history of heart disease
What are the diagnostic tests or procedures ordered by a Cardiologist?
Cardiologist will inquire about your medical history and that of your family before carrying out any tests. They may also do a physical exam and a host of other tests and procedures which may include:
- Electrocardiogram (ECG) – The procedure records the heart’s electrical signals. It monitors its rate and rhythm and assists the doctor in detecting any irregularities in the rhythm and structure. ECG is performed when you’re exercising or during rest.
- Blood tests – The doctor may use blood tests to measure the extent of the heart damage. When the cells of the heart are injured, they release cardiac enzymes into the bloodstream. Measuring the level of these enzymes will help determine the extent of the damage.
- Chest x-ray – To take a look at the inner structure of the heart, blood vessels and lungs, a chest x-ray is beneficial. This imaging reveals any anomalies and disorders that could be CHD related.
- Echocardiography – Defined as the use of sound waves and echo to create images of the heart, Echocardiography reveals details about the shape and size of the heart. Echo can detect heart muscle injury, poor blood flow, valve disease and unusual contractions.
- Stress test – Stress testing uses rigorous exercises or medication to raise your heart rate. The doctor then performs tests to check how your heart is responding to the demand for more blood and oxygen.
- Heart Monitor: It can be placed for 24 hours or up to 30 days to check the heart beat and rule out arrhythmias.
- Cardiac Catheterization (Heart cath or Angiogram): This is a procedure to check for blockage of heart arteries. A catheter (small tube) is inserted through groin or wrist artery to reach the heart and then pictures are taken with contrast (dye) and X-ray.
- Electrophysiology study: Some patients with arrhythmias or skipped beats may need catheterization based tests to study the electrical system of the heart. An electrophysiology study is often needed prior to ablation for the arrhythmias.
What are different types of cardiologist?
Cardiologist completes three to four years of training after their internal medicine training. They manage and diagnose all kind of heart problems including chest pain, shortness of breath, angina. They also work with patients for prevention of heart disease with focus on treatment of risk factors like hypertension, hyperlipidemia.
Cardiologist who specializes in treatment of coronary artery disease or structural heart disease with catheter based technology. They perform procedures like stents, balloon angioplasty to open up blockages for heart attack and chest pain
Heart Failure/ Transplant Cardiologist
Some Cardiologist specializes in advanced heart failure, heart transplant and Heart pumps like LVAD.
Cardiologist who gain expertise in treatment of arrhythmias like atrial fibrillation, Supraventricular tachycardia, Premature beats with medicines and catheter based procedures like ablation. They also implant devices like pacemakers and defibrillators to treat slow heart rate, cardiac arrest.
Peripheral Interventional Cardiologist
Some Interventional cardiologist can train in treatment of leg and neck arteries with angioplasty and stent in addition to treatment of the heart arteries.
Structural Heart disease Interventionalist
Some Interventional cardiologist can train in treatment of heart valves with catheter based procedures rather than open heart surgery. These procedures include treatment of aortic stenosis with Transcatheter aortic valve replacement (TAVR) and mitral regurgitation with mitral clip.
Congenital Heart Disease Specialist
Cardiologists specializes in management of patients with congenital heart disease. According to guidelines any adult who was diagnosed with congenital heart disease as a child should see Adult congenital heart disease specialist at least once.
Pediatricians who train in cardiology become pediatric cardiologist. They take care of cardiac issues for infants and kids till they are eighteen years of age.
How do cardiologist treat heart problems?
After the evaluation a diagnosis of problems, the cardiologist may commence the following treatments:
- Medications – aspirin, antiplatelet agents (clopidogrel, prasugrel), beta blockers, ACE inhibitors, Blood thinners like warfarin.
- Coronary angioplasty and stenting – a long tube is inserted into the artery to unblock and restore blood flow.
- Devices: Pacemakers to maintain the heart rate in normal range and ICDs(Defibrillators) which shock the heart if heart is beating too fast.
- Ablation: This involves destroying (burning or freezing) the area of heart which is triggering abnormal rhythm
- Valve Procedures: like Transcatheter aortic valve replacement (TAVR), Balloon valvuloplasty, mitral clip.