What is a Cardiologist?

Cardiologist is medical doctors who specialize in Cardiology. Cardiologists have expertise in the treatment of the diseases of heart and blood vessels. A cardiologist is a Heart Specialist and not a heart surgeon. Cardiology is a subspecialty 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 specialize further with spending another 1-2 years in training.

What does a Cardiologist do?

The common problems treated by a 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 the inability of the heart to pump enough blood to meet body needs due to muscle weakness or muscle stiffness. Heart failure is NOT a 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.

Arrhythmias

The heart has an inbuilt electrical system which makes the heart muscles pump to send blood to the body. There can be damage to the electrical system leading to a slow heart rate requiring pacemakers. There can be extra electrical signals in the heart causing skipped beats, palpitations, fast heart rates 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 life. It includes problems like a 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

Hypertension

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
• Dizziness
• Syncope or passing out
• Fatigue
• Leg swelling or edema
• Leg pain
• High Blood Pressure
• High Cholesterol
• Family history of heart disease

What are the tests or procedures done by a Cardiologist?

The 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 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. The 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 heartbeat 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 the 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 arrhythmias.

How many different types of cardiologists are there?

General Cardiologist

The cardiologist completes three to four years of training after their internal medicine training. They manage and diagnose all kinds of heart problems including chest pain, shortness of breath, angina. They also work with patients for the prevention of heart disease with a focus on the treatment of risk factors like hypertension, hyperlipidemia.

Interventional Cardiologist

A cardiologist who specializes in the 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.

Electrophysiologist

Cardiologists who gain expertise in the 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 cardiologists can train in the treatment of leg and neck arteries with angioplasty and stent in addition to the treatment of the heart arteries.

Structural Heart disease Interventionalist

Some Interventional cardiologists can train in the 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 specialize in the management of patients with congenital heart disease. According to guidelines, any adult who was diagnosed with congenital heart disease as a child should see an Adult congenital heart disease specialist at least once.

Pediatric Cardiologist

Pediatricians who train in cardiology become a pediatric cardiologist. They take care of cardiac issues for infants and kids till they are eighteen years of age.

How do cardiologists treat heart problems?

After the evaluation of 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 the normal range and ICDs(Defibrillators) which shock the heart if the heart is beating too fast.
• Ablation: This involves destroying (burning or freezing) the area of the heart which is triggering abnormal rhythm
• Valve Procedures: like Transcatheter aortic valve replacement (TAVR), Balloon valvuloplasty, mitral clip.Did you also know that studies show a link between cardiac health and zinc supply?