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Cardiologists are physicians who train in the diagnosis and management of diseases and disorders of the heart and parts of the circulatory system. These conditions include issues such as coronary artery disease, valvular heart disease, heart failure, congenital heart defects and rhythm abnormalities.
In order for a doctor to specialise as a cardiologist they will have to complete their undergraduate medical degree and this takes 5-6 years to complete. This is followed by an internship period that lasts for 1-2 years.
Thereafter, a qualified doctor is then eligible to apply for a specialist position in internal medicine. This residency programme takes 4 years to complete and a doctor then qualifies as a specialist physician. In order to become a cardiologist, a physician then has to complete a fellowship training programme that take another 3 years to accomplish. It can therefore take up to 15 years for an individual to become a cardiologist.
Sub-specialties in cardiology are available for cardiologists who want to focus on a specific area. These include the following:
- Echocardiography - this is where ultrasound is used to study the physics or mechanical function of the heart.
- Cardiac electrophysiology - here a cardiologist studies the electrical properties and conduction diseases of the heart.
- Nuclear cardiology - this is the use of radioactive sources to visualize the uptake of an isotope by the heart.
- Interventional cardiology - the cardiologist uses catheters for the treatment of ischaemic and structural diseases of the heart.
Conditions managed by Cardiologists
The heart can be affected by numerous conditions and they include the following:
Hypertension is elevated blood pressure above the normal reading of 120/80 and a persistently elevated blood pressure can result in conditions such as ventricular hypertrophy (enlargement of the myocardium, especially the left ventricle) and pulmonary hypertension (increased pressure in the pulmonary vessels which leads to an enlarged right ventricle).
Since the heart muscle becomes enlarged, the heart begins to struggle to pump effectively and the patient can end up in heart failure. Other causes of hypertrophy include alcohol abuse, persistent tachycardia and emotional stressors.
Disorder of the coronary circulation
The heart receives its blood supply during diastole rather that systole. The two main coronary arteries, the left coronary artery (LCA) and the right coronary artery (RCA), branch off from the proximal part of the ascending aorta (therefore supplying the heart) and the LCA further branches into the left anterior descending artery (LAD) and the left circumflex artery (LCx).
Combined, the RCA, LAD and the LCx make up the 3 main coronary arteries and any disorders of these vessels can have severe consequences to the heart. The conditions that affect these arteries include the following:
- Coronary artery disease (CAD) - the broad term given to the reduced flow of blood in the coronary artery circulation.
- Acute coronary syndrome (ACS) - otherwise known as a heart attack due to narrowing of any of the mentioned coronary arteries. Decreased blood flow to the heart tissue results in these cells dying and is known as a myocardial infarction.
- Angina pectoris - chest pain due to decreased oxygenation of the heart tissue caused by issues such as heart failure, anaemia and coronary artery disease.
- Atherosclerosis - hardening and narrowing of the arterial wall due to the build-up of cholesterol resulting in CAD.
The following arrhythmias (abnormal rhythms of the heart) are the most commonly ones dealt with by cardiologists:
- Ventricular fibrillation (vfib) which is a medical emergency.
- Ventricular tachycardia (vtach)
- Supraventricular tachycardia (SVT)
- Atrial fibrillation (AF)
- Atrial flutter (AFL)
- Premature atrial contractions (PACs)
- Premature ventricular contractions (PVCs)
- Heart block which is the decreased ability of the conduction system to transmit action pulses in an orderly manner.
- Sick sinus syndrome causing irregular changes in heart rate.
- Torsades de pointes which is a polymorphic arrhythmia.
This refers to the normal systemic circulation of the heart stopping due to failure in proper contraction of the heart.
This refers to there being no electrical activity of the heart.
Pulseless electrical activity (PEA)
Pulseless electrical activity is when the electrocardiogram (ECG) shows a rhythm but there is no pulse present.
This is the medical term for infection or inflammation of the myocardium and the causes include drugs (clozipine, anthracyclines), infections (Lyme disease, parvovirus B19) or immune-related conditions (sarcoidosis, systemic lupus erythematosus)
This is inflammation of the pericardium due to infections and other idiopathic causes.
Heart valve disorders
The heart contains 4 valves including the mitral (left atrium), aortic (left ventricle), tricuspid (right atrium) and pulmonary (right ventricle) valves. These valves can become sclerotic, stenotic or prolapsed and incompetent and would therefore need further management.