The Daily Schedule Of A Cardiologist

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.

Training

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

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. 

Arrhythmias

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.

Cardiac arrest

This refers to the normal systemic circulation of the heart stopping due to failure in proper contraction of the heart. 

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Asystole ("Flatline") 

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.

Myocarditis

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)

Pericarditis

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.

The Daily Schedule Of A Cardiologist

A cardiologist will consult with their hospital patients on a daily basis, including those who are admitted in the cardiac ICUs. The patients in the latter unit may be seen up to 2-3 times a day depending on their health status. Cardiology patients need aggressive treatment and they may need emergency management as they could have a recurrent heart attack. The office of a cardiologist is based in the hospital so that they can get to their patients as soon as possible. 

Cardiologists have to provide emergency services for the hospital they work at and have to be on call after hours and on weekends. Depending on how many cardiologists are working at the hospital, they may have to be on call 2-3 times per week. The emergency cases cardiologists have to deal with include sudden myocardial infarctions or acute coronary syndromes.

Monday

Non-clinical aspects such as confirming meetings and dealing with financial issues of the practice are dealt with on Monday mornings. The cardiologist will then start to consult with patients that have been referred to them. These patients will be treated conservatively with medication, sent for further investigations or admitted to the hospital for further management.

Tuesday

The cardiologist will consult with patients on a Tuesday morning and continue to manage them accordingly.

In the afternoon, the cardiologist will receive heart sonars (echocardiograms) and ECGs from medical technologists that performed these procedures on patients. The duty of the cardiologist will then be to examine and interpret these tests and give their opinion on any possible abnormalities. The patients will then be contacted regarding these results and managed appropriately or the reports will be sent back to referring physicians who ordered the tests.

Wednesday

A cardiologist can perform certain surgical procedures and these include angiograms, where patients have catheters inserted in them which are placed through the coronary arteries in order to stent any obstructed vessels, and inserting pacemakers for patients with severe or symptomatic heart blocks. 

The angiograms are done in the catheter lab, which is a specific theatre equipped to perform this procedure, and the pacemaker procedure is done in a normal operating theatre.

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Thursday

In the morning the cardiologist will continue to consult and manage elective patients. The afternoon will be used for offering training to undergraduate medical students and postgraduate clinical assistants, or for filling in of chronic prescriptions, motivation letters and doing research for the cardiologists own continued professional development.

Friday

Friday is used for consulting and managing patients in the morning, and the early afternoon for sorting out any unfinished administrative issues. Once all the patients have been seen and all the office's tasks have been concluded then so can the work week.

The cardiologist working over the weekend will be responsible for the medical care of their patients and patients who have been discussed by their colleagues.