cardiology - wikipedia, the free encyclopedia
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Cardiology
Blood flow diagram of the human heart. Blue
components indicate de-oxygenated blood pathway
and red components indicate oxygenated pathways
System Cardiovascular
Subdivisions Interventional, Nuclear
Significant
diseases
Heart disease, Cardiovascular
disease, Atherosclerosis,
Cardiomyopathy, Hypertension(High Blood Pressure)
Significant
tests
Blood tests, Electrophysiology
study, Cardiac imaging, ECG,
Echocardiograms, Stress test
Specialist Cardiologist
CardiologyFrom Wikipedia, the freeencyclopedia
Cardiology(fromGreek kardi, "heart" and -
-logia, "study") is a branch of medicine dealing
with disorders of the heart be it human or animal. The
field includes medical diagnosis and treatment of
congenital heart defects, coronary artery disease, heartfailure, valvular heart disease and electrophysiology.
Physicians whospecialize in this field of medicine are
called cardiologists. Physicians who specialize in
cardiac surgery are called cardiac surgeons.
Contents
1 Specialization2 The heart
3 Disorders
3.1 Disorders of the coronary circulation
3.2 Cardiac arrest
3.3 Disorders of the myocardium (muscle
of the heart)
3.4 Disorders of the pericardium (outer
lining of the heart)
3.5 Disorders of the heart valves
3.6 Congenital heart defect
3.7 Diseases ofblood vessels (vascular
diseases)
3.8 Procedures to counter coronary artery
disease
3.9 Devices used in cardiology3.10 Diagnostic tests and procedures
4 Cardiologists
5 Journals
6 Associations
7 See also
8 References
9 External links
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Specialization
Cardiology is a specialty of internal medicine. To be 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 United States by the ACGME are:
Cardiac electrophysiology: Study of the electrical properties and conduction diseases of the heart.
Echocardiography: The use of ultrasound to study the mechanical function/physics of the heart.
Interventional cardiology: The use of catheters for the treatment of structural and ischemic diseases
of the heart.
Nuclear cardiology: The use of nuclear medicine to visualize the uptake of an isotope by the heart
using radioactive sources.
Recognized subspecialties in the United States by the American Osteopathic Association Bureau of
Osteopathic Specialists (AOABOS) include:[1]
Clinical cardiac electrophysiology
Interventional cardiology
The heart
As the center focus of cardiology, the heart has numerous anatomical features (e.g., atria, ventricles, heart
valves) and numerous physiological features (e.g., systole, heart sounds, afterload) that have been
encyclopedically documented for many centuries.
Disorders of the heart lead to heart disease and cardiovascular disease and can lead to a significant number
of deaths: cardiovascular disease is the leading cause of death and caused 29.34% of all deaths in 2002.
The primary responsibility of the heart is to pump blood throughout the body. It pumps blood from the bod
called the systemic circulation through the lungs called the pulmonary circulation and then
back out to the body. This means that the heart is connected to and affects the entirety of the body.
Simplified, the heart is a circuit of the Circulation. While plenty is known about the healthy heart, the bulk
of study in cardiology is in disorders of the heart and restoration, and where possible, of function.
The heart is a muscle that squeezes blood and functions like a pump. Each part of the heart is susceptible t
failure or dysfunction and the heart can be divided into the mechanical and the electrical parts.
The electrical part of the heart is centered on the periodic contraction (squeezing) of the muscle cells that i
caused by the cardiac pacemaker located in the sinoatrial node. The study of the electrical aspects is a sub-
field of electrophysiology called cardiac electrophysiology and is epitomized with the electrocardiogram
(ECG/EKG). The action potentials generated in the pacemaker propagate throughout the heart in a specific
pattern. The system that carries this potential is called the electrical conduction system. Dysfunction of the
electrical system manifests in many ways and may include WolffParkinsonWhite syndrome, ventricular
fibrillation, and heart block.
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Coronary arteries labeled in red text and other landmarks in
blue text.
The mechanical part of the heart is centered on the fluidic movement of blood and the functionality of the
heart as a pump. The mechanical part is ultimately the purpose of the heart and many of the disorders of th
heart disrupt the ability to move blood. Failure to move sufficient blood can result in failure in other organ
and may result in death if severe. Heart failure is one condition in which the mechanical properties of the
heart have failed or are failing, which means insufficient blood is being circulated.
isorders
Cardiology is concerned with the normal functionality of the heart and the deviation from a healthy heart.
Many disorders involve the heart itself but some are outside of the heart.
Disorders of the coronary circulation
Contrary to a basic understanding of the
cardiovascular system, the heart cannot itself
receive enough oxygen and nutrients from the
blood it pumps and it must be supplied with
blood as if it were any other organ in the body.Unlike the systemic organs the heart receives
perfusion in the phase of diastole rather than
systole. This circulation of blood is called the
coronary circulation. The coronary circulation
consists of coronary arteries and coronary veins.
Disorders of the coronary circulation can have
devastating effects to the heart since damage to
the heart can reduce coronary circulation which
causes further damage. A few examples arepresented, as follows:
Acute coronary syndrome (ACS)
Acute coronary syndrome is a broad term encompassing many acute myocardial infarction
symptoms.
Angina pectoris
Angina pectoris literally means "chest pain" that refers to pain caused by ischemia of the heart.
Atherosclerosis
Atherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty
materials (e.g., cholesterol). Atherosclerosis of a coronary artery leads to coronary heart disease.
Coronary heart disease
Coronary heart disease is a general term for any reduction in coronary circulation. One such
condition is atherosclerosis.
Myocardial infarction (aka heart attack)
A myocardial infarction is the death of a part of the heart which is typically caused by a blockage of
the coronary circulation or coronary heart disease.
Restenosis
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A rhythm strip showing a couple beats of normal sinus
rhythm followed by an atrial beat and asystole ("flatline").
Recurrence of stenosis which would refer to a narrowing of a coronary artery in the context of the
coronary circulation.
Cardiac arrest
Cardiac arrest refers to the cessation(to cease)of
normal systemic circulation due to failure in
proper contraction of the heart. There areseveral conditions that can cause cardiac arrest.
Asystole ("flatline")
Asystole refers to the absence of
electrical activity of the heart and is
sometimes referred to as a "flatline"
because the electrocardiogram shows a
solid line due to the absence of electrical activity.
Pulseless electrical activity (PEA)
Pulseless electrical activity is when the electrocardiogram shows a rhythm that should produce a
pulse but it does not. PEA is commonly caused by the 6 H's and 6 T's (see PEA article).
Pulseless ventricular tachycardia
Pulseless ventricular tachycardia (VT) Is one classification of VT such that no pulse is felt because o
an ineffective cardiac output which causes cardiac arrest.
Sudden cardiac death
Sudden cardiac death is a concept of natural death rather than a specific medical condition. There ar
several causes of sudden cardiac death and it is distinct from cardiac arrest.Ventricular fibrillation
Ventricular fibrillation is fibrillation of the ventricles of the heart. Rhythmic contraction is necessary
for efficient movement of blood and fibrillation disrupts this rhythm sufficiently to cause cardiac
arrest
Treatment of cardiac arrest includes cardiopulmonary resuscitation (CPR) and defibrillation depending on
the exact cause of cardiac arrest.
Disorders of the myocardium (muscle of the heart)
Cardiomyopathy
Cardiomyopathy is a deterioration of the myocardium.
Ischemic cardiomyopathy
Cardiomyopathy causing ischemia of the heart due to coronary artery disease.
Nonischemic cardiomyopathy
Cardiomyopathy not caused by ischemia of the heart.
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The diagram shows a healthy heart (left) and one suffering
from right ventricular hypertrophy (right).
Amyloid cardiomyopathy
Cardiomyopathy caused by amyloidosis.
Hypertrophic cardiomyopathy (HCM)
Cardiomyopathy caused by hypertrophy of the heart.
Hypertrophic obstructive cardiomyopathy (HOCM) (Idiopathic hypertrophic
subaortic stenosis (IHSS))
Dilated cardiomyopathy
Cardiomyopathy caused by
dilation of the heart.
Alcoholic cardiomyopathy
A type of dilated
cardiomyopathy
caused by chronic
abuse of alcohol.
Tachycardia induced
cardiomyopathy
A type of dilated
cardiomyopathy
caused by chronic tachycardia.
Takotsubo cardiomyopathy (Transient apical ballooning, stress-induced
cardiomyopathy)
A type of dilated cardiomyopathy caused by a sudden temporary weakening of th
myocardium.
Arrhythmogenic right ventricular dysplasia (Arrhythmogenic right ventricular
cardiomyopathy)
Cardiomyopathy caused by a genetic mutation of the desmosomes that connect
myocytes.
Restrictive cardiomyopathy
Cardiomyopathy caused by excessive rigidity of the heart.
Heart failure
Failure of the heart to produce sufficient blood flow to meet metabolic demands of the body.
Cor pulmonale
Untreated cor pulmonale can cause right heart failure from chronic pulmonary hypertrophy.
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A man with congestive heart failure and marked
jugular venous distension. External jugular vein
marked by an arrow.
Posterior wall of the pericardial sac.
Ventricular hypertrophy
Hypertrophy of the ventricle.
Left ventricular hypertrophy
Hypertrophy of the left ventricle.
Right ventricular hypertrophy
Hypertrophy of the right ventricle.
Primary tumors of the heart
Tumors that arise initially in the heart and not
from elsewhere in the body.
Myxoma
Most common tumor of the heart.
Myocardial rupture
A gross structural failure of the heart. Commonly
a result of myocardial infarction.
Disorders of the pericardium (outer lining of
the heart)
The pericardium is a double-walled sac fibrous
pericardium and serous pericardium that contains the heart.
Constrictive pericarditisPericarditis that constricts the expansion of the heart and
inhibits heart function.
Pericardial effusion
An abnormal accumulation of fluid in the pericardium that
can lead to tamponade.
Pericardial tamponade
Accumulation of fluid in the pericardium that inhibits heart
function.Pericarditis
Inflammation of the pericardium.
Disorders of the heart valves
The heart contains four valves that direct the flow of blood in a single direction. Failure to prevent reverse-
flow is called regurgitation, or insufficiency. Narrowing of the valves obstructs flow and is called stenosis.
Aortic valve
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3D reconstruction of the heart as viewed from the
apex towards the valves, image flipped 180
relative to illustration above. Pulmonary valve notvisible, leaflets of the tricuspid and aortic valves
only partly visible. To the left two images in 2D
from the same dataset, showing tricuspid and mitral
valves (above) and aortal and mitral valve (below).
Disorders and treatments of the aortic valve that separates the left ventricle and aorta.
Aortic regurgitation / aortic insufficiency
Deficiency of the aortic valve that permits
regurgitation from the aorta into the left
ventricle.
Aortic stenosis
Narrowing of the aortic valve opening that
reduces blood flow through the valve.
Aortic valve replacement
Replacement of the aortic valve due to
aortic regurgitation, aortic stenosis, or other
reasons.
Aortic valve repair
Repair, instead of replacement, of the
aortic valve.
Aortic valvuloplasty
Repair of the valve by using a
balloon catheter to force it open.
Mitral valve
Disorders and treatments of the mitral valve that separates the left atrium and left ventricle.
Mitral valve prolapse
Prolapse of the mitral valve into the left atrium during ventricular systole.
Mitral regurgitation / mitral insufficiency
Deficiency of the mitral valve that permits regurgitation from the left ventricle into the left
atrium.
Mitral stenosis
Narrowing of the mitral valve opening that reduces blood flow through the valve.Mitral valve replacement
Replacement of the mitral valve due to mitral regurgitation, mitral stenosis, or other reasons.
Mitral valve repair
Repair, instead of replacement, of the mitral valve.
Mitral valvuloplasty
Repair of the valve by using a balloon catheter to force it open.
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Atrial septal defect with left-to-right shunt.
Pulmonary valve
Disorders of the pulmonary valve that separates the right ventricle and pulmonary artery.
Pulmonary regurgitation / pulmonary insufficiency
Deficiency of the pulmonary valve that permits regurgitation from the pulmonary artery into
the right ventricle.
Pulmonic stenosisNarrowing of the pulmonary valve opening that reduces blood flow through the valve.
Tricuspid valve
Disorders of the tricuspid valve that separates the right atrium and right ventricle.
Tricuspid regurgitation / tricuspid insufficiency
Deficiency of the tricuspid valve that permits regurgitation from the right ventricle into the
right atrium.
Congenital heart defect
Congenital heart defects are defects in the
structure of the heart which are present at birth.
Atrial septal defect
Defect in the interatrial septum that
permits blood flow between atria,
including a patent foramen ovale (PFO).Bicuspid aortic valve
Formation of two valve leaflets in the
aortic valve instead of three leaflets.
Hypoplastic left heart syndrome
Defect in the development of the left
heart such that it is hypoplastic (under
developed).
Patent ductus arteriosus (PDA)
Failure of the ductus arteriosus to close on birth.
Patent foramen ovale (PFO)
An atrial septal defect in that the foramen ovale fails to close at birth.
Persistent truncus arteriosus
Defect in that the truncus arteriosus fails to divide.
Tetralogy of Fallot
Set of four anatomical abnormalities: pulmonary stenosis, overriding aorta, ventricular septal defect,
and right ventricular hypertrophy.
Transposition of the great vessels (TGV)
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The progression of atherosclerosis (size exaggerated).
Abnormal spatial arrangement of the great vessels (superior vena cava, inferior vena cava, pulmonar
arteries, pulmonary veins, and aorta).
Ventricular septal defect
Defect in the ventricular septum that permits blood flow between ventricles.
Diseases of blood vessels (vascular diseases)
Atherosclerosis
Thickening of an arterial wall due to
increased cholesterol and macrophages.
Aneurysm
Balloon-like bulging of the artery.
Aorta
Diseases of the aorta:
Coarctation of the aorta
Narrowing of the aorta at the
ductus arteriosus/ligamentum
arteriosum.
Aortic dissection
Dissection along the length of the
aorta between the layers of the
aortic wall and filled with blood.
Aortic aneurysmAneurysm of the aorta.
Carotid artery
Diseases of the carotid arteries:
Carotid artery stenosis / carotid artery disease Narrowing of the carotid artery, typically due
to atherosclerosis.
Carotid artery dissection
Dissection along the length of the carotid artery between the layers of the carotid wall and
filled with blood.
Deep vein thrombosis (DVT)
Formation of a thrombus in a deep vein, commonly in the legs.
Traveller's thrombosis / economy class syndrome
A DVT due to being sedentary during air travel.
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An example of a drug-eluting stent. This i
the TAXUS Express2 Paclitaxel-Eluting
Coronary Stent System, which releases
paclitaxel.
A stethoscope.
Varicose veins
Veins that have become enlarged and tortuous with failed valves, commonly in the legs.
Vasculitis
Inflammation of blood vessels.
Procedures to counter coronary artery disease
Coronary artery bypass surgery (CABG)Grafting an artery or vein from elsewhere (typically the
leg) to bypass a stenotic coronary artery.
Enhanced external counterpulsation (EECP)
Pneumatically assisting the heart to move blood using
inflatable cuffs on the legs.
Percutaneous coronary intervention (PCI)
Procedures to treat stenotic coronary arteries by
accessing through a blood vessel.
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Enlarging the lumen of a coronary artery by forcibly
expanding it with a balloon.
Atherectomy
Enlarging the lumen of a coronary artery by removal of
atherosclerotic plaque.
Stenting
Enlarging the lumen of a coronary artery by forcibly expanding it with a metal wire tube.
Devices used in cardiology
Stethoscope
Acoustic device for hearing internal sounds including heart
sounds.
Devices used to maintain normal electrical rhythm
Pacemaker
An implanted electrical device that replaces the heart's
natural pacemaker.
Defibrillator
Electrical devices to alter the heart's rhythm with
electrical energy.
Automated external defibrillator (AED)
An external defibrillator that is commonly found outside of health care settings. Often
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Cardiologists use diagrams like this: a
heart with an ECG indicator
designed for anyone to use.
Implantable cardioverter-defibrillator (ICD)
An implanted device to prevent life-threatening conditions (e.g., ventricular tachycardia
ventricular fibrillation).
Devices used to maintain blood pressure
Artificial heart
An internal pump that wholly replaces the pumping action of the heart.
Cardiopulmonary bypass (CPB) / heart-lung machine
External pump to take over the function of both the heart and lungs.
Intra-aortic balloon pump (IABP)
A balloon placed in the thoracic aorta to supplement cardiac output from the heart.
Ventricular assist device
Internal pump to supplement or replace the pumping action of a ventricle.
Diagnostic tests and procedures
Various cardiology diagnostic tests and procedures.
Blood tests
Echocardiography ("echo")
Ultrasonography of the heart to inspect chambers, valves, and
blood flow.
Transthoracic echocardiogram (TTE)
Echocardiogram of the heart through the thorax external
to the body.
Transesophageal echocardiogram (TEE)
Echocardiogram of the heart through a catheter placed
in the esophagus.
Cardiovascular magnetic resonance imaging (CMR)Magnetic resonance imaging (MRI) of the heart that utilizes
the ECG for gating and to look at specific mechanical functions of the heart.
Cardiac stress test
Testing of the cardiovascular system through controlled exercise or drugs.
Auscultation
Listening to sounds (e.g., heart sounds) with a stethoscope.
Electrocardiography (ECG or EKG)
Measurement of the electrical activity of the heart, typically with 4 or 10 electrodes on the skin.
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Cardiologist
Occupation
Names Doctor, Medical Specialist
Occupation
typeSpecialty
Activity
sectorsMedicine
Description
Education
required Doctor of Medicine (M.D.)Doctor of Osteopathic
Medicine (D.O.)
Holter monitor
Portable ECG device for continuous monitoring.
Electrophysiology study
Studying the electrical activity of the heart through the use of catheters placed in the heart via veins
or arteries.
Sphygmomanometer
Blood pressure cuff used to measure arterial blood pressure.
Cardiac marker
Testing for biomarkers in the blood that may indicate various conditions.
Coronary catheterization
Catheterization of the coronary arteries.
Fractional flow reserve (FFRmyo)
Testing the blood flow through a stenosis of a coronary artery to determine the perfusion of th
heart.
Intravascular ultrasound (IVUS)Ultrasonography of a coronary artery.
Optical coherence tomography (OCT)
Testing through the use of optical scattering for coronary artery disease.
Cardiologists
Robert Atkins (19302003), known for the Atkins
diet
Eugene Braunwald (born 1929), editor of
Braunwald's Heart Diseaseand 1000+
publications
Willem Einthoven (18601927), a physiologist
who built the first practical ECG and won the 1924
Nobel prize in medicine
Andreas Gruentzig (19391985), first developed
balloon angioplasty
Max Holzmann (1899-1994), co-founder of the
Swiss Society of Cardiology, president from 1952
1955
Samuel A. Levine (18911966), recognized the sign known as Levine's sign as well as the current
grading of the intensity of heart murmurs, known as the Levine scale
Henry Marriott (19172007), ECG interpretation andMarriott's Practical Electrocardiography
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John Parkinson (18851976), known for WolffParkinsonWhite syndrome
Helen B. Taussig (18981986), founder of pediatric cardiology and extensively worked on blue baby
syndrome
Paul Dudley White (18861973), known for WolffParkinsonWhite syndrome
Louis Wolff (18981972), known for WolffParkinsonWhite syndrome
Bernard Lown (born 1921) known for being the original developer of the Defibrillator
Journals
Acta Cardiologica
American Journal of Cardiology
Annals of Cardiac Anaesthesia
Cardiology
Cardiology in Review
Circulation
Circulation Research
Clinical and Experimental Hypertension
Clinical Cardiology
EP Europace
European Heart Journal
Heart
Heart RhythmInternational Journal of Cardiology
Journal of the American College of Cardiology
Pacing and Clinical Electrophysiology
Associations
American College of Cardiology
American Heart AssociationHeart Rhythm Society
National Heart Foundation of Australia
See also
Interventional cardiology
Clinical cardiac electrophysiology
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List of cardiac pharmaceutical agents
References
1. ^"Specialties & Subspecialties" (http://www.osteopathic.org/inside-aoa/development/aoa-board-
certification/Pages/specialty-subspecialty-certification.aspx). American Osteopathic Association. Retrieved
23 September 2012.
External links
U.S. National Institute of Health (NIH) : Heart and Circulation (http://health.nih.gov/search.asp/10)
American College of Cardiology (http://www.acc.org)
The Beginners Guide to Understanding Cardiology
(http://www.publicsafetydegrees.com/articles/ems/cardiology-guide.php)
Cardiology news website (http://www.theheart.org/)Cardiology Trials summaries (http://cardiologytrials.org)
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Categories: Cardiology
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