Cardiology & Heart Diseases

Invasive cardiology uses open or minimally-invasive surgery to identify or treat structural or electrical abnormalities within the heart structure. When plaque clogs your arteries, it becomes difficult for blood to flow normally. Angioplasty inserts a tiny balloon into your clogged vein and pushes plaque against the walls, allowing for increased blood flow. Stenting is usually done in conjunction with angioplasty. A cardiac stent is a small metal coil which permanently holds a clogged vein open.

• Angioplasty
•  Stenting

Non-invasive cardiology identifies heart problems without using any needles, fluids, or other instruments which are inserted into the body. Nuclear cardiology is a non-invasive study of cardiovascular disorders by means of various types of imaging which may use radioactive elements. Echocardiograph is the usage of ultrasound waves to create images of the heart and surrounding structures in order to identify how well the heart pumps blood, infections, and structural abnormalities. Cardiac electrophysiology is the study and testing of the electrical currents which generate heartbeats. Stress tests usually involve exercise which is monitored by your cardiologist. These exercises provide your cardiologist information about how your heart performs under physical stress. Heart monitors may also be called a Holter monitor or cardiac event recorder. Heart monitors are essentially tape recorders for your heart’s electrical activity over a set amount of time. CT scans produce images which your cardiologist can examine for heart disease and atherosclerosis.

• Echocardiography
• Cardiac electrophysiology
• Stress tests
• Heart monitors
• CT scans

Interventional cardiology is a non-surgical option which uses a catheter – a small, flexible tube – to repair damaged or weakened vessels, narrowed arteries, or other affected parts of the heart structure. Coronary artery disease  A narrowing of the arteries which supply the heart muscle with blood and oxygen. Heart valve disease occurs when the valves which control blood flow into the heart’s chambers are not working correctly. Peripheral vascular disease heart can also be affected by clogged or hardened veins and arteries which are in other parts of your body. Angioplasty  is an intervention to dilate either arteries or veins. Coronary angioplasty/Percutaneous coronary intervention is an intervention for the treatment of coronary artery disease. It can be culprit-vessel revascularization only or complete revascularization. valvuloplasty It is the dilation of narrowed cardiac valves (usually mitral, aortic, or pulmonary). Congenital heart defect correction Percutaneous approaches can be employed to correct atrial septal and ventricular septal defects, closure of a patent ductus arteriosus, and angioplasty of the great vessels. Percutaneous valve replacement an alternative to open heart surgery, percutaneous valve replacement is the replacement of a heart valve using percutaneous methods. This is performed on the aortic valve, pulmonary valve and recently the mitral valve. Percutaneous valve repair An alternative to open heart surgery, percutaneous valve repair is performed on the mitral valve using the MONARC system or MitraClip system. Coronary thrombectomy Coronary thrombectomy involves the removal of a thrombus (blood clot) from the coronary arteries.

• Coronary artery disease
• Heart valve disease
• Peripheral vascular disease
• Angioplasty
• Coronary angioplasty/Percutaneous coronary intervention
• Congenital heart defect correction
• Percutaneous valve replacement
• Percutaneous valve repair
• Coronary thrombectomy

Pediatric Cardiologists care for patients with congenital or acquired cardiac and cardiovascular abnormalities. The scope of pediatric cardiology practice is extensive. Pediatric Cardiologists evaluate and care for fetuses, neonates, infants, children, adolescents, young adults, and adults.

Special areas of clinical and academic interest include: Intensive Cardiac Care, Cardiac Catheterization and Intervention, Electrophysiology, Imaging, Fetal Cardiology, Exercise Physiology, Preventive Cardiology, Heart Failure and Transplantation, and Pulmonary Hypertension.

cardiovascular diseases seen in paediatrics are as follows :

• Aortic senosis
• Arrhythmias
• Atrial septic defect
• Cardiac failure
• Cardiomyopathy
• Coarctation of aorta
• Congenital heart disease
• Endocardial cushion defect
• Kawasaki disease
• Pulmonary atresia and pulmonary stenosis
• Pulmonary hypertension
• Rheumatic heart disease
• Total Anomalous Pulmonary Venous Connection
• Transposition of great arteries
• Tricus arteriosus
• Ventricular septal defect

A physician may recommend cardiac imaging to support a diagnosis of a heart condition. Medical specialty professional organizations discourage the use of routine cardiac imaging during pre-operative assessment for patients about to undergo low or mid-risk non-cardiac surgery because the procedure carries risks and is unlikely to result in the change of a patient's management. Stress cardiac imaging is discouraged in the evaluation of patients without cardiac symptoms or in routine follow-ups.

• Magnetic resonance
• Coronary CT calcium scan
• Computed tomography angiography
• Positron emission tomography
• Echocardiogram
• Intravascular ultrasound
• Fractional flow reserve
• Coronary catheterization

Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include 

• Stroke
• Heart failure
• Hypertensive heart disease
• Rheumatic heart disease
• Cardiomyopathy
• Heart arrhythmia
• Congenital heart disease
• Valvular heart disease
• Carditis
• Aortic aneurysms
• Peripheral artery disease
• Thromboembolic disease
• Venous thrombosis.

Heart failure can be brought on by many conditions that damage the heart, including: Coronary artery disease. This is a disease of the arteries that supply blood and oxygen to your heart. It decreases blood flow to your heart muscle. If the arteries narrow or get blocked, your heart becomes starved for oxygen and nutrients and can't pump as well. Heart attack. This may happen when a coronary artery is blocked suddenly, which stops the flow of blood to your heart muscle. Cardiomyopathy. This is damage to your heart muscle that can be caused by artery or blood flow problems, infections, and alcohol and drug abuse. Other diseases or genetic issues can also bring it on. Make sure your doctor knows your family's health history. Conditions that overwork the heart. These include things like high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or heart defects you've had since you were born.  

• Coronary artery disease
• Heart attack
• Conditions that overwork the heart.
• Cardiomyopathy

Stages of Heart Failure:

Stage A. This is the period when you are at risk for heart failure. You may be in this stage if you have:

• High blood pressure
• Diabetes
• Coronary artery disease
• Metabolic syndrome

You may also be at risk if you have a history of:

• Cardiotoxic drug therapy
•  Alcohol abuse
• Rheumatic fever
• Family members with cardiomyopathy

Stage B. You're in this phase if you never had symptoms of heart failure but you're diagnosed with systolic left ventricular dysfunction, which means the left chamber of your heart doesn't pump well. You may be in this group if you had or have:

• Heart attack
• Valve disease
• Cardiomyopathy

Stage C. You're in this phase if you have systolic heart failure along with symptoms such as:

• Shortness of breath
• Fatigue
• Less ability to exercise

Stage D. You're in this phase if you have systolic heart failure and advanced symptoms after you get medical care.

Even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That's because people with diabetes, particularly type 2 diabetes, may have the following conditions that contribute to their risk for developing cardiovascular disease.

• Glycemic control
• Obesity
• Dyslipidemia
• Hypertension
• Oxidativestress
• Epigenetics
• Inflammatory cascde, therosclerosis
• Endothelial dysfunction
• Cardiovascular autonomic neuropathy

Several prominent electrophysiologic differences have been noted between the sexes. By 5 years of age, girls have a higher heart rate than do boys, which might be explained by a shorter sinus node refractory time. The shorter QT interval in men is noted during puberty, as sex hormone levels rise. The length of the QT interval in men increases linearly through adulthood until the age of 50, when it becomes similar to that of women, which correlates with the decrease in androgen levels. Furthermore, QRS amplitude and duration are greater in men, consequent to a higher cardiac mass and thicker left ventricular walls.

• Effects of Sex Hormones
• Atrial Fibrillation

Critical cardiac care (CIC) which is also known as coronary care unit (CCU)  is a hospital ward specialized in the care of patients with heart attacks, unstable angina, cardiac dysrhythmia and  various other cardiac conditions that require continuous monitoring and treatment or first aid treatment till the doctor comes. There are also units available in the hospitals to take care of the emergency situation. The Cardiac intensive care unit (CICU) is a specialized ICU dealing with cardiac patients and is usually staffed by cardiologists. It offers critical care staff especially trained in acute coronary syndromes and has additional technology such as intra-aortic balloon pumps, etc.

• Cardiopulmonary resuscitation
• Extracorporeal membrane oxygenation (ECMO)
• Clot busting medicine
• Oxygen therapy
• Emergency medicine
• Acute coronary care
• Subacute coronary care

The surgery done to heart by an professional cardiologist to treat its dysfunction. There are many different types of cardiac surgeries available to cure different type of cardiac problems some of them are mentioned below

• Open heart surgery
• Modern beating heart surgery
• Heart transplant
• Coronary artery bypass grafting
• Minimally invasive surgery

Cardio-oncology is the intersection of heart conditions in patients who have been treated for cancer. Cardiologists can assess patients for potential risk of developing heart conditions if patients take certain types of cancer drugs, or following radiation treatment to the chest. By designing Cardio-Oncology Program to provide cancer patients with excellent, multidisciplinary care. We combine advanced imaging and treatment protocols with a knowledgeable team of oncologists and cardiologists working together.

 Atherosclerosis is a disease in which the inside of an artery narrows due to the build up of plaque. Initially, there are generally no symptoms. When severe, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney problems depending on the arteries which are affected. Symptoms, if they occur, generally do not begin until middle age.

Modifiable:  

• Diabetes
• Dyslipidaemia
• Tobacco smoking
• Trans fat
• Abdominal obesity
• Western pattern diet
• Insulin resistance
• Hypertension

Nonmodifiable:

• Advanced age
• Family history
• Genetic abnormalities

Obesity has numerous consequences on the CV system. Chronic accumulation of excess body fat leads to a variety of metabolic changes, increasing the prevalence of CVD risk factors but also affecting systems modulating inflammation. obesity promotes alterations in other intermediate risk factors such as dyslipidemia, HTN, glucose intolerance, inflammatory state, obstructive sleep apnea/hypoventilation, and a prothrombotic state, as well as probably many additional unknown mechanisms. Obesity also induces a variety of structural adaptations/alterations in CV structure/function.  Being obese can raise blood cholesterol and triglyceride levels. lower "good" HDL cholesterol. HDL cholesterol is linked with lower heart disease and stroke risk, so low LDL tends to raise the risk. increase blood pressure. diabetes. In some people, diabetes makes other risk factors much worse. The danger of heart attack is especially high for these people.

Correlation of obesity and heart:

• Obesity and hypertension
• Obesity and coronary heart disease
• Obesity and heart failure
• Obesity and atrial fibrillation
• Obesity and stoke
• Obesity and ventricular arrhythmias
• Obesity and sleep apnea
• Obesity and venous disease

These are different class of drugs which are used to treat cardiac diseases and even to prevent occurrence of cardiac failure

• ACE inhibitors: These medications block stress hormones and relieve stress on the heart’s pumping action. They improve symptoms and reduce hospitalizations for patients with heart failure.
• Antiarrhythmics: These control irregular heartbeats — and maintain a normal heart rate and rhythm.
• Anticoagulants and platelet inhibitors: These cause your blood to take longer to clot, which can reduce the risk of strokes and heart attacks that can occur when blood clots get stuck in small blood vessels.
• Antihypertensives: These are commonly used to treat high blood pressure by relaxing and widening blood vessels.
• Beta blockers: These medications are often prescribed to treat angina, high blood pressure, and irregular heart rhythms. They  Block stress hormones and relieve stress on the heart’s pumping action . Relax the blood vessels so blood can move more easily. Improve the heart’s function . Reduce symptoms and lessen the chance of future hospitalizations
• Calcium channel blockers: These are commonly used to treat high blood pressure, coronary artery spasms, and angina. They restrict the normal flow of calcium into the cells of the heart and blood vessels, which discourages smaller vessels from narrowing and going into spasm, and also reduces the heart’s workload and need for oxygen.
• Digitalis glycosides: These strengthen the heart muscle, treat irregular heart rhythms, and improve exercise tolerance.
• Diuretics: These help rid your body of excess fluid and salt. They are often prescribed for high blood pressure and congestive heart failure.
• Lipid medications: The medications in this category work in different ways. Depending on which one you’re taking, lipid medications can lower your levels of cholesterol, LDL, and triglycerides — as well as treat abnormally low levels of HDL cholesterol.
• Nitrates and other antianginals : These are commonly used to prevent, reduce, or relieve angina pain. They work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart — while reducing the blood pressure that your heart has to pump against.

There are some non pharmacotherapies are available to prevent and to control heart diseases. These non pharmaco therapies can be implemented along with pharmacotherapy.

Cardiac nursing is a nursing specialty that works with patients who suffer from various conditions of the cardiovascular system. Cardiac nurses help treat conditions such as unstable angina, cardiomyopathy, coronary artery disease, congestive heart failure, myocardial infarction and cardiac dysrhythmia under the direction of a cardiologist.

Cardiac nurses perform postoperative care on a surgical unit, stress test evaluations, cardiac monitoring, vascular monitoring, and health assessments. Cardiac nurses must have Basic Life Support and Advanced Cardiac Life Support certification. In addition, cardiac nurses must possess specialized skills including electrocardiogram monitoring, defibrillation, and medication administration by continuous intravenous drip.

Cardiac nurses work in many different environments, including coronary care units (CCU), cardiac catheterization, intensive care units (ICU), operating theatres, cardiac rehabilitation centers, clinical research, cardiac surgery wards, cardiovascular intensive care units (CVICU), and cardiac medical wards.

Cardiology conferences comprises the current research in cardiology contains the new innovative methods that are coming in cardiology related field.

• Statin therapy
• Thrombolytic therapy
• Cardiac rehabilitation
• 3-D imaging
• Wearable technologies
• Wireless technologies and biosensors 
• Percutaneous mitral valve repair devices
• 3-D bioprinting

Pregnancy increases the risk of new-onset SVT. This risk is higher in pregnant patients with Wolff-Parkinson-White syndrome. In the absence of structural heart disease, AF and atrial flutter are rare during pregnancy. Nonsustained ventricular arrhythmias occur in up to 50% of pregnant women, but the clinical risk of sustained ventricular arrhythmia in the absence of structural heart disease is low.

Most antiarrhythmic drugs are classified as category C drugs during pregnancy by the United States Food and Drug Administration (FDA) .Therefore, drug therapy should be used only in patients who have life-threatening arrhythmias or debilitating symptoms. Most β-blockers are classified as category C drugs by the FDA; however, atenolol is classified as a category D drug because it has been implicated in intrauterine growth retardation, and sotalol, pindolol, and acebutolol are classified as category B drugs. Other class C drugs include adenosine, digoxin, and heparin, whereas lidocaine and enoxaparin are class B drugs. Enoxaparin is safe for the fetus, but some formulations contain the preservative benzylalcohol, which can be harmful. Amiodarone is considered a category D drug, and warfarin (category X) should not be used at all during pregnancy because of its teratogenicity.

A congenital heart defect (CHD), also known as a congenital heart anomaly or congenital heart disease, is a problem in the structure of the heart that is present at birth. Signs and symptoms depend on the specific type of problem. Symptoms can vary from none to life-threatening. When present they may include rapid breathing, bluish skin, poor weight gain, and feeling tired. It does not cause chest pain. Most congenital heart problems do not occur with other diseases. Complications that can result from heart defects include heart failure.

The cause of a congenital heart defect is often unknown. Certain cases may be due to infections during pregnancy such as rubella, use of certain medications or drugs such as alcohol or tobacco, parents being closely related, or poor nutritional status or obesity in the mother. Having a parent with a congenital heart defect is also a risk factor. A number of genetic conditions are associated with heart defects including Down syndrome, Turner syndrome, and Marfan syndrome. Congenital heart defects are divided into two main groups: cyanotic heart defects and non-cyanotic heart defects, depending on whether the child has the potential to turn bluish in color. The problems may involve the interior walls of the heart, the heart valves, or the large blood vessels that lead to and from the heart.