How Cardiologists Were Selected

Consumers' Research Council of America has compiled a list of Cardiologists throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining top health care professionals.

The criteria that was used and assessed a point value is as follows:

Simply put, Cardiologists that have accumulated a certain amount of points qualified for the list. This does not mean that doctors that did not accumulate enough points are not good Cardiologists; they merely did not qualify for this list because of the points needed for qualification.

Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals who they would recommend. We found this method to be more of a popularity contest. For instance, professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition, many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.

Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients of a particular Cardiologist on their level of satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.

We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, being board certified is better than not being certified, etc.

The Top Cardiologist list that we have compiled is current as of a certain date and other doctors may have qualified since that date. Nonetheless, we feel that the list of top Cardiologists is a good starting point for you to find a qualified specialist.

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, ensuring an unbiased selection.

Coronary Angioplasty

Coronary Angioplasty (AN-jee-oh-plas-tee) is a medical procedure used to restore blood flow through a narrowed or blocked artery in the heart. The arteries of the heart (the coronary arteries) can become narrowed and blocked due to buildup of a material called plaque on their inner walls. This narrowing reduces the flow of blood through the artery and can lead, over time, to coronary artery disease and heart attack. In angioplasty, a thin tube with a balloon or other device on the end is first threaded through a blood vessel in the arm or groin (upper thigh) up to the site of a narrowing or blockage in a coronary artery. Once in place, the balloon is then inflated to push the plaque outward against the wall of the artery, widening the artery and restoring the flow of blood through it. Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patient's legs, stomach or chest and grafting them to the front and back of the blocked arteries.

Angioplasty is used to:

		Relieve chest pain caused by reduced blood flow to the heart.
		Minimize damage to the heart muscle during a heart attack. This damage occurs when blood flow is totally cut off to an area of the heart

Angioplasty was first used in 1977. A tiny balloon was used to open or widen narrowed arteries. Since then, new devices and medicines have improved the procedure and made it appropriate for more people. The improvements include:

		Stents. A stent is a tiny mesh tube that looks like a small spring. The stent is inserted in the area where the artery is narrowed to keep it open. Some stents are "coated" with medication to help prevent the artery from closing again. Stents are used in most angioplasties except when an artery is too small for a stent to fit.
		When a stent is used, in 2 out of 10 people the artery will close again within the first 6 months.
		When a stent is not used, in 4 out of 10 people the artery will close again within the first 6 months.
		Plaque removers. Many kinds of plaque removers exist. They are used to cut away plaque that narrows the inside of the arteries.
		Laser. A laser is used to dissolve or vaporize plaque. First approved in 1992, laser devices are used in many major U.S. medical centers.

Today, angioplasty is performed on more than 1 million people a year in the United States. The procedure is best done:

		By doctors who do at least 75 angioplasties a year
		In hospitals that do at least 400 angioplasties a year

Research on angioplasty continues to:

		Increase its safety
		Prevent the artery from closing again
		Make it an option for more people

What Happens After Coronary Angioplasty?

Angioplasty is not a cure for coronary artery disease (CAD). You should discuss with your doctor what led to CAD and the need for angioplasty. Select the links below for more information on how to slow the development of CAD and how to lower your chance of having a heart attack:

		Preventing coronary artery disease
		Living with angina
		Life after a heart attack

Going Home

When you are ready to leave the hospital, you will receive instructions to follow at home, including:

		How much activity or exercise you can do.
		When you should follow up with your doctor.
		What medicines you should take.
		What you should look for daily when checking for signs of infection around the area where the tube was inserted, such as:      Redness Swelling Drainage
		When you should call your doctor, for example:      If you have a fever or signs of infection If you have pain or bleeding where the tube was inserted When you should call 911. For example, if you have any chest pain.

Your doctor will prescribe medicine to prevent blood clots from forming. It is very important that you take the medicine as directed. The medicine can prevent the stent from becoming blocked. Types of medicine may include:

		Anticoagulants
		Antiplatelet drugs, such as aspirin and clopidogrel (Plavix)

Most people can return to work and other normal activities about 1 week after angioplasty.

Cardiac Rehabilitation

Your doctor may recommend that you participate in a cardiac rehabilitation (rehab) program. Cardiac rehab provides medical guidance and support to help you return to work or daily activities. "Recovering From Heart Problems Through Cardiac Rehabilitation: Patient Guide" from the U.S. Agency for Healthcare Research and Quality gives more information on cardiac rehabilitation.

Coronary Artery Bypass Graft Surgery

Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patients legs, stomach or chest and grafting them to the front and back of the blocked arteries.

During a bypass procedure the heart-lung machine takes over the functions of the heart and  lungs. This is done so the heart can be carefully stopped and the surgeon can work in a blood-free environment. The heart-lung machine keeps oxygen-rich blood flowing through the body. It receives the blood and removes the carbon dioxide and other waste products, warms and/or cools the blood and adds oxygen as it pumps the blood through the patient's body. At the conclusion of the bypass surgery, the heart is restarted and the heart-lung machine is disconnected.

New advances in bypass surgery are continuing. A minimally invasive bypass surgery technique is being tested with promising results. This new procedure requires the surgeon to work on the front of the heart through a four inch incision while it is beating slowly. Another type is that the heart is stopped and a surgeon uses a fiberoptic scope that is passed through a 4 ½ inch incision and the surgeon works on all sides of the heart by viewing a video image. This less invasive procedure would be less expensive and requires a much shorter hospital stay.

Cardiac Catheterization

Cardiac catheterization (KATH-e-ter-i-ZA-shun) is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart. Cardiac catheterization is usually performed in a hospital by heart doctors (called cardiologists) that specialize in the treatment of heart diseases.

To diagnose some heart conditions, doctors may put a special dye into the catheter to make the inside of the heart and blood vessels show up on x rays. Doctors may take samples of blood and heart muscle through the tube. They can also treat certain heart problems during this procedure.

Why Is Cardiac Catheterization Done?

Often a doctor does a cardiac catheterization to find out why a patient is having chest pain. The procedure can reveal blocked or narrowed places in the heart’s arteries that can cause this pain. During the cardiac catheterization, a doctor might be able to open up the blocked arteries by doing another procedure called angioplasty (AN-jee-oh-plas-tee).

Most people who have heart attacks have arteries that are partly or completely blocked. That is why doctors often do cardiac catheterizations after patients have heart attacks. The procedure can tell them if there are blocked arteries that can be treated with angioplasty or surgery.

Another reason doctors may do cardiac catheterizations is to see the overall shape of the heart and the four large spaces (heart chambers) inside it. That way they can:

		Find any likely problems in people about to have open heart surgery
		See heart abnormalities in children or adults

Sometimes doctors do cardiac catheterizations to see how well the tissue flaps (valves) at the openings and exits of the heart chambers are working. To do this, the doctor will measure blood flow and oxygen levels in different parts of the heart. Cardiac catheterizations are also done to check the functioning of artificial heart valves.

Doctors may also perform cardiac catheterizations so they can do minor surgery on the heart. For example, doctors may do the procedure to remove (biopsy) a small piece of heart tissue to see if there is an infection or tumor, or they might repair holes in the heart or other heart defects.

What are the risks with Cardiac Catheterization?

Cardiac catheterization is a common medical procedure that rarely causes serious problems. But complications can include:

		Bleeding, infection, and pain where the tube (catheter) was inserted
		Damage to blood vessels
		An allergic reaction to the dye used

Other less common complications of the procedure include:

		An irregular heartbeat.
		Damage to the kidneys caused by the dye used.
		Blood clots that can trigger strokes, heart attacks, or other serious problems.
		Low blood pressure.
		A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes, although rarely, be fatal.

The risk of complications with cardiac catheterization is higher in:

		People with diabetes
		People with kidney disease
		Older people (ages 75 and older)
		Women
		People having emergency catheterization for serious heart symptoms

What Happens During a Cardiac Catheterization?

During a cardiac catheterization, you are kept on your back and awake. That way you can follow your doctor’s instructions during the procedure. You are given a drug to help you relax. This drug may make you sleepy.

Your doctor or nurse will numb the area where the small plastic tube (catheter) will enter the blood vessel through a small cut or needle in the arm, upper thigh (groin), or neck. The doctor then threads the tube through the vessel and into the large spaces (chambers) of the heart. Special x-ray movies are taken of the tube as it is threaded up into the heart. This helps the doctor see where to put the tube.

Once the catheter is at the right spot, your doctor can use it to conduct several tests or treatments. Often, special dye is put in the tube to make the inside of the heart’s arteries and other structures show up on an x ray. Your doctor may use a procedure called angioplasty to open up the blocked arteries. He or she may also take blood samples from different parts of the heart or do minor heart surgery.

Once your doctor does all of the needed tests or treatments, the catheter will be taken out. The opening in the blood vessel that the tube went through will then be closed up and bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply more pressure. This will help prevent major bleeding from the site.

What Happens After a Cardiac Catheterization?

After a cardiac catheterization, you will be moved to a special care area where you will stay for several hours or overnight. While you recover in this area, your movement will be limited to avoid bleeding from where the tube (catheter) was inserted. Nurses will check your heart rate and blood pressure regularly. They will also check to see if there is any bleeding from the tube insertion site.

Eventually, a small bruise will appear where the tube was put in. That area may feel sore or tender for about a week. Be sure to let your doctor know if:

		You have a constant or large amount of blood at the site that cannot be stopped with a small bandage.
		You have any unusual pain, swelling, redness, or other signs of infection at or near the insertion site.

Your doctor may tell you to avoid certain activities, such as heavy lifting, for a short time after the procedure.

Key Points

		Cardiac catheterization is a procedure in which a thin tube (catheter) is put into a blood vessel in the arm, upper thigh (groin), or neck and threaded up into the heart to do tests or treatments on the heart.
		Cardiac catheterizations often are done after a heart attack or to find out why a patient is having chest pain.
		Cardiac catheterization is a common medical procedure that rarely causes serious complications. The risk of complications is higher in people with diabetes and kidney disease, and in older people and women.
		Before having a cardiac catheterization, it is a good idea to meet with your doctor to learn about the procedure and how to prepare for it.
		You may have to stop taking certain medicines before the procedure.
		Patients are not usually allowed to drive the same day as the procedure. If you don’t have to stay overnight after the procedure, you should arrange for a ride to and from the hospital.
		You are kept awake during a cardiac catheterization. Afterwards, you will be moved to a special care area where you will stay for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the tube was inserted.
		The area where the tube was put in may feel sore for about a week. You need to let your doctor know if you have an excessive bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the procedure.

All About Angina

What Is Angina?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of Coronary Artery Disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called Atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle. Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. The buildup of plaque on the inner walls of the arteries can cause angina in two ways:

		By narrowing the artery to the point where the flow of blood is greatly reduced
		By forming blood clots that partially or totally block the artery

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.