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What is Cardiology?
Cardiology is the discipline
that researches, diagnoses and treats heart injuries and diseases as well as
their causes. Cardiologists will treat your heart problem while staying aware of
other conditions, including high blood pressure, high cholesterol, diabetes and
other factors that risk damaging the heart. Risk factors may include a family
history of heart disease, obesity, cigarette smoking, poor diet and a sedentary
lifestyle. What Does a Cardiologist Do?
A cardiologist is a physician who is board
certified to diagnose and treat problems of the cardiovascular system- the
heart, arteries, and veins. Cardiology is classified as an internal
medicine subspecialty. Knowledge of internal medicine and other
specialties is required to obtain certification. Finding A Top Cardiologist
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:
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 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:
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:
When you are ready to leave the hospital, you will receive instructions to follow at home, including:
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:
Most people can return to work and other normal activities about 1 week after angioplasty.
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 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
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.
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:
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.
Cardiac catheterization is a common medical procedure that rarely causes serious problems. But complications can include:
As with any procedure involving the heart, complications can sometimes, although rarely, be fatal. The risk of complications with cardiac catheterization is higher in:
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.
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 doctor may tell you to avoid certain activities, such as heavy lifting, for a short time after the procedure. Key Points
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:
The three types of angina are stable, unstable, and
variant (Prinzmetal's). It is very important to know the differences among the
types.
The pain usually goes away in a few minutes after you rest or take your angina medicine. Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future. Physical exertion is the most common cause of pain and discomfort from stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you are sitting). But with exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. Other causes include:
Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.
Other Names for Angina
More than 6 million people in the United States have angina. People with coronary artery disease or who have had a heart attack are more likely to have angina. Unstable angina occurs more often in older adults. Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. People with variant angina are often younger than those with other forms of angina.
Pain and discomfort are the main symptoms of angina. These symptoms:
Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur. Symptoms vary based on the type of angina.
The pain or discomfort:
The pain or discomfort:
The pain or discomfort:
Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having—or are about to have—a heart attack. Call 9–1–1 right away.
To find out if you have angina, your doctor will:
Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina. The tests your doctor may order include:
If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done. During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle. Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.
Your doctor may also order blood tests, such as:
Treatment for angina includes lifestyle changes, medicine, special procedures, and cardiac rehabilitation. The main goals of treatment are to:
Lifestyle changes and medicine may be the only treatments needed if your symptoms are mild and are not getting worse. Unstable angina is an emergency condition that requires treatment in the hospital.
You can also make other lifestyle changes, for example:
Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.
When medicines and other treatments do not control angina, special (invasive) procedures may be needed. Two commonly used procedures are:
Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after bypass surgery, angioplasty, or a heart attack.
Rehab has two parts:
You can prevent or lower your risk for heart disease and angina by making lifestyle changes and getting treatment for related conditions.
In addition to making lifestyle changes, you can help prevent angina and heart disease by treating related conditions, such as:
Angina is not a heart attack, but it does mean that you are at greater risk of having a heart attack than someone who does not have angina. The risk is even higher if you have unstable angina. For these reasons, it is important that you know:
Stable angina usually occurs in a pattern. You should know:
After several episodes, you will learn to recognize when you are having angina. It is important for you to notice if the pattern starts to change. Changes in the pattern to look for may include:
These changes in the pattern may be a sign that your symptoms are getting worse or becoming unstable. You should seek medical attention. Unstable angina suggests that you are at high risk for a heart attack very soon.
You should know what medicines you are taking, the purpose of each, how and when to take them, and possible side effects. It is very important that you know exactly when and how to take fast-acting nitroglycerin or other nitrates to relieve chest pain. They should be taken:
Men with impotence (erectile dysfunction) who take sildenafil (Viagra®) should talk with their doctor. Taking sildenafil and nitroglycerin or other nitrates within 24 hours of each other can cause serious problems. Ask your doctor about your other medicines. Also, see the Treatment section to read descriptions of the medicines that you are taking.
Most people with stable angina can continue their normal activities. This includes work, hobbies, and sexual relations. However, if you engage in very strenuous activity or have a stressful job, you may need to discuss this with your doctor.
If you have angina, you are at high risk of having a heart attack. Therefore, it is very important that you and your family know how and when to seek medical attention. Talk to your doctor about making an emergency action plan. The plan should include:
Be sure to discuss your emergency plan with your family members. Take action quickly if your chest pain becomes severe, lasts longer, or is not relieved by rest or medicine. Sometimes, it may be difficult to tell the difference between unstable angina and a heart attack. Most heart attack victims wait 2 hours or more after their symptoms begin before they seek medical help. This delay can result in death or lasting heart damage.
Minimally Invasive Heart Surgery Recent advances in surgical techniques and equipment allow surgeons to perform Coronary Artery Bypass Surgery in a less traumatic way. Minimally Invasive Coronary Artery Surgery is also called Limited Access Coronary Artery Surgery. It is as an alternative to the standard methods of Coronary Artery Bypass Graft Surgery. Unlike conventional surgery, which utilizes a 10-12" incision and requires the patient to be placed on the heart-lung machine, new minimally invasive surgery may avoid placing the patient on the machine, and can be performed through a 3-5" incision placed between the ribs, or may be done with several small incisions. Like conventional surgery, the surgery is done to reroute, or bypass, blood around coronary arteries clogged by fatty buildups of plaque and improve the supply of blood and oxygen to the heart. Minimally Invasive Coronary Artery Bypass—also called MIDCAB—is used to avoid the heart-lung machine. It's done while your heart is still beating and is intended for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes, or ports, in your chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision. Minimally Invasive Bypass Surgery has the same beneficial results as conventional bypass surgery. It restores adequate blood flow and normal delivery of oxygen and nutrients to the heart. This type of surgery has additional advantages, including the ability of the surgeon to work on a beating heart or through smaller incisions.
Risks
Performing
surgery on a beating heart is more difficult than working on a heart
that has been stopped with the help of the heart-lung machine. In
addition, the stress on the heart during the procedure may lead to more
heart muscle damage, lower blood pressure, irregular heartbeat and
potential brain injury if blood flow to the brain is reduced for too
long during surgery. In some cases—usually less than 10 percent—it
is necessary to convert to conventional methods on an emergency basis. Weight Control
Your primary goal should be to have a healthy body. Healthy bodies come in different shapes and sizes. Weight control is just a part of having a healthy body. Other factors include your diet, nutrition and the amount and kind of exercising you are getting. Displayed later on in this chapter is a height/weight chart that will serve as a guideline. When you see your family doctor, they
will check your height, weight, and blood pressure, blood lipids, (cholesterol,
triglycerides), and blood sugar (for people with diabetes). All of these involve
medical conditions related to weight. Proper weight control and weight
management can help provide for a healthy body.
Obesity is basically a medical condition that signifies the excess storage of body fat. It is normal for the body to store fat tissue under the skin and around joints and organs. Fat is essential for good health because it provides energy when the body demands it and provides insulation and protection for vital organs. It is the accumulation of too much fat that poses the health problems of obesity. These health problems include diabetes, hypertension, stroke, heart disease and arthritis. The United States has one of the highest percentages of obese adults. It is estimated that over 36% of adults in America are obese. Obesity is most common among minorities, especially minority females. Over 50% of African-American and Mexican-American women are obese. Over 20% of children between the ages of 6 to 17 fit in the obese category. A primary concern of obesity is the risk of developing disease. Obese people are twice as likely to develop high blood pressure and over 70% of heart disease cases are linked to excess body fat. Obese women are twice as likely to develop breast cancer and 40% more likely to develop colon cancer. Close to 80% of Type II or non-insulin dependent diabetics are obese. Obesity is partially
determined by genetic makeup. Research has revealed that basal metabolic rate
and the size and number of a person's fat cells help in determining the amount
of weight loss that is possible. When calories from food intake equal the amount
of energy that the body requires to function the weight remains the same.
However, when more calories are consumed than the body needs, the body will
store the extra calories, resulting in weight gain.
Diets are the most common treatment for obesity. There seem to be countless diets that are promoted and it is recommended that your weight control diet be supervised by a your family doctor. Most health care professionals will recommend a diet that consists of 1200 - 1500 calories per day. People who are over 40 pounds overweight may require a more aggressive approach and may be put on a restricted diet of 500 to 800 calories per day. There many types of weight
loss medications on the market today but there are also many side effects that
include insomnia, anxiety and irritability. Your family doctor can evaluate your
particular condition, health issues and can recommend weight-loss
medications under the right circumstances. Used correctly, they can be very
effective in the treatment of overweight people.
A long-term exercise plan sometimes requires lifestyle and behavior modification, which can be hard for many obese people to accept. Successful weight management plans require strong discipline to control eating urges and to implement exercise plans. New habits need to be learned and many old bad habits need to changed, such as food types consumed and unproductive eating habits. When choosing an exercise program, the person should consult their family doctor. The exercise program will be designed around the person's work capacity, which will be determined by your doctor. Exercise tests using the treadmill or stationary bicycle are the most common ways to determine and measure work capacity. Once your work capacity has been determined, an exercise program can be recommended. The formula will include what your training heart rate should be and how much intensity should be expended during your workout. An exercise program can be the most important part of your weight management program because it will give you so many other added health benefits. Many studies show a direct correlation between physical fitness and mental achievement. Weight Chart The following charts provide healthy weight ranges for different body sizes and builds:
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All About High Blood Pressure
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Cardiology is the study of cardiovascular illness and the care of all things
related to the heart. Cardiology is classified as an internal medicine
sub-specialty. It includes veins and arteries, and it used to diagnose and treat
conditions like blockages. Cardiologists should not be confused with cardiac
surgeons. Cardiac surgeons go into the chest and perform heart surgeries, while
cardiologists perform tests and procedures like angioplasty.
Choosing a Cardiologist is an
important decision. Thus, our goal is to assist you in making that decision.
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.
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.
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.
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.
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.
The first thing that you need to do is change your living habits to avoid
bringing on an episode of angina.
Nitrates are the most commonly used medicines to treat angina. Fast-acting
preparations are taken when angina occurs or is expected to occur. Nitrates
relax and widen blood vessels, allowing more blood to flow to the heart while
reducing its workload.
Weight control
is an important part of our culture. We are reminded daily in our society that
being overweight is not "in" or fashionable. Just look at TV or any
type of media advertising and you will soon see that being thin and in good
shape is what is popular.
Exercise should be an
important part of your weight management plan. Calorie reduction alone is not a
complete plan will not result in long-term weight loss. Regular exercise is a
long-term plan for continuing weight reduction. Exercise will also improve some
of the medical conditions associated with obesity which include high cholesterol
levels, high blood pressure and diabetes.
E