Cardiology

From Wikipedia, the free encyclopedia

Cardiology (from Greek kardi, "heart" and

- -logia, "study") is a branch of medicine
dealing with disorders of the heart as well as parts of
the circulatory system. The field includes medical
diagnosis and treatment of congenital heart defects,
coronary artery disease, heart failure, valvular heart
disease and electrophysiology. Physicians who
specialize in this field of medicine are called
cardiologists, a specialty of internal medicine.
Pediatric cardiologists are pediatricians who
specialize in cardiology. Physicians who specialize in
cardiac surgery are called cardiothoracic surgeons
or cardiac surgeons, a specialty of general surgery.
Although the cardiovascular system is inextricably
linked to blood, cardiology is relatively unconcerned
with hematology and its diseases. Some obvious
exceptions that affect the function of the heart would
be blood tests (electrolyte disturbances, troponins),
decreased oxygen carrying capacity (anemia,
hypovolemic shock), and coagulopathies.

Contents
1 Specialization
1.1 Adult cardiology
1.2 Pediatric cardiology
2 The heart
3 Physical exam
4 Disorders
4.1 Hypertension
4.2 Arrhythmias
4.3 Disorder of the coronary
circulation
4.4 Cardiac arrest
4.5 Disorders of the myocardium
4.6 Disorders of the pericardium
4.7 Disorders of the heart valves
4.8 Congenital heart defect
4.9 Diseases of blood vessels

Cardiology

Blood flow diagram of the human heart. Blue

components indicate de-oxygenated blood
pathways and red components indicate oxygenated
blood 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

4.10 Procedures to counter coronary

artery disease
4.11 Devices used in cardiology
4.12 Diagnostic tests and procedures
5 Drugs
5.1 Drugs for the cardiovascular
system
5.1.1 Ion channels
5.1.2 Receptors
5.1.3 Enzymes
5.2 Drugs with cardiovascular side
effects
6 Cardiologists
7 Journals
8 Associations
9 See also
10 References
11 External links

Specialization
All cardiologists study the disorders of the heart, but the study of adult and child heart disorders are
through different training pathways. Therefore, an adult cardiologist (often simply called "cardiologist")
is inadequately trained to take care of children, and pediatric cardiologists are inadequately trained to
take care of adults. The surgical aspects are not included in cardiology and are in the domain of
cardiothoracic surgery. For example, coronary artery bypass surgery (CABG) and cardiopulmonary
bypass are both surgical procedures performed by surgeons, not cardiologists. However the insertion of
stents and pacemakers are performed by cardiologists.

Adult cardiology
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
Per doximity, adult cardiologists make an average of $436,849 in the United States.[2]

Pediatric cardiology
Pediatric cardiology is a specialty of pediatrics. To be a pediatric cardiologist in the United States, it is
required that a three-year residency in pediatrics is followed by a three-year fellowship in pediatric
cardiology, Per doximity, pediatric cardiologists make an average of $303,917 in the United States.[3]

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 body called the
Blood flow through the valves
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
to 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 is 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 WolffParkinson
White syndrome, ventricular fibrillation, and heart block.

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 the heart disrupt the ability to move blood. Failure to move sufficient blood can result in failure in
other organs 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.

Physical exam
The cardiac physical exam focuses on portions of the physical exam that elucidate information about
diseases and disorders outlined below. Clinical judgment, of course, should guide the physical exam but
the following are pertinent things related to a general / broad cardiac exam.

Apex beat (point of maximum impulse)

Bruits: carotid, renal
Edema of the lower extremities and ascites that may indicate right heart failure
Heart sounds, heart murmurs, pericardial rub, mechanical heart valve clicking
Jugular venous distension
Retina exam with ophthalmoscope for signs of hypertension (retinal hemorrhage) and diabetic
retinopathy (cotton wool spots)
Pulses: carotid, dorsalis pedis, femoral, popliteal, posterior tibial, radial, temporal, ulnar
Heart rate
Pulse quality: pulsus paradoxus, pulsus parvus et tardus
Respiratory sounds for crackles (edema) and other lung pathologies that can affect the heart
Rheumatic diseases can have significant cardiac findings and is too lengthy to include here
Arthritis is common amongst rheumatic diseases
Skin exam for rashes (systemic lupus erythematosus, scleroderma, dermatomyositis,
vasculitis)
Skin exam
Diabetic neuropathy
Endocarditis signs: Janeway lesions, Osler's nodes, splinter hemorrhages
Peripheral vascular disease
Scars indicating procedures: sternotomy, thoracotomy, pericardial window, carotid
endarterectomy, thyroidectomy, etc.
Skin bulges indicating implanted devices: pacemaker, ICD, implantable loop recorder,
vagus nerve stimulation
Vasculitis rashes
Xanthomas & xanthelasmas
Vital signs
Blood pressure: hypertension, congenital heart disease manifestations
Heart rate: bradycardia & tachycardia
Respiratory rate: in distress, shortness of breath causes

Disorders
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 and in the vascular
system. Collectively, the two together is termed the cardiovascular system and diseases of one part tends
to affect the other part. The following attempts to categorize the lengthy list of disorders & diseases of
the cardiovascular system, but there is overlap and a single entity may appear in multiple areas.

Hypertension
Hypertension is elevated blood pressure above
"normal." Blood pressure is reported as fraction of
systolic blood pressure over diastolic blood
pressure and typically at the brachial artery while
seated and measured in mmHg. The normal blood
pressure changes with age with a general trend that
it increases with age. Normal pressure for
newborns is around 90/60 and young adults
classically being 120/80 (pronounced "120 over
80").
Hypertension has significant impact on the
cardiovascular system other systems too and
is the motivating reason for treatment. Reduction
of morbidity from hypertension is the end-goal of
therapy.
Types of hypertension

Diagram illustrating the main complications of

persistent high blood pressure

Essential hypertension
Hypertension with no known cause, which is about 90-95% of people with hypertension.
Often thought to be due to lifestyle. Management is through medications and blood pressure
that does not respond is a red flag that it may be secondary hypertension. Due to the
widespread nature of hypertension, cardiologists will end up managing or recommending
treatments for essential hypertension.
Secondary hypertension
Most causes of secondary hypertension are from kidney and endocrine disorders.
Cardiovascular causes of hypertension include coarctation of aorta, atherosclerosis, and
aortic stenosis.
Complications of hypertension
Hypertrophic cardiomyopathy
Increased pressure results in hypertrophy of the myocardium, particularly left ventricular
hypertrophy. Pulmonary hypertension which is separate from "hypertension" described
above can result in right ventricular hypertrophy.
Hypertensive crisis

Generally considered to be a systolic blood pressure over 180. If there is no organ

dysfunction it is called a hypertensive urgency, but if there is (e.g., confusion,
breathlessness) then it is called hypertensive emergency.
Pre-eclampsia (PreE) / Eclampsia
PreE is a disease of pregnancy that results in hypertension and proteinuria. PreE has
negative consequences for both the mother and fetus/baby. Progression to eclampsia
involves seizures. Currently, the only definitive treatment is delivery of the fetus.
Hemorrhagic stroke
Infarction of the brain due to internal bleeding from CharcotBouchard aneurysms.
Hypertensive encephalopathy, hypertensive nephropathy, hypertensive retinopathy
Damage to organs from chronic hypertension.

Arrhythmias
Proper function of the heart relies on a healthy
Electrical conduction system of the heart and an
orderly transmission of the action potentials that
signal the myocardium to contract. Cardiac
arrhythmias have numerous causes and have varying
outcomes and complications.
Atrial fibrillation (afib or AF)
Fibrillation of the atria is fairly common and
more common with increased age and overall
Ventricular fibrillation is a medical emergency
disease of the heart. If the ventricular rate
exceeds 100 then the afib is further classified
as "afib with RVR" meaning rapid ventricular
response.
Atrial flutter (AFL)
A re-entrant tachycardia greater than 240 beats per minute and produces a characteristic saw-tooth
pattern on ECG. It often degenerates to atrial fibrillation.
Heart block
A decrease in the ability of the conduction system to transmit action pulses in the orderly manner.
Blockage of the signal at different areas results in different types of heart block (e.g., first-degree
AV block, left bundle branch block).
Long QT syndrome
Lengthening of the QT interval can result in arrhythmias and sudden cardiac death. Specifically, it
can lead to torsades de pointes than can then lead to ventricular fibrillation. It can be an inherited
disorder or be acquired. Certain medications are associated with lengthening of the QT interval
drug-induced QT prolongation and an EKG may be warranted before starting the medication to
ensure a normal QT interval, but this practice is debated.
Premature atrial contractions (PACs or APCs)
Normal beats originate in the SA node and extra beats originating from the atria are called PACs.
They can be found in normal hearts and be asymptomatic; symptomatic PACs can be treated with
beta blockers. PACs, like PVCs, can pair up with normal beats in a pattern called bigeminy.
Premature ventricular contractions (PVCs)
Normal beats are conducted through the AV node to the ventricles resulting in a narrow QRS
complex. With PVCs, the extra beat originates within the ventricles and results in a wide QRS

complex. Like PACs, they can be found in healthy hearts but are more likely to be found in
bigeminy than PACs.
Sick sinus syndrome, Bradycardia-tachycardia syndrome (BTS)
Disease of the SA node that results in irregular changes in heart rate and in the case of BTS the
arrhythmia alternates between bradycardia and tachycardia.
Supraventricular tachycardia (SVT)
A collection of tachycardia rhythms that originate before the ventricles and include the SA node,
atria, and AV node. It is a broad, encomparsing term that includes other rhythms in this list (e.g.,
afib with RVR) and others.
Torsades de pointes
A polymorphic arrhythmia that can be syptomatic and tends to resolve to a normal sinus rhythm.
However, there is a concern
Ventricular fibrillation (vfib)
Fibrillation of the ventricles is a life-threatening arrhythmia and should be treated by defibrillation
and is a medical emergency. Vfib results from uncoordinated contraction of the ventricles and
defibrillation acts as a 'reset' to synchronize contraction (i.e., a normal rhythm).
Ventricular tachycardia (vtach)
Tachycardia that originates from within the ventricles. Typically, "vtach" implies
monomorphology but it can be an umbrella term for both monomorphic and polymorphic (i.e.,
torsade de pointes). To classify a ventricular rhythm as vtach, at least 3 beats in a row must
originate from the ventricles and have a rate over 100. If it lasts longer than 30 seconds, it can
additionally be labelled as a sustained vtach.

Disorder 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. The
two main coronary arteries right coronary
Coronary arteries labeled in red text and other landmarks in
artery (RCA) and left coronary artery (LCA)
blue text.
branch off of the ascending aorta and the
left further branches into the left circumflex
artery (LCx) and left anterior descending artery (LAD). Combined, the RCA, LCx, and LAD comprise
the three main coronary arteries (e.g., "three vessel disease"). Lastly, the posterior descending artery
(PDA) is supplied by the RCA and/or LCx, and this connection determines the "dominance" of the heart
(e.g., if the RCA supplies the PDA then the heart is "right dominant").
Disorders of the coronary circulation can have devastating effects to the heart that results in a downward
spiral of worse circulation leading to worse heart function leading to worse circulation and so on.

Acute coronary syndrome (ACS)

ACS is a medical emergency and is a broad term encompassing many acute myocardial infarction
symptoms. As a syndrome, it consists of a constellation of symptoms and can have many causes.
The top three causes of ACS are ST elevation myocardial infarction (STEMI, 30%), non ST
elevation myocardial infarction (NSTEMI, 25%), or unstable angina (38%). The first two are
myocardial infarctions which are more commonly known as "heart attacks."
Angina pectoris
Angina pectoris literally means "chest pain" that refers to pain caused by ischemia of the heart.
The main cause of angina is coronary artery disease, but can result from other non-atherosclerotic
causes such as anemia and heart failure. Stable angina results if the angina resolves with rest or
nitroglycerin, but can progress to unstable angina which is a form of acute coronary syndrome.
Atherosclerosis
Atherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty
materials (e.g., cholesterol) and white blood cells ("foam cells"). Atherosclerosis of a coronary
artery leads to coronary artery disease (CAD). Atherosclerosis is a broad term referring to loss of
elasticity of arteries and more specific terms exist arteriosclerosis and arteriolosclerosis to
narrow which arteries are diseased and can easily be confused due to similar spelling. Overall,
atherosclerosis tends to affect the arteries of highest pressure: aorta, coronary, renal, femoral,
cerebral, and carotid.
Coronary artery disease (CAD)
Coronary artery disease is a general term for any reduction in coronary circulation. One such
cause is atherosclerosis. CAD can lead to ischemia (angina pectoris) or infarction (myocardial
infarction). Treatment of CAD includes angioplasty, stenting, and coronary artery bypass surgery
(CABG).
Myocardial infarction (a.k.a. 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 but can be caused by other insufficiency such as cardiogenic shock.
Restenosis
Recurrence of stenosis after being treated (e.g., stenting).

Cardiac arrest
Cardiac arrest refers to the cessation of
normal systemic circulation due to failure in
proper contraction of the heart. There are
several conditions that can cause cardiac
arrest. Treatment of cardiac arrest includes
cardiopulmonary resuscitation (CPR),
defibrillation, and advanced cardiac life
support (ACLS), and treatment of the
underlying cause of arrest.

A rhythm strip showing a couple beats of normal sinus

rhythm followed by an atrial beat and asystole ("flatline").

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. This flatline is commonly used in television and movies to signal death. There are
numerous causes of asystole that may be reversible if determined quickly enough, however,
survival is very unlikely (~2% if not in a hospital). In contrast, asystole is desired and induced
during cardiopulmonary bypass through a cardioplegia solution containing very high amounts of

potassium. One additional example is the use of high potassium in lethal injection that results in
asystole, cardiac arrest, and then death.
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) and results
in decreased cardiac output and insufficient oxygen delivery to the body.
Pulseless ventricular tachycardia
Pulseless ventricular tachycardia (VT) Is one classification of VT such that no pulse is felt
because of an ineffective cardiac output which causes cardiac arrest, which also results in
insufficient oxygen delivery to the body.
Sudden cardiac death (SCD)
Sudden cardiac death is a concept of natural death rather than a specific medical condition. There
are several causes of sudden cardiac death and it is distinct from cardiac arrest. The leading cause
of SCD in young athletes is hypertrophic cardiomyopathy but can also result from commotio
cordis that is often sustained during athletic activity.
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.

Disorders of the myocardium

The layer of the heart responsible for
mechanical function is the myocardium. The
myocardium is sandwiched between two
thin layers the epicardium &
endocardium and is composed of a
special type of muscle cell called
cardiomyocytes. Disorders of these cells
results in dysfunction of the structure and
function of the heart.
Cardiomyopathy
Cardiomyopathy is a deterioration of
the myocardium. Several
classifications have been used to
categorize cardiomyopathies with the
most common being primary vs.
secondary, and dilated vs. restrictive
vs. hypertrophic (presented below).

The diagram shows a healthy heart (left) and one suffering

from right ventricular hypertrophy (right).

Ischemic cardiomyopathy
Cardiomyopathy causing ischemia of the heart due to coronary artery disease.
Nonischemic cardiomyopathy
Cardiomyopathy caused by something other than ischemia.
Amyloid cardiomyopathy
Cardiomyopathy caused by amyloidosis.
Hypertrophic cardiomyopathy (HCM)

Cardiomyopathy caused by
hypertrophy of the heart and is
the leading cause of sudden
cardiac death in young adults.
Hypertrophic obstructive
cardiomyopathy (HOCM)
(Idiopathic hypertrophic
subaortic stenosis (IHSS))
Dilated cardiomyopathy (DCM)
Cardiomyopathy caused by
dilation of the heart, typically
caused by "drugs and bugs." It is
the most common form of nonischemic cardiomyopathy and the
dilitation of the heart results in
larger chamber volumes &
thinner myocardial walls, both of
which decrease the ability to
pump. Specific kinds of dilated
cardiomyopathy are listed below,
and other causes include Chagas
disease, chemotherapeutic agents
(e.g., doxorubicin), tuberculosis,
and pregnancy.

A man with congestive heart failure and marked

jugular venous distension. External jugular vein
marked by an arrow.

Alcoholic cardiomyopathy
A type of dilated cardiomyopathy caused by chronic abuse of alcohol and
results from direct toxicity of ethanol on the myocardium.
Tachycardia induced cardiomyopathy
A type of dilated cardiomyopathy caused by chronic tachycardia. A common
arrhythmia that can lead to this form of cardiomyopathy is the common atrial
fibrillation.
Takotsubo cardiomyopathy (Transient apical ballooning, stress-induced
cardiomyopathy)
A type of dilated cardiomyopathy caused by a sudden temporary weakening of
the myocardium, which can include emotional stress (i.e. broken-heart
syndrome). It presents as sudden heart failure with ECG changes similarly
found in myocardial infarction and typically is found in post-menopausal
women.
Arrhythmogenic right ventricular dysplasia (Arrhythmogenic right ventricular
cardiomyopathy)
Cardiomyopathy caused by a genetic mutation of the desmosomes that connect
myocytes.
Restrictive cardiomyopathy (RCM)
Cardiomyopathy caused by excessive rigidity of the heart that prevents effective
contraction and pumping. In comparison to DCM, RCM is often secondarily caused
by other diseases such as amyloidosis, scleroderma, hemachromatosis (iron overload)

and eosinophilic granulomatosis with polyangiitis. As such, the treatment for RCM is
to treat the disease causing the RCM.
Heart failure
Heart failure is failure of the heart to produce sufficient blood flow to meet metabolic demands of
the body, or to do so at higher filling pressures. The hallmark signs of heart failure include
shortness of breath (especially on exertion, at night, or while lying down) and leg swelling. Chest
pain is rarely a feature of heart failure, which would point a diagnosis more toward angina
pectoris or myocardial infarction. Perhaps confusingly, heart failure can be caused by coronary
artery disease (CAD) and myocardial infarction (MI) that result in a deficiency in pumping that
then leads to heart failure. Treatment of heart failure, like most secondary disorders, depends upon
treatment of the primary cause which includes CAD & MI but also valvular problems like aortic
stenosis and hypertension.
Cor pulmonale
Untreated cor pulmonale can cause right heart failure from chronic pulmonary hypertrophy.
Ventricular hypertrophy
Hypertrophy of the ventricle. Thickening of the myocardium (i.e., hypertrophy) can be
physiological (a normal response) or pathological. An example of physiological hypertrophy is the
result of significant athletic training (athletic heart syndrome).
Left ventricular hypertrophy (LVH)
Hypertrophy of the left ventricle is more common than in the right and typically due to
increased afterload on the heart such as from hypertension and aortic stenosis, but also from
long standing mitral valve regurgitation. It can be diagnosed by echocardiography or ECG.
Right ventricular hypertrophy (RVH)
Hypertrophy of the right ventricle and, it too, can be physiological from athletic training.
Other causes include pulmonary hypertension and COPD as well as several congenital heart
defects like ventricular septal defect, tetralogy of Fallot and hypoplastic left heart syndrome.
Heart cancer
Cancer of the heart is very rare and those cancers tend to be benign.
Myxoma
Most common tumor of the heart. It is a benign tumor most commonly found in the left
atrium and can be associated with Carney syndrome.
Myocardial rupture and ventricular aneurysm
Rupture is a gross structural failure of the heart. Commonly a result of myocardial infarction that
weakens the wall sufficiently to result in frank rupture and is typically seen 710 days after
infarction. If not significant enough, the wall can develop into a ventricular aneurysm.
Myocarditis
Infection and inflammation of the myocardium is myocarditis. Most causes are infectious
(parvovirus B19, Lyme disease, Chagas disease), toxic (ethanol, anthracyclines, clozipine), or
immunologic (systemic lupus erythematosus, sarcoidosis, and some of the vasculitidies (see
below)). Definitive diagnosis requires a biopsy.
Uhl anomaly
A congenital heart defect in which the right ventricular myocardium is too thin or absent. It is a
very rare disorder.

Disorders of the pericardium

The pericardium is a double-walled sac fibrous pericardium
and serous pericardium that contains the heart. The serous
pericardium like other similar structures (e.g., pulmonary
pleurae, synovium, bursae) contains a thin layer of fluid that
reduces friction from movement. The fibrous pericardium fixes
the heart in the mediastinum.
Pericarditis
Inflammation of the pericardium that is typically
idiopathic or infectious in nature. Treatment of viral &
idiopathic pericarditis is NSAIDs or aspirin.
Constrictive pericarditis
Pericarditis that constricts the expansion of the heart
and inhibits heart function. Causes include
infections (tuberculosis, fungus, parasites) and
surgery. Definitive surgery is a pericardiectomy.

Posterior wall of the pericardial sac.

Dressler syndrome
A form of pericarditis that develops 2-3 weeks after myocardial infarction and is
accompanied by fever, pleuritic chest pain, and symptoms of pericarditis.
Pericardial effusion
The serous pericardium normally contains fluid that reduces friction, but an abnormal
accumulation of fluid in the pericardium is called a pericardial effusion. The list of causes is
lengthy but includes pericarditis, rheumatic diseases (e.g., systemic lupus erythematosus), trauma,
and blood from myocardial rupture. If an effusion worsens then the fluid can inhibit heart function
and symptoms of cardiac tamponade appear. Treatment includes pericardiocentesis to drain the
fluid, if necessary, and treatment of the underlying cause.
Pericardial tamponade
Tamponade is a medical emergency resulting from accumulation of fluid in the pericardium that
inhibits heart function. Tamponade is a consequence of the fibrous pericardium being too inelastic
to permit adequate heart expansion during diastole. The classic finding is pulsus paradoxus as well
as Beck's triad (low arterial blood pressure, distended neck veins, & soft heart sounds). Treatment
is supportive until in a hospital where pericardiocentesis or a pericardial window can be
performed to drain the fluid.

Disorders of the heart valves

The heart contains four valves that direct the flow of blood in a single direction. Venous/deoxygenated
blood returns to the heart through the tricuspid valve (TV) and pulmonary valve (PV); and
arterial/oxygenated blood leaves the heart through the mitral valve (MV) and aortic valve (AV). Valves
function to move blood in one direction only and failure to prevent back-flow is called regurgitation or
insufficiency; and failure to easily move blood in the forward direction is through narrowing of the valve
called stenosis. There are eight combinations of the four valves and two disorders.
Specific valvular problems

Specific problems of each valve.

Aortic valve
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. Stenosis
commonly occurs from
calcification of the valve, which
happens prematurely in those
with a bicuspid aortic valve.
Stenosis of the aortic valve
produces a harsh systolic murmur
that classically radiates in the
carotid arteries as well as pulsus
parvus et tardus.
Aortic valve replacement
Replacement of the aortic valve
due to aortic regurgitation, aortic
stenosis, or other reasons. A
special kind of replacement called
percutaneous aortic valve
replacement is done through
catheters are does not require
open-heart surgery.
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.

Heart schematic showing the four valves

3D reconstruction of the heart as viewed from the

apex towards the valves, image flipped 180
relative to illustration above. Pulmonary valve not
visible, 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).

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. Regurgitation produces a systolic murmur that radiates into the axilla.
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.
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 stenosis
Narrowing 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.
Tricuspid stenosis
Narrowing of the tricuspid valve opening that reduces blood flow through the valve.
Ebstein's anomaly
A congenital heart defect that results in the tricuspid valve leaflets being deeper in the
heart (toward the apex) than normal. The annulus of the valve is in the correct
position, however, and the portion of the ventricle affected becomes "atrialized" with
thinner walls. The right atrium becomes hypertrophied and can result in conduction
defects (e.g., WolffParkinsonWhite syndrome).
Tricuspid atresia
A congenital heart defect that results in the absence of the tricuspid valve
Endocarditis
The thin, inner lining of the heart is the endocardium and inflammation of this layer is called
endocarditis. Endocarditis commonly affects the heart valves.
Infective endocarditis
Commonly affects the valves due to absence of blood supply to the heart valve, which
results in a decreased immune response to the valve leaflets. Typically, bacteria cause
infective endocarditis of the mitral valve, but intravenous drug users (e.g., heroin,
methamphetamine) have an increased risk of infection of the tricuspid valve. Common signs

include Janeway lesions (non-tender), Osler's nodes (tender), and splinter hemorrage of the
nails.
Nonbacterial thrombotic endocarditis (NBTE)
Growths on the valves that are not from an infectious source and are composed of fibrin and
platelets, and is associated with a history of rheumatic fever. The aortic valve is the most
common valve affected (followed by mitral, tricuspid, & then pulmonary).
LibmanSacks endocarditis
A form of nonbacterial endocarditis specific to systemic lupus erythematosus (SLE) and
tends to affect the mitral valve (unlike NBTE which affects the aortic valve). It is the
second most common heart finding in SLE after pericarditis.

Congenital heart defect

Congenital heart defects (CHD) are defects
in the structure of the heart which are
present at birth and are often the result of
aberrant embryological development.
Defects can be syndromic or non-syndromic,
with the later meaning defects that are
isolated and not found in patterns (i.e., a
syndrome). The top two syndromic causes of
CHD are Noonan syndrome and Down
syndrome. Down syndrome is more common
than Noonan syndrome, but has a lower
incidence of CHD, which makes Noonan
syndrome the most common syndromic
cause of CHD.
Atrial septal defect with left-to-right shunt.
CHD should make one consider the
VACTERL association, namely ASD, VSD,
& ToF, and other syndromes like Noonan, Down, and DiGeorge syndromes.

Listed below include congenital defects that do not affect the heart (e.g., CoA, PDA), but are included
anyway because they affect the cardiovascular system.
Atrial septal defect (ASD)
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. This leads to aortic
stenosis as the valve prematurely calcifies (as compared to calcification of a trileflet valve).
Coarctation of the aorta (CoA)
Narrowing of the aorta, typically of the aortic arch and is classically found in Turner syndrome. A
"complete" coarction is called an interrupted aortic arch.
Cor triatriatum
A membrane that divides one of the atria results in "three" atria (hence "triatriatum"). This tends
to affect the left atrium more than the right atrium. The membrane may be present without

complete division of the atrium. It presents similarly to stenosis of the respective semilunar valve
(i.e., tricuspid stenosis for right atrium).
Dextrocardia
Dextrocardia is a condition in which the apex of the heart is on the right side of the body, instead
of the left. This can exist in isolation or as a part of situs inversus in which the entire body is
mirrored not just the heart. Situs inversus can be a part of primary ciliary dyskinesia (aka
Kartagener syndrome) that has recurrent respiratory infections and male infertility. A simple chest
xray is sufficient to diagnose dextrocardia, provided care is taken in marking the correct side of
the radiograph.
Ebstein's anomaly
Malformation of the tricuspid valve (see above).
Great artery defects
There are several conditions that affect the great arteries (e.g., double aortic arch, aberrant
subclavian artery) that often result in problems with the trachea and breathing.
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.
Pulmonary valve stenosis (PVS)
Narrowing of the pulmonary valve that is the key finding in Noonan syndrome.
Tetralogy of Fallot (ToF)
Set of four anatomical abnormalities: pulmonary stenosis, overriding aorta, ventricular septal
defect, and right ventricular hypertrophy.
Transposition of the great vessels (TGV)
Abnormal spatial arrangement of the great vessels (superior vena cava, inferior vena cava,
pulmonary arteries, pulmonary veins, and aorta).
Uhl anomaly
Partial or total loss of the right ventricular wall.
Ventricular septal defect (VSD)
Defect in the ventricular septum that permits blood flow between ventricles.

Diseases of blood vessels

Diseases of the blood vessels can be multidisciplinary in nature. For example, medical treatment of
atherosclerosis tends to be managed by cardiologists while vascular surgery repairs aneurysms and
stenotic arteries.
Atherosclerosis
Thickening of an arterial wall due to increased cholesterol and macrophages (see above).
Aneurysm
Balloon-like bulging of arteries (also possible of the heart: see ventricular aneurysm above).
Aortic aneurysm
Aneurysm of the aorta, typically of the abdominal aorta (abdominal aortic aneurysm or
AAA). They are associated with a smoking history and in connective tissue diseases (e.g.,

Marfan syndrome, EhlersDanlos syndrome). Current

USPSTF recommendations are
for a single abdominal
ultrasound screening for a AAA
in anyone 65 or older who has
smoked. Surgical repair of a
AAA is advised after it is larger
than 5.0-5.5 cm because of
concern for rupture that leads to
death from internal bleeding.
Cerebral aneurysm
Aneurysms of the arteries in the
brain most commonly affect the
anterior cerebral artery. Rupture
of the aneurysm results in a
subarachnoid hemorrhage and a
very severe headache.
Aortic dissection
Dissection along the length of the
aorta between the layers of the aortic
The progression of atherosclerosis (size exaggerated).
wall. Dissection of the ascending aorta
(type A) is a surgical emergency while
dissection of the descending aorta
(type B) can possibly be managed medically. Dissection of the ascending aorta is an emergency
because dissection may interrupt coronary blood flow and blood flow to the brain, neither of
which tolerate ischemia particularly well.
Aortic rupture
Frank rupture of the aorta is often fatal from internal bleeding. Rupture of the aorta can occur at
the sites of aneurysm, but is also due to trauma and results in a traumatic aortic rupture.
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) and pulmonary embolism (PE)
Formation of a thrombus in a deep vein, commonly in the legs that may break loose, travel to the
lungs, and occlude blood flow (pulmonary embolism) sufficient to interrupt oxygenation to the
body.
Traveller's thrombosis / economy class syndrome
A DVT due to being sedentary during air travel.
Microangiopathy

Disease of capillaries in which the walls become thick and weak, and result in bleeding and
decreased blood flow. One very common cause is diabetes mellitus in which microangiopathy
results in diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy.
Varicose veins
Veins that have become enlarged and tortuous with failed valves, commonly in the legs. Vericose
veins have cosmetic concerns, but they may become painful. Surgery and sclerotherapy are two
options for treating varicose veins.
Vasculitis
Inflammation of blood vessels (veins & arteries) with a long list of causes.
Aortitis
Inflammation of the aorta that can be seen in giant cell arteritis, polymyalgia rheumatica,
rheumatoid arthritis, syphilis and Takayasu's arteritis.
Behet's disease
Affects small-sized vessels that often initially presents with oral aphthous ulcers, genital
ulcers and uveitis, and can be fatal from ruptured aneurysms. Pericarditis is commonly seen
with Behet's.
Eosinophilic granulomatosis with polyangiitis (EGPA; aka Churg-Strauss syndrome)
Affects small- & medium-sized vessels that often affects lungs, kidneys, & heart in those
with a history of airway allergic hypersensitivity and p-ANCA antibodies.
Giant-cell arteritis (GCA) / Temporal arteritis
Affects medium- & large-sized vessels of the head, typically branches of the external
carotid artery and namely the temporal artery. Occlusion of the ophthalmic artery results in
blindness. Suspicion of GCA necessitates immediate treatment with glucocorticoids and
temporal artery biopsy.
Granulomatosis with polyangiitis (GPA; aka Wegener's granulomatosis)
Affects small- & medium-sized vessels that often affects the lung & kidneys (RPGN) with
classic saddle nose and c-ANCA antibodies.
IgA vasculitis (IgAV; aka Henoch-Schnlein purpura)
Affects small-sized vessels and produces palpable purpura and proteinuria from
immunocomplex (IgA) deposition.
Kawasaki disease
Affects medium-sized vessels mostly seen in young children with myocarditis, &
pericarditis, and is the most common cause of acquired heart disease in children (results in
coronary artery aneurysms). Myocardial infarction from coronary thrombosis is the most
common cause of death from Kawasaki disease.
Thromboangiitis obliterans
Affects small- & medium-sized vessels that is strongly associated with tobacco products.
Pain, diminished pulses, gangrene and eventual amputation of affected hands and feet.

Procedures to counter coronary artery disease

Coronary artery disease is not currently reversible and eventually requires surgical management if it
progresses.
Coronary artery bypass surgery (CABG)
Grafting an artery or vein from elsewhere to bypass a stenotic coronary artery. Performed by
cardiothoracic surgeons, a sternotomy is performed to open the chest and then grafts are
performed. Cardiopulmonary bypass may be necessary. The internal mammary artery or

saphenous vein can be used as grafts. The grafts are

used to provide an alternate path for blood flow
around a stenosis.
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. Angioplasty in this
manner is PTCA (described below) but may also
involve the insertion of stents to keep vessels open.
An example of a drug-eluting stent. This is
Percutaneous Transluminal Coronary Angioplasty
(PTCA)
the TAXUS Express2 Paclitaxel-Eluting
Insertion of a catheter through the skin
Coronary Stent System, which releases
("percutaneous") into a blood vessel ("transluminal")
paclitaxel.
to enlarging the lumen of a coronary artery by
forcibly expanding it with a balloon ("angioplasty"),
hence the name. It is a form of PCI and generally what is implied when referring to "PCI."
Atherectomy
Enlarging the lumen of an artery by removal of atherosclerotic plaque by means of catheterization.
This is in contrast to angioplasty that does not remove the plaque but merely pushes it out of the
way to increase the lumen size. This method is primarily used in peripheral disease, but has been
used for coronary disease as well.
Endarterectomy
Enlarging the lumen of an artery by removal of atherosclerotic plaque by means of open surgery.
This is primarily done on the carotid arteries (Carotid endarterectomy or CEA) but was first
performed on the superficial femoral artery. While not performed on coronary arteries, it is
mentioned here for completeness.
Stenting
Enlarging the lumen of an artery by forcibly expanding it with a metal wire tube by means of
catheterization. Typically, the artery is expanded first through angioplasty (see PTCA above).

Devices used in cardiology

Stethoscope
Acoustic device for hearing internal sounds including
heart sounds. The stethoscope is the quintessential medical
icon, regardless of specialty. Modern stethoscopes can
have a diaphragm and a bell, and be sized for adults or
children. In cardiology, it is primarily used to listen to
heart sounds it can also be used to listen for bruits (carotid
& renal for renal artery stenosis), bowel sounds, and lung
sounds. Electronic stethoscopes can amplify and record
sounds.
EKG calipers
A type of divider caliper that can be used to measure
intervals and compare intervals on EKGs. Special rulers
can be used to measure the intervals as well.

A stethoscope.

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. As the name implies, a
defibrillator is used to stop fibrillation of the heart. It can be used to cardiovert atrial
fibrillation if certain conditions are met, but is mainly used to cardiovert ventricular
fibrillation which is life-threatening. Contrary to popular media's use, a defibrillator cannot
and should not be used for asystole (a "flatline") as it has been shown to be ineffective in
restoring a rhythm. If a person is in a rhythm not convertible by a defibrillator, then
cardiopulmonary resuscitation (CPR) or more advanced care should be started.
Automated external defibrillator (AED)
An external defibrillator that is commonly found outside of health care settings and is
often designed for anyone to use through verbal instructions. AED's have increased in
popularity and dispersal so that people with cardiac arrest in public can be
cardioverted to a safer rhythm before help can arrive.
Implantable cardioverter-defibrillator (ICD)
An implanted device to prevent life-threatening conditions (e.g., ventricular
tachycardia, ventricular fibrillation) in people predisposed to these rhythms.
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. Commonly used in
cardiothoracic surgery when the heart is being operated on for such surgeries like open
valve replacement or CABG on the posterior side of the heart. The bypass machine is
responsible for oxygenation of blood, removal of carbon dioxide, heating the blood (heat is
lost from being outside the body) to maintain core body temperature or cooling blood for
controlled hypothermia, and providing volatile anesthetics (e.g., isoflurane) if the lungs are
not ventilated during bypass (the movement can be problematic while performing surgery).
A cardioplegic solution is used to stop the heart from beating and combination with
hypothermia reduces oxygen demand of the heart significantly (>97%) such that surgery is
possible without causing damage.
Intra-aortic balloon pump (IABP)
A balloon placed in the thoracic aorta to supplement cardiac output from the heart. It
pulsates opposite to the heart such that it inflates during diastole and relaxes during systole.
Deflation during systole decreases afterload (vacuum effect), thus decreasing myocardial
oxygen demand, and inflates during diastole to increase diastolic pressure which increases
coronary artery perfusion of the endocardium (the heart perfuses itself during diastole, not
systole).
Ventricular assist device (VAD)
Internal pump to supplement or replace the pumping action of a ventricle. Can be referred to
RVAD or LVAD depending on if it's attached to the right or left ventricle.

Diagnostic tests and procedures

Various cardiology diagnostic tests and procedures.
Blood tests
Cholesterol
Current prevailing hypothesis is that LDL
cholesterol is "bad" and HDL cholesterol is "good."
Creatine kinase
When skeletal muscle injury is absent, CK-MB is
fairly specific to myocardium injury.
Troponin
The troponin complex is present in skeletal and
cardiac muscle, but cardiac-specific forms of
troponin I and troponin T are used as sensitive &
specific indicators of heart damage if acute coronary
Cardiologists use diagrams like this: a
syndrome is suspected. The presence of troponins
heart with an ECG indicator
are not exclusive to myocardial infarction, and so
other conditions should be considered (e.g., heart
failure, cardiomyopathies, trauma, defibrillation,
cardioversion, ASD closure, radiofrequency ablation, toxicity from chemotherapy, snake
venom, cyanide poisoning, ascending aortic dissection, stroke, seizure).
Echocardiography ("echo")
Ultrasonography of the heart to inspect chambers, valves, and blood flow. Often utilizes the
Doppler effect to determine blood flow through valves (stenosis & regurgitation) and through the
septum (ASD & VSD). Agitated saline can be used as contrast for blood flow and microbubbles
for capillary blood flow contrast.
Transthoracic echocardiogram (TTE)
Echocardiogram of the heart through the thorax external to the body. Much easier to
perform than TEE because it is non-invasive and takes less time, but has several
disadvantages (namely clarity of images).
Transesophageal echocardiogram (TEE)
Echocardiogram of the heart through the esophagus. TEE can require sedation or general
anesthesia and the patient must be NPO.
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.
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
the heart.
Intravascular ultrasound (IVUS)
Ultrasonography of a coronary artery.
Optical coherence tomography (OCT)
Testing through the use of optical scattering for coronary artery disease.

Drugs
There are several classes of pharmaceutical drugs used in cardiology to manage various diseases and a
lot of drugs have cardiovascular side effects.

Drugs for the cardiovascular system

Drugs that manipulate the cardiovascular system do so through several ways. The first is ion channels,
which are often manipulated to manage arrhythmias. The second is receptors of various types. The third
is manipulation of enzymes.
Ion channels
Ion channels are responsible for cell membrane voltage, depolarization, and repolarization. These
actions lead to conduction of signals down nerves and contraction of cardiomyocytes. Perhaps the most
prominent manipulation of ion channels is through antiarrhythmic agents. These agents are commonly
classified by the type of ion they manipulate and named the Vaughan Williams classification:
Class I Sodium channel blockers
Class Ia Fast sodium channels (quinidine, ajmaline, procainamide, disopyramide)
Class Ib Sodium channels (lidocaine, phenytoin, mexiletine, tocainide)
Class Ic Decrease conductivity (encainide, flecainide, propafenone, moricizine)
Class II Beta blockers (carvedilol, propranolol, esmolol, timolol, metoprolol, atenolol,
bisoprolol)
Class III Potassium channel blockers (amiodarone, sotalol, ibutilide, dofetilide, dronedarone)
Class IV Calcium channel blockers (verapamil, diltiazem)
Class V Other (adenosine, digoxin, magnesium Sulfate)
Specifically, types I, III, & IV manipulate ion channels while the others are not.

Receptors
The adrenergic receptor is a set of receptors that are commonly manipulated. Four properties of the heart
chronotropy, dromotropy, inotropy, & lusitropy are manipulated by adrenergic receptors. For
example, the 1 receptor increases all four of these properties: chrontropy at the SA node, dromotropy
through the AV node, inotropy of the cardiomyocytes through increased calcium, and lusitropy through
phosphorylation of phospholamban. Catecholamines are a set of drugs and hormones that manipulate the
adrenergic receptors. The natural catecholamines are norepinephrine, epinephrine, and dopamine. There
are numerous other drugs (e.g., dobutamine, ephedrine, isoproterenol) that manipulate the adrenergic
receptors and have variable specificity for the receptors and are, thus, used for various reasons.
Angiotensin II receptor antagonists (ARBs) block the angiotensin II receptors that are linked to
hypertension and heart failure, mainly through vasodilation & heart remodeling inhibition.
Enzymes
ACE inhibitors works upstream from angiotensin II receptor antagonists and have similar effects on
management of hypertension and heart failure.
Sodium nitroprusside and nitroglycerin function by causing vasodilation through nitric oxide, which
manipulates cGMP levels through guanylate cyclase.
COX inhibitors (namely aspirin), warfarin, direct Xa inhibitors, direct thrombin inhibitors, heparin, lowmolecular weight heparins, antibodies (e.g., abciximab), and a few others are used for anticoagulation
therapy. This is important in those predisposed to blood clots (e.g., Factor V Leiden) but also for
thrombus formation when an atherosclerotic plaque rupture that would, otherwise, lead to myocardial
infarction.

Drugs with cardiovascular side effects

Numerous drug classes have well-known cardiovascular side effects.
Anesthetics
As a general rule, all agents used in anesthesia have depressant effects on the cardiovascular
system with notable exception of ketamine.
Chemotherapy
Doxorubicin is one agent known to have heart toxicity (leads to dilated cardiomyopathy).
Diuretics
The primary effect of diuretics is removal of intravascular volume, which then has secondary
benefits to the cardiovascular system in diseases like heart failure.
Lithium
Teratogenic effect of causing Ebstein's anomaly in mothers taking lithium.
Opioids
Decreases blood pressure.

Selective serotonin reuptake inhibitors (SSRI)

Toxicity causes arrhythmias including sinus tachycardia, junctional rhythms, and trigeminy.
SSRI's also have interactions with anti-coagulation therapy and increases the risk of bleeding
while on them.
Serotoninnorepinephrine reuptake inhibitors (SNRI)
Due to manipulation of norepinephrine, SNRI's can cause hypertension and so hypertension
should be reduced before starting an SNRI.
Tricyclic antidepressants (TCAs)
TCAs behave like type Ia antiarrhythmics and could terminate ventricular fibrillation and decrease
contractility. They can also cause tachycardia and hypotension.

Cardiologists
Robert Atkins (19302003), known for the
Cardiologist
Atkins diet
Eugene Braunwald (born 1929), editor of
Occupation
Braunwald's Heart Disease and 1000+
Names
Doctor, Medical Specialist
publications
Occupation
Specialty
Wallace Brigden (1916-2008), identified
type
cardiomyopathy
Activity sectors Medicine
Willem Einthoven (18601927), a physiologist
who built the first practical ECG and won the
Description
1924 Nobel Prize in Physiology or Medicine
Education
("for the discovery of the mechanism of the
Doctor of Medicine
required
electrocardiogram")
(M.D.)
Werner Forssmann (19041979), who
Doctor of Osteopathic
infamously performed the first human
Medicine (D.O.)
catheterization on himself that led to him being
let go from Berliner Charit Hospital, quitting
cardiology as a speciality, and then winning the
1956 Nobel Prize in Physiology or Medicine ("for their discoveries concerning heart
catheterization and pathological changes in the circulatory system")
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 Joseph Llewellyn "Barney" Marriott (19172007), ECG interpretation and Practical
Electrocardiography
Jacqueline Noonan (born 1928), discoverer of Noonan syndrome that is the top syndromic cause
of congenital heart disease
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 Rhythm
International Journal of Cardiology
Journal of the American College of Cardiology
Pacing and Clinical Electrophysiology

Associations

American College of Cardiology

American Heart Association
Heart Rhythm Society
Indian Heart Association
National Heart Foundation of Australia

See also
Interventional cardiology
Clinical cardiac electrophysiology
List of cardiac pharmaceutical agents

Look up cardiology in
Wiktionary, the free
dictionary.

References
1. "Specialties & Subspecialties". American Osteopathic Association. Retrieved 23 September 2012.
2. http://www.theatlantic.com/health/archive/2015/01/physician-salaries/384846/
3. http://www.theatlantic.com/health/archive/2015/01/physician-salaries/384846/

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)
Education for Cardiology Disease Professionals (http://www.radcliffecardiology.com/)
Cardiology & other speciality (http://www.OmniMD.com/)
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