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Cardiology

From Wikipedia, the free encyclopedia

Cardiology (from Greek καρδίᾱ kardiā, "heart" and
-λογία -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

Simplified. the bulk of study in cardiology is in disorders of the heart and restoration. 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. 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. it is required that a three-year residency in pediatrics is followed by a three-year fellowship in pediatric cardiology. of function. To be a pediatric cardiologist in the United States.. ventricles.[3] The heart As the center focus of cardiology. ventricular fibrillation.[2] Pediatric cardiology Pediatric cardiology is a specialty of pediatrics. Per doximity. The action potentials generated in the pacemaker propagate throughout the heart in a specific pattern. The primary responsibility of the heart is to pump blood throughout the body. adult cardiologists make an average of $436.34% of all deaths in 2002. Each part of the heart is susceptible to failure or dysfunction and the heart can be divided into the mechanical and the electrical parts.g. the heart is a circuit of the Circulation..917 in the United States. heart sounds. afterload) that have been encyclopedically documented for many centuries.849 in the United States. and where possible. the heart has numerous anatomical features (e. atria. systole. Dysfunction of the electrical system manifests in many ways and may include Wolff–Parkinson –White syndrome. .Osteopathic Specialists (AOABOS) include:[1] ◾ Clinical cardiac electrophysiology ◾ Interventional cardiology Per doximity. The study of the electrical aspects is a sub-field of electrophysiology called cardiac electrophysiology and is epitomized with the electrocardiogram (ECG/EKG). While plenty is known about the healthy heart. 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. pediatric cardiologists make an average of $303. The heart is a muscle that squeezes blood and functions like a pump. The system that carries this potential is called the electrical conduction system. heart valves) and numerous physiological features (e.g. This means that the heart is connected to and affects the entirety of the body. and heart block.

heart murmurs. 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. renal Edema of the lower extremities and ascites that may indicate right heart failure Heart sounds. pericardial window. implantable loop recorder. popliteal. ICD. Osler's nodes. carotid endarterectomy. vagus nerve stimulation ◾ Vasculitis rashes ◾ Xanthomas & xanthelasmas Vital signs ◾ Blood pressure: hypertension. temporal. Failure to move sufficient blood can result in failure in other organs and may result in death if severe. ulnar ◾ Heart rate ◾ Pulse quality: pulsus paradoxus. ◾ ◾ ◾ ◾ ◾ ◾ ◾ ◾ ◾ ◾ ◾ Apex beat (point of maximum impulse) Bruits: carotid. should guide the physical exam but the following are pertinent things related to a general / broad cardiac exam. posterior tibial. pericardial rub. radial. thyroidectomy. vasculitis) Skin exam ◾ Diabetic neuropathy ◾ Endocarditis signs: Janeway lesions. dorsalis pedis.The mechanical part of the heart is centered on the fluidic movement of blood and the functionality of the heart as a pump. Clinical judgment. which means insufficient blood is being circulated. of course. Heart failure is one condition in which the mechanical properties of the heart have failed or are failing. scleroderma. thoracotomy. congenital heart disease manifestations ◾ Heart rate: bradycardia & tachycardia ◾ Respiratory rate: in distress. ◾ Skin bulges indicating implanted devices: pacemaker. The mechanical part is ultimately the purpose of the heart and many of the disorders of the heart disrupt the ability to move blood. splinter hemorrhages ◾ Peripheral vascular disease ◾ Scars indicating procedures: sternotomy. Physical exam The cardiac physical exam focuses on portions of the physical exam that elucidate information about diseases and disorders outlined below. etc. femoral. dermatomyositis. shortness of breath causes . 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.

but there is overlap and a single entity may appear in multiple areas. Management is through medications and blood pressure that does not respond is a red flag that it may be secondary hypertension. Secondary hypertension Most causes of secondary hypertension are from kidney and endocrine disorders. The following attempts to categorize the lengthy list of disorders & diseases of the cardiovascular system. cardiologists will end up managing or recommending treatments for essential hypertension. and aortic stenosis. 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. Collectively. which is about 90-95% of people with hypertension. atherosclerosis. Types of hypertension Diagram illustrating the main complications of persistent high blood pressure Essential hypertension Hypertension with no known cause. the two together is termed the cardiovascular system and diseases of one part tends to affect the other part. Cardiovascular causes of hypertension include coarctation of aorta. Many disorders involve the heart itself but some are outside of the heart and in the vascular system. particularly left ventricular hypertrophy. Complications of hypertension Hypertrophic cardiomyopathy Increased pressure results in hypertrophy of the myocardium. Reduction of morbidity from hypertension is the end-goal of therapy. Often thought to be due to lifestyle. Hypertensive crisis . Due to the widespread nature of hypertension.Disorders Cardiology is concerned with the normal functionality of the heart and the deviation from a healthy heart." 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. Pulmonary hypertension — which is separate from "hypertension" described above — can result in right ventricular hypertrophy. The normal blood pressure changes with age with a general trend that it increases with age. Hypertension Hypertension is elevated blood pressure above "normal.

but if there is (e. the only definitive treatment is delivery of the fetus. It can be an inherited disorder or be acquired. If the ventricular rate exceeds 100 then the afib is further classified as "afib with RVR" meaning rapid ventricular response.g. Premature ventricular contractions (PVCs) Normal beats are conducted through the AV node to the ventricles resulting in a narrow QRS complex. like PVCs. Hypertensive encephalopathy. Pre-eclampsia (PreE) / Eclampsia PreE is a disease of pregnancy that results in hypertension and proteinuria. Currently. 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. confusion. Blockage of the signal at different areas results in different types of heart block (e. Specifically. Heart block A decrease in the ability of the conduction system to transmit action pulses in the orderly manner. hypertensive nephropathy. Hemorrhagic stroke Infarction of the brain due to internal bleeding from Charcot–Bouchard aneurysms..Generally considered to be a systolic blood pressure over 180. it can lead to torsades de pointes than can then lead to ventricular fibrillation. Cardiac arrhythmias have numerous causes and have varying outcomes and complications. the extra beat originates within the ventricles and results in a wide QRS . symptomatic PACs can be treated with beta blockers. can pair up with normal beats in a pattern called bigeminy. 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. PreE has negative consequences for both the mother and fetus/baby. Premature atrial contractions (PACs or APCs) Normal beats originate in the SA node and extra beats originating from the atria are called PACs.g. It often degenerates to atrial fibrillation. They can be found in normal hearts and be asymptomatic. left bundle branch block). With PVCs. If there is no organ dysfunction it is called a hypertensive urgency. but this practice is debated.. first-degree AV block. PACs. Atrial flutter (AFL) A re-entrant tachycardia greater than 240 beats per minute and produces a characteristic saw-tooth pattern on ECG. 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. hypertensive retinopathy Damage to organs from chronic hypertension. Progression to eclampsia involves seizures. Long QT syndrome Lengthening of the QT interval can result in arrhythmias and sudden cardiac death. breathlessness) then it is called hypertensive emergency.

e.g. The coronary circulation consists of coronary arteries and coronary veins. the RCA. they can be found in healthy hearts but are more likely to be found in bigeminy than PACs.g. 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. Like PACs. This circulation of blood is called the coronary circulation. Torsades de pointes A polymorphic arrhythmia that can be syptomatic and tends to resolve to a normal sinus rhythm. "vtach" implies monomorphology but it can be an umbrella term for both monomorphic and polymorphic (i. If it lasts longer than 30 seconds. "three vessel disease"). and this connection determines the "dominance" of the heart (e. it can additionally be labelled as a sustained vtach. Supraventricular tachycardia (SVT) A collection of tachycardia rhythms that originate before the ventricles and include the SA node. at least 3 beats in a row must originate from the ventricles and have a rate over 100. if the RCA supplies the PDA then the heart is "right dominant"). However. — branch off of the ascending aorta and the left further branches into the left circumflex artery (LCx) and left anterior descending artery (LAD). 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.. afib with RVR) and others. Typically. encomparsing term that includes other rhythms in this list (e. 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. and AV node. Combined. . Disorder of the coronary circulation Contrary to a basic understanding of the cardiovascular system.. and LAD comprise the three main coronary arteries (e. LCx. Ventricular tachycardia (vtach) Tachycardia that originates from within the ventricles. To classify a ventricular rhythm as vtach. Lastly. 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. the posterior descending artery (PDA) is supplied by the RCA and/or LCx.complex. Unlike the systemic organs the heart receives perfusion in the phase of diastole rather than systole. a normal rhythm).g. Sick sinus syndrome.. torsade de pointes). 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. atria.e.. Vfib results from uncoordinated contraction of the ventricles and defibrillation acts as a 'reset' to synchronize contraction (i. It is a broad..

cholesterol) and white blood cells ("foam cells"). Atherosclerosis of a coronary artery leads to coronary artery disease (CAD).. and carotid.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. 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. There are several conditions that can cause cardiac arrest. Atherosclerosis Atherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty materials (e." Angina pectoris Angina pectoris literally means "chest pain" that refers to pain caused by ischemia of the heart.k..g. defibrillation. but can result from other non-atherosclerotic causes such as anemia and heart failure. The first two are myocardial infarctions which are more commonly known as "heart attacks. non ST elevation myocardial infarction (NSTEMI. One such cause is atherosclerosis. A rhythm strip showing a couple beats of normal sinus rhythm followed by an atrial beat and asystole ("flatline"). and coronary artery bypass surgery (CABG). it consists of a constellation of symptoms and can have many causes. renal. however. but can progress to unstable angina which is a form of acute coronary syndrome. femoral. 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. Stable angina results if the angina resolves with rest or nitroglycerin. The top three causes of ACS are ST elevation myocardial infarction (STEMI. As a syndrome. coronary. Coronary artery disease (CAD) Coronary artery disease is a general term for any reduction in coronary circulation. and advanced cardiac life support (ACLS). Treatment of cardiac arrest includes cardiopulmonary resuscitation (CPR). Restenosis Recurrence of stenosis after being treated (e.g. and treatment of the underlying cause of arrest. cerebral. 25%). stenting). asystole is desired and induced during cardiopulmonary bypass through a cardioplegia solution containing very high amounts of . The main cause of angina is coronary artery disease. atherosclerosis tends to affect the arteries of highest pressure: aorta. stenting. CAD can lead to ischemia (angina pectoris) or infarction (myocardial infarction). There are numerous causes of asystole that may be reversible if determined quickly enough. Cardiac arrest Cardiac arrest refers to the cessation of normal systemic circulation due to failure in proper contraction of the heart. or unstable angina (38%). This flatline is commonly used in television and movies to signal death. Treatment of CAD includes angioplasty. Myocardial infarction (a.Acute coronary syndrome (ACS) ACS is a medical emergency and is a broad term encompassing many acute myocardial infarction symptoms. 30%). survival is very unlikely (~2% if not in a hospital). Overall. In contrast.

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. Ischemic cardiomyopathy Cardiomyopathy causing ischemia of the heart due to coronary artery disease. Nonischemic cardiomyopathy Cardiomyopathy caused by something other than ischemia. There are several causes of sudden cardiac death and it is distinct from cardiac arrest. The myocardium is sandwiched between two thin layers — the epicardium & endocardium — and is composed of a special type of muscle cell called cardiomyocytes. Rhythmic contraction is necessary for efficient movement of blood. cardiac arrest. Sudden cardiac death (SCD) Sudden cardiac death is a concept of natural death rather than a specific medical condition. restrictive vs. Disorders of these cells results in dysfunction of the structure and function of the heart. secondary. and then death. 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. The diagram shows a healthy heart (left) and one suffering from right ventricular hypertrophy (right).potassium. Amyloid cardiomyopathy Cardiomyopathy caused by amyloidosis. Cardiomyopathy Cardiomyopathy is a deterioration of the myocardium. 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. One additional example is the use of high potassium in lethal injection that results in asystole. which also results in insufficient oxygen delivery to the body. 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. Hypertrophic cardiomyopathy (HCM) . and dilated vs. Pulseless electrical activity (PEA) Pulseless electrical activity is when the electrocardiogram shows a rhythm that should produce a pulse but it does not. hypertrophic (presented below). Several classifications have been used to categorize cardiomyopathies with the most common being primary vs.

" It is the most common form of nonischemic cardiomyopathy and the dilitation of the heart results in larger chamber volumes & thinner myocardial walls. and pregnancy. It presents as sudden heart failure with ECG changes similarly found in myocardial infarction and typically is found in post-menopausal women.e. Restrictive cardiomyopathy (RCM) Cardiomyopathy caused by excessive rigidity of the heart that prevents effective contraction and pumping. External jugular vein marked by an arrow. Specific kinds of dilated cardiomyopathy are listed below. A man with congestive heart failure and marked jugular venous distension.Cardiomyopathy caused by hypertrophy of the heart and is the leading cause of sudden cardiac death in young adults. tuberculosis. scleroderma. both of which decrease the ability to pump. hemachromatosis (iron overload) .g. In comparison to DCM. broken-heart syndrome). typically caused by "drugs and bugs. Arrhythmogenic right ventricular dysplasia (Arrhythmogenic right ventricular cardiomyopathy) Cardiomyopathy caused by a genetic mutation of the desmosomes that connect myocytes. chemotherapeutic agents (e. Takotsubo cardiomyopathy (Transient apical ballooning. Alcoholic cardiomyopathy A type of dilated cardiomyopathy caused by chronic abuse of alcohol and results from direct toxicity of ethanol on the myocardium. doxorubicin). and other causes include Chagas disease. Hypertrophic obstructive cardiomyopathy (HOCM) (Idiopathic hypertrophic subaortic stenosis (IHSS)) Dilated cardiomyopathy (DCM) Cardiomyopathy caused by dilation of the heart.. which can include emotional stress (i. RCM is often secondarily caused by other diseases such as amyloidosis. stress-induced cardiomyopathy) A type of dilated cardiomyopathy caused by a sudden temporary weakening of the myocardium. A common arrhythmia that can lead to this form of cardiomyopathy is the common atrial fibrillation. Tachycardia induced cardiomyopathy A type of dilated cardiomyopathy caused by chronic tachycardia.

Myxoma Most common tumor of the heart. Definitive diagnosis requires a biopsy. clozipine). Chagas disease). which would point a diagnosis more toward angina pectoris or myocardial infarction. An example of physiological hypertrophy is the result of significant athletic training (athletic heart syndrome). Cor pulmonale Untreated cor pulmonale can cause right heart failure from chronic pulmonary hypertrophy. Ventricular hypertrophy Hypertrophy of the ventricle. the treatment for RCM is to treat the disease causing the RCM. like most secondary disorders. depends upon treatment of the primary cause which includes CAD & MI but also valvular problems like aortic stenosis and hypertension. Myocarditis Infection and inflammation of the myocardium is myocarditis. or immunologic (systemic lupus erythematosus. 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. and some of the vasculitidies (see below)). sarcoidosis. but also from long standing mitral valve regurgitation. It is a benign tumor most commonly found in the left atrium and can be associated with Carney syndrome. Perhaps confusingly. It can be diagnosed by echocardiography or ECG. Myocardial rupture and ventricular aneurysm Rupture is a gross structural failure of the heart. it too. Thickening of the myocardium (i. Treatment of heart failure. Commonly a result of myocardial infarction that weakens the wall sufficiently to result in frank rupture and is typically seen 7–10 days after infarction. toxic (ethanol. Uhl anomaly A congenital heart defect in which the right ventricular myocardium is too thin or absent.e. 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.. Other causes include pulmonary hypertension and COPD as well as several congenital heart defects like ventricular septal defect.and eosinophilic granulomatosis with polyangiitis. Chest pain is rarely a feature of heart failure. the wall can develop into a ventricular aneurysm. or while lying down) and leg swelling. Heart cancer Cancer of the heart is very rare and those cancers tend to be benign. It is a very rare disorder. or to do so at higher filling pressures. . tetralogy of Fallot and hypoplastic left heart syndrome. hypertrophy) can be physiological (a normal response) or pathological. As such. at night. can be physiological from athletic training. The hallmark signs of heart failure include shortness of breath (especially on exertion. Lyme disease. If not significant enough. Heart failure Heart failure is failure of the heart to produce sufficient blood flow to meet metabolic demands of the body. Most causes are infectious (parvovirus B19. Right ventricular hypertrophy (RVH) Hypertrophy of the right ventricle and. anthracyclines.

Dressler syndrome A form of pericarditis that develops 2-3 weeks after myocardial infarction and is accompanied by fever. trauma. Treatment is supportive until in a hospital where pericardiocentesis or a pericardial window can be performed to drain the fluid.g.. and symptoms of pericarditis. Pericarditis Inflammation of the pericardium that is typically idiopathic or infectious in nature. The fibrous pericardium fixes the heart in the mediastinum. The serous pericardium — like other similar structures (e. Causes include infections (tuberculosis. & soft heart sounds). Disorders of the heart valves The heart contains four valves that direct the flow of blood in a single direction. Pericardial tamponade Tamponade is a medical emergency resulting from accumulation of fluid in the pericardium that inhibits heart function. synovium. Specific valvular problems .g. Posterior wall of the pericardial sac. The classic finding is pulsus paradoxus as well as Beck's triad (low arterial blood pressure. There are eight combinations of the four valves and two disorders. pleuritic chest pain. parasites) and surgery. and arterial/oxygenated blood leaves the heart through the mitral valve (MV) and aortic valve (AV). Treatment of viral & idiopathic pericarditis is NSAIDs or aspirin. Venous/deoxygenated blood returns to the heart through the tricuspid valve (TV) and pulmonary valve (PV). if necessary. fungus. but an abnormal accumulation of fluid in the pericardium is called a pericardial effusion. and treatment of the underlying cause. The list of causes is lengthy but includes pericarditis. systemic lupus erythematosus). Pericardial effusion The serous pericardium normally contains fluid that reduces friction. and blood from myocardial rupture. Treatment includes pericardiocentesis to drain the fluid. distended neck veins. pulmonary pleurae. Valves function to move blood in one direction only and failure to prevent back-flow is called regurgitation or insufficiency. If an effusion worsens then the fluid can inhibit heart function and symptoms of cardiac tamponade appear. Definitive surgery is a pericardiectomy. rheumatic diseases (e. bursae) — contains a thin layer of fluid that reduces friction from movement.Disorders of the pericardium The pericardium is a double-walled sac — fibrous pericardium and serous pericardium — that contains the heart. Constrictive pericarditis Pericarditis that constricts the expansion of the heart and inhibits heart function.. and failure to easily move blood in the forward direction is through narrowing of the valve called stenosis. Tamponade is a consequence of the fibrous pericardium being too inelastic to permit adequate heart expansion during diastole.

Aortic regurgitation / aortic insufficiency Deficiency of the aortic valve that permits regurgitation from the aorta into the left ventricle. Pulmonary valve not visible. Aortic valve replacement Replacement of the aortic valve due to aortic regurgitation. Aortic valvuloplasty Repair of the valve by using a balloon catheter to force it open. Stenosis commonly occurs from calcification of the valve. leaflets of the tricuspid and aortic valves only partly visible. Heart schematic showing the four valves 3D reconstruction of the heart as viewed from the apex towards the valves. instead of replacement. To the left two images in 2D from the same dataset. or other reasons. image flipped 180° relative to illustration above.Specific problems of each 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 stenosis Narrowing of the aortic valve opening that reduces blood flow through the valve. A special kind of replacement called percutaneous aortic valve replacement is done through catheters are does not require open-heart surgery. showing tricuspid and mitral valves (above) and aortal and mitral valve (below). Mitral valve prolapse Prolapse of the mitral valve into the left atrium during ventricular systole. of the aortic valve. Aortic valve repair Repair. Mitral valve Disorders and treatments of the mitral valve that separates the left atrium and left ventricle. aortic stenosis. which happens prematurely in those with a bicuspid aortic valve. Aortic valve Disorders and treatments of the aortic valve that separates the left ventricle and aorta. Mitral regurgitation / mitral insufficiency .

Mitral valve replacement Replacement of the mitral valve due to mitral regurgitation. bacteria cause infective endocarditis of the mitral valve. Pulmonary valve Disorders of the pulmonary valve that separates the right ventricle and pulmonary artery. Ebstein's anomaly A congenital heart defect that results in the tricuspid valve leaflets being deeper in the heart (toward the apex) than normal. Pulmonic stenosis Narrowing of the pulmonary valve opening that reduces blood flow through the valve. The annulus of the valve is in the correct position. but intravenous drug users (e. and the portion of the ventricle affected becomes "atrialized" with thinner walls. methamphetamine) have an increased risk of infection of the tricuspid valve. Common signs .. Tricuspid stenosis Narrowing of the tricuspid valve opening that reduces blood flow through the valve. Mitral valvuloplasty Repair of the valve by using a balloon catheter to force it open. however. or other reasons. Mitral valve repair Repair. Mitral stenosis Narrowing of the mitral valve opening that reduces blood flow through the valve. Endocarditis commonly affects the heart valves. Wolff–Parkinson–White syndrome). mitral stenosis. Tricuspid valve Disorders of the tricuspid valve that separates the right atrium and right ventricle. instead of replacement. Regurgitation produces a systolic murmur that radiates into the axilla. Tricuspid regurgitation / tricuspid insufficiency Deficiency of the tricuspid valve that permits regurgitation from the right ventricle into the right atrium.g. Pulmonary regurgitation / pulmonary insufficiency Deficiency of the pulmonary valve that permits regurgitation from the pulmonary artery into the right ventricle. inner lining of the heart is the endocardium and inflammation of this layer is called endocarditis.Deficiency of the mitral valve that permits regurgitation from the left ventricle into the left atrium.. heroin. of the mitral valve. 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.g. Typically. Tricuspid atresia A congenital heart defect that results in the absence of the tricuspid valve Endocarditis The thin. The right atrium becomes hypertrophied and can result in conduction defects (e.

and other syndromes like Noonan. The top two syndromic causes of CHD are Noonan syndrome and Down syndrome. a syndrome). Down. This leads to aortic stenosis as the valve prematurely calcifies (as compared to calcification of a trileflet valve). but has a lower incidence of CHD.g.e. Osler's nodes (tender). The membrane may be present without . Bicuspid aortic valve Formation of two valve leaflets in the aortic valve instead of three leaflets. PDA). & ToF. Atrial septal defect (ASD) Defect in the interatrial septum that permits blood flow between atria. with the later meaning defects that are isolated and not found in patterns (i.. Atrial septal defect with left-to-right shunt. It is the second most common heart finding in SLE after pericarditis. The aortic valve is the most common valve affected (followed by mitral. but are included anyway because they affect the cardiovascular system. and splinter hemorrage of the nails. 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. CoA. which makes Noonan syndrome the most common syndromic cause of CHD. This tends to affect the left atrium more than the right atrium. CHD should make one consider the VACTERL association. and is associated with a history of rheumatic fever. Defects can be syndromic or non-syndromic. Listed below include congenital defects that do not affect the heart (e. Down syndrome is more common than Noonan syndrome. tricuspid. & then pulmonary). A "complete" coarction is called an interrupted aortic arch. typically of the aortic arch and is classically found in Turner syndrome. Nonbacterial thrombotic endocarditis (NBTE) Growths on the valves that are not from an infectious source and are composed of fibrin and platelets. and DiGeorge syndromes. VSD.include Janeway lesions (non-tender). namely ASD. including a patent foramen ovale (PFO). Cor triatriatum A membrane that divides one of the atria results in "three" atria (hence "triatriatum"). Libman–Sacks 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).. Coarctation of the aorta (CoA) Narrowing of the aorta.

complete division of the atrium. Pulmonary valve stenosis (PVS) Narrowing of the pulmonary valve that is the key finding in Noonan syndrome. Transposition of the great vessels (TGV) Abnormal spatial arrangement of the great vessels (superior vena cava. They are associated with a smoking history and in connective tissue diseases (e. pulmonary arteries. tricuspid stenosis for right atrium). and aorta). Patent foramen ovale (PFO) An atrial septal defect in that the foramen ovale fails to close at birth. Ventricular septal defect (VSD) Defect in the ventricular septum that permits blood flow between ventricles. pulmonary veins. Situs inversus can be a part of primary ciliary dyskinesia (aka Kartagener syndrome) that has recurrent respiratory infections and male infertility. typically of the abdominal aorta (abdominal aortic aneurysm or AAA). instead of the left.g. ventricular septal defect. Tetralogy of Fallot (ToF) Set of four anatomical abnormalities: pulmonary stenosis. inferior vena cava. Dextrocardia Dextrocardia is a condition in which the apex of the heart is on the right side of the body. For example. It presents similarly to stenosis of the respective semilunar valve (i. Hypoplastic left heart syndrome Defect in the development of the left heart such that it is hypoplastic (under developed).g. provided care is taken in marking the correct side of the radiograph. double aortic arch. This can exist in isolation or as a part of situs inversus in which the entire body is mirrored not just the heart. Great artery defects There are several conditions that affect the great arteries (e. Uhl anomaly Partial or total loss of the right ventricular wall. Aortic aneurysm Aneurysm of the aorta.. Diseases of blood vessels Diseases of the blood vessels can be multidisciplinary in nature. medical treatment of atherosclerosis tends to be managed by cardiologists while vascular surgery repairs aneurysms and stenotic arteries. and right ventricular hypertrophy. A simple chest xray is sufficient to diagnose dextrocardia.. . Patent ductus arteriosus (PDA) Failure of the ductus arteriosus to close on birth. Aneurysm Balloon-like bulging of arteries (also possible of the heart: see ventricular aneurysm above). Atherosclerosis Thickening of an arterial wall due to increased cholesterol and macrophages (see above). Ebstein's anomaly Malformation of the tricuspid valve (see above). aberrant subclavian artery) that often result in problems with the trachea and breathing. Persistent truncus arteriosus Defect in that the truncus arteriosus fails to divide.. overriding aorta.e.

Carotid artery dissection Dissection along the length of the carotid artery between the layers of the carotid wall and filled with blood. Carotid artery Diseases of the carotid arteries: Carotid artery stenosis / carotid artery disease Narrowing of the carotid artery. Rupture of the aneurysm results in a subarachnoid hemorrhage and a very severe headache. but is also due to trauma and results in a traumatic aortic rupture. Current USPSTF recommendations are for a single abdominal ultrasound screening for a AAA in anyone 65 or older who has smoked. neither of which tolerate ischemia particularly well. Dissection of the ascending aorta is an emergency because dissection may interrupt coronary blood flow and blood flow to the brain. Microangiopathy . Cerebral aneurysm Aneurysms of the arteries in the brain most commonly affect the anterior cerebral artery. typically due to atherosclerosis.Marfan syndrome. Dissection of the ascending aorta (type A) is a surgical emergency while dissection of the descending aorta (type B) can possibly be managed medically.5 cm because of concern for rupture that leads to death from internal bleeding. travel to the lungs. commonly in the legs that may break loose. and occlude blood flow (pulmonary embolism) sufficient to interrupt oxygenation to the body. Deep vein thrombosis (DVT) and pulmonary embolism (PE) Formation of a thrombus in a deep vein. Traveller's thrombosis / economy class syndrome A DVT due to being sedentary during air travel. Rupture of the aorta can occur at the sites of aneurysm. Aortic rupture Frank rupture of the aorta is often fatal from internal bleeding. EhlersDanlos syndrome). Surgical repair of a AAA is advised after it is larger than 5. Aortic dissection Dissection along the length of the aorta between the layers of the aortic The progression of atherosclerosis (size exaggerated).0-5. wall.

Thromboangiitis obliterans Affects small. and can be fatal from ruptured aneurysms. kidneys. aka Wegener's granulomatosis) Affects small. Occlusion of the ophthalmic artery results in blindness. Varicose veins Veins that have become enlarged and tortuous with failed valves. and result in bleeding and decreased blood flow. & heart in those with a history of airway allergic hypersensitivity and p-ANCA antibodies. diminished pulses. Vasculitis Inflammation of blood vessels (veins & arteries) with a long list of causes. Vericose veins have cosmetic concerns. Aortitis Inflammation of the aorta that can be seen in giant cell arteritis. Myocardial infarction from coronary thrombosis is the most common cause of death from Kawasaki disease. polymyalgia rheumatica. Granulomatosis with polyangiitis (GPA. & pericarditis.& medium-sized vessels that often affects the lung & kidneys (RPGN) with classic saddle nose and c-ANCA antibodies. IgA vasculitis (IgAV. Kawasaki disease Affects medium-sized vessels mostly seen in young children with myocarditis. One very common cause is diabetes mellitus in which microangiopathy results in diabetic nephropathy. rheumatoid arthritis.& medium-sized vessels that is strongly associated with tobacco products. genital ulcers and uveitis. Coronary artery bypass surgery (CABG) Grafting an artery or vein from elsewhere to bypass a stenotic coronary artery. but they may become painful. typically branches of the external carotid artery and namely the temporal artery.& medium-sized vessels that often affects lungs. Surgery and sclerotherapy are two options for treating varicose veins.Disease of capillaries in which the walls become thick and weak. Cardiopulmonary bypass may be necessary. a sternotomy is performed to open the chest and then grafts are performed. aka Churg-Strauss syndrome) Affects small. gangrene and eventual amputation of affected hands and feet. The internal mammary artery or . Behçet's disease Affects small-sized vessels that often initially presents with oral aphthous ulcers. commonly in the legs. Eosinophilic granulomatosis with polyangiitis (EGPA. Procedures to counter coronary artery disease Coronary artery disease is not currently reversible and eventually requires surgical management if it progresses. aka Henoch-Schönlein purpura) Affects small-sized vessels and produces palpable purpura and proteinuria from immunocomplex (IgA) deposition. Pain. and diabetic neuropathy. Giant-cell arteritis (GCA) / Temporal arteritis Affects medium. Performed by cardiothoracic surgeons. Pericarditis is commonly seen with Behçet's.& large-sized vessels of the head. syphilis and Takayasu's arteritis. Suspicion of GCA necessitates immediate treatment with glucocorticoids and temporal artery biopsy. and is the most common cause of acquired heart disease in children (results in coronary artery aneurysms). diabetic retinopathy.

It is a form of PCI and generally what is implied when referring to "PCI. Percutaneous coronary intervention (PCI) Procedures to treat stenotic coronary arteries by accessing through a blood vessel. it is primarily used to listen to heart sounds it can also be used to listen for bruits (carotid & renal for renal artery stenosis). 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. but has been used for coronary disease as well. In cardiology. The stethoscope is the quintessential medical icon. EKG calipers A type of divider caliper that can be used to measure intervals and compare intervals on EKGs. regardless of specialty. which releases ("percutaneous") into a blood vessel ("transluminal") paclitaxel. Devices used in cardiology Stethoscope Acoustic device for hearing internal sounds including heart sounds. Endarterectomy Enlarging the lumen of an artery by removal of atherosclerotic plaque by means of open surgery. Typically. and be sized for adults or children. hence the name. An example of a drug-eluting stent. This is primarily done on the carotid arteries (Carotid endarterectomy or CEA) but was first performed on the superficial femoral artery. Modern stethoscopes can have a diaphragm and a bell. Electronic stethoscopes can amplify and record sounds. Enhanced external counterpulsation (EECP) Pneumatically assisting the heart to move blood using inflatable cuffs on the legs. While not performed on coronary arteries." Atherectomy Enlarging the lumen of an artery by removal of atherosclerotic plaque by means of catheterization. . Stenting Enlarging the lumen of an artery by forcibly expanding it with a metal wire tube by means of catheterization. to enlarging the lumen of a coronary artery by forcibly expanding it with a balloon ("angioplasty"). it is mentioned here for completeness.saphenous vein can be used as grafts. This method is primarily used in peripheral disease. Angioplasty in this manner is PTCA (described below) but may also involve the insertion of stents to keep vessels open. and lung sounds. Special rulers can be used to measure the intervals as well. The grafts are used to provide an alternate path for blood flow around a stenosis. A stethoscope. bowel sounds. the artery is expanded first through angioplasty (see PTCA above). This is Percutaneous Transluminal Coronary Angioplasty (PTCA) the TAXUS Express2 Paclitaxel-Eluting Insertion of a catheter through the skin Coronary Stent System.

thus decreasing myocardial oxygen demand. Devices used to maintain blood pressure Artificial heart An internal pump that wholly replaces the pumping action of the heart. .Devices used to maintain normal electrical rhythm Pacemaker An implanted electrical device that replaces the heart's natural pacemaker. Contrary to popular media's use. not systole). 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. As the name implies. ventricular fibrillation) in people predisposed to these rhythms. It pulsates opposite to the heart such that it inflates during diastole and relaxes during systole. Implantable cardioverter-defibrillator (ICD) An implanted device to prevent life-threatening conditions (e.g.. Intra-aortic balloon pump (IABP) A balloon placed in the thoracic aorta to supplement cardiac output from the heart. and providing volatile anesthetics (e. It can be used to cardiovert atrial fibrillation if certain conditions are met.. Ventricular assist device (VAD) Internal pump to supplement or replace the pumping action of a ventricle. Defibrillator Electrical devices to alter the heart's rhythm with electrical energy. then cardiopulmonary resuscitation (CPR) or more advanced care should be started. and inflates during diastole to increase diastolic pressure which increases coronary artery perfusion of the endocardium (the heart perfuses itself during diastole. heating the blood (heat is lost from being outside the body) to maintain core body temperature or cooling blood for controlled hypothermia.g. a defibrillator cannot and should not be used for asystole (a "flatline") as it has been shown to be ineffective in restoring a rhythm. 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. removal of carbon dioxide. Cardiopulmonary bypass (CPB) / heart-lung machine External pump to take over the function of both the heart and lungs. isoflurane) if the lungs are not ventilated during bypass (the movement can be problematic while performing surgery). The bypass machine is responsible for oxygenation of blood. Deflation during systole decreases afterload (vacuum effect). Can be referred to RVAD or LVAD depending on if it's attached to the right or left ventricle. If a person is in a rhythm not convertible by a defibrillator. but is mainly used to cardiovert ventricular fibrillation which is life-threatening. ventricular tachycardia. 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. 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. a defibrillator is used to stop fibrillation of the heart.

heart sounds) with a stethoscope. Often utilizes the Doppler effect to determine blood flow through valves (stenosis & regurgitation) and through the septum (ASD & VSD). stroke. 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. Transesophageal echocardiogram (TEE) Echocardiogram of the heart through the esophagus. Blood tests Cholesterol Current prevailing hypothesis is that LDL cholesterol is "bad" and HDL cholesterol is "good.g. Agitated saline can be used as contrast for blood flow and microbubbles for capillary blood flow contrast. ascending aortic dissection. defibrillation. radiofrequency ablation. CK-MB is fairly specific to myocardium injury. toxicity from chemotherapy. typically with 4 or 10 electrodes on the skin. cardiomyopathies. valves. Auscultation Listening to sounds (e. Transthoracic echocardiogram (TTE) Echocardiogram of the heart through the thorax external to the body. TEE can require sedation or general anesthesia and the patient must be NPO. The presence of troponins heart with an ECG indicator are not exclusive to myocardial infarction. heart failure. Holter monitor Portable ECG device for continuous monitoring. and blood flow. 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.g.. and so other conditions should be considered (e. . ASD closure. cyanide poisoning. cardioversion.Diagnostic tests and procedures Various cardiology diagnostic tests and procedures. but has several disadvantages (namely clarity of images). Much easier to perform than TEE because it is non-invasive and takes less time. Cardiac stress test Testing of the cardiovascular system through controlled exercise or drugs. Echocardiography ("echo") Ultrasonography of the heart to inspect chambers.. snake venom. Electrocardiography (ECG or EKG) Measurement of the electrical activity of the heart. seizure). trauma. Troponin The troponin complex is present in skeletal and cardiac muscle." Creatine kinase When skeletal muscle injury is absent.

These actions lead to conduction of signals down nerves and contraction of cardiomyocytes. Coronary catheterization Catheterization of the coronary arteries. timolol. phenytoin. Sphygmomanometer Blood pressure cuff used to measure arterial blood pressure. ajmaline. III. metoprolol. The second is receptors of various types. Cardiac marker Testing for biomarkers in the blood that may indicate various conditions. procainamide. moricizine) ◾ Class II — Beta blockers (carvedilol. dronedarone) ◾ Class IV — Calcium channel blockers (verapamil. dofetilide. Perhaps the most prominent manipulation of ion channels is through antiarrhythmic agents. Drugs There are several classes of pharmaceutical drugs used in cardiology to manage various diseases and a lot of drugs have cardiovascular side effects.Electrophysiology study Studying the electrical activity of the heart through the use of catheters placed in the heart via veins or arteries. propafenone. depolarization. tocainide) ◾ Class Ic — Decrease conductivity (encainide. The third is manipulation of enzymes. digoxin. Ion channels Ion channels are responsible for cell membrane voltage. Optical coherence tomography (OCT) Testing through the use of optical scattering for coronary artery disease. & IV manipulate ion channels while the others are not. 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. and repolarization. Fractional flow reserve (FFRmyo) Testing the blood flow through a stenosis of a coronary artery to determine the perfusion of the heart. ibutilide. Drugs for the cardiovascular system Drugs that manipulate the cardiovascular system do so through several ways. which are often manipulated to manage arrhythmias. disopyramide) ◾ Class Ib — Sodium channels (lidocaine. types I. atenolol. propranolol. . Intravascular ultrasound (IVUS) Ultrasonography of a coronary artery. magnesium Sulfate) Specifically. mexiletine. sotalol. The first is ion channels. flecainide. bisoprolol) ◾ Class III — Potassium channel blockers (amiodarone. diltiazem) ◾ Class V — Other (adenosine. esmolol.

dobutamine. Catecholamines are a set of drugs and hormones that manipulate the adrenergic receptors.g. isoproterenol) that manipulate the adrenergic receptors and have variable specificity for the receptors and are. direct thrombin inhibitors.. mainly through vasodilation & heart remodeling inhibition.. heparin.. Diuretics The primary effect of diuretics is removal of intravascular volume. lowmolecular weight heparins.Receptors The adrenergic receptor is a set of receptors that are commonly manipulated. otherwise. The natural catecholamines are norepinephrine. dromotropy through the AV node. . Angiotensin II receptor antagonists (ARBs) block the angiotensin II receptors that are linked to hypertension and heart failure. Enzymes ACE inhibitors works upstream from angiotensin II receptor antagonists and have similar effects on management of hypertension and heart failure. Four properties of the heart — chronotropy. and a few others are used for anticoagulation therapy. dromotropy. Sodium nitroprusside and nitroglycerin function by causing vasodilation through nitric oxide. Anesthetics As a general rule. Opioids Decreases blood pressure. lead to myocardial infarction. There are numerous other drugs (e. the β1 receptor increases all four of these properties: chrontropy at the SA node. and lusitropy through phosphorylation of phospholamban. Factor V Leiden) but also for thrombus formation when an atherosclerotic plaque rupture that would. inotropy. COX inhibitors (namely aspirin). which then has secondary benefits to the cardiovascular system in diseases like heart failure. direct Xa inhibitors. For example. warfarin.g. which manipulates cGMP levels through guanylate cyclase. abciximab). ephedrine. Drugs with cardiovascular side effects Numerous drug classes have well-known cardiovascular side effects. thus. inotropy of the cardiomyocytes through increased calcium. & lusitropy — are manipulated by adrenergic receptors. all agents used in anesthesia have depressant effects on the cardiovascular system with notable exception of ketamine. epinephrine. and dopamine. This is important in those predisposed to blood clots (e.g. Lithium Teratogenic effect of causing Ebstein's anomaly in mothers taking lithium. Chemotherapy Doxorubicin is one agent known to have heart toxicity (leads to dilated cardiomyopathy). used for various reasons. antibodies (e.

) ◾ Werner Forssmann (1904–1979). 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 (1939–1985). discoverer of Noonan syndrome that is the top syndromic cause of congenital heart disease ◾ John Parkinson (1885–1976). junctional rhythms. recognized the sign known as Levine's sign as well as the current grading of the intensity of heart murmurs. quitting cardiology as a speciality. known as the Levine scale ◾ Henry Joseph Llewellyn "Barney" Marriott (1917–2007). Serotonin–norepinephrine reuptake inhibitors (SNRI) Due to manipulation of norepinephrine. They can also cause tachycardia and hypotension. and trigeminy. co-founder of the Swiss Society of Cardiology.) catheterization on himself that led to him being let go from Berliner Charité Hospital. ECG interpretation and Practical Electrocardiography ◾ Jacqueline Noonan (born 1928). SNRI's can cause hypertension and so hypertension should be reduced before starting an SNRI.O. Medical Specialist publications Occupation Specialty ◾ Wallace Brigden (1916-2008). identified type cardiomyopathy Activity sectors Medicine ◾ Willem Einthoven (1860–1927). first developed balloon angioplasty ◾ Max Holzmann (1899-1994). editor of Occupation Braunwald's Heart Disease and 1000+ Names Doctor. Taussig (1898–1986). founder of pediatric cardiology and extensively worked on blue baby syndrome ◾ Paul Dudley White (1886–1973). Cardiologists ◾ Robert Atkins (1930–2003).D.Selective serotonin reuptake inhibitors (SSRI) Toxicity causes arrhythmias including sinus tachycardia. 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. known for Wolff–Parkinson–White syndrome ◾ Helen B. president from 1952 –1955 ◾ Samuel A. Tricyclic antidepressants (TCAs) TCAs behave like type Ia antiarrhythmics and could terminate ventricular fibrillation and decrease contractility. Levine (1891–1966). who ◾ Doctor of Osteopathic infamously performed the first human Medicine (D. known for the Cardiologist Atkins diet ◾ Eugene Braunwald (born 1929). known for Wolff–Parkinson–White syndrome . SSRI's also have interactions with anti-coagulation therapy and increases the risk of bleeding while on them.

http://www.com/health/archive/2015/01/physician-salaries/384846/ .com/health/archive/2015/01/physician-salaries/384846/ 3.theatlantic. References 1. known for Wolff–Parkinson–White 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. 2. "Specialties & Subspecialties". Retrieved 23 September 2012.◾ Louis Wolff (1898–1972). the free dictionary. http://www. American Osteopathic Association.theatlantic.

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