Cardiology



       A cardiologist is a doctor with special training and skill in finding, treating and preventing diseases of the heart and blood vessels.


What Does a Cardiologist Do?

       Whether the cardiologist sees you in the office or in the hospital, he or she will review your medical history and perform a physical examination which may include checking your blood pressure, weight, heart, lungs, and blood vessels. Some problems may be diagnosed by your symptoms and the doctor’s findings when you are examined. You may need additional tests such as an ECG, x-ray, CT scan or blood test. Other problems will require more specialized testing. Your cardiologist may recommend lifestyle changes or medicine. Each patient’s case is unique.


How are Cardiologists Trained?

       Cardiologists receive extensive education, including four years of medical school and three years of training in general internal medicine. After this, a cardiologist spends three or more years in specialized training. That’s ten or more years of training!


How Does a Cardiologist Become Certified?

       In order to become certified, doctors who have completed a minimum of ten years of clinical and educational preparation must pass a rigorous two-day exam given by the American Board of Internal Medicine. This exam tests not only their knowledge and judgment, but also their ability to provide superior care.


When Would I See a Cardiologist?

       If your general medical doctor feels that you might have a significant heart or related condition, he or she will often call on a cardiologist for help. Symptoms like shortness of breath, chest pains, or dizzy spells often require special testing. Sometimes heart murmurs or ECG changes need the evaluation of a cardiologist. Cardiologists help victims of heart disease return to a full and useful life and also counsel patients about the risks and prevention of heart disease. Most importantly, cardiologists are involved in the treatment of heart attacks, heart failure, and serious heart rhythm disturbances. Their skills and training are required whenever decisions are made about procedures such as cardiac catheterization, balloon angioplasty, or heart surgery.


What Questions Should I Ask My Cardiologist?

       There are basic questions to remember to ask, in addition to whatever questions are on your mind. For instance, if you have had a coronary angiogram, you may ask to see the pictures of your heart and have your cardiologist explain what they mean. Your heart and health are, of course, vitally important to you. Remember, your cardiologist wants you to understand your illness and be an active participant in your own care.


Will My Insurance Cover the Services of a Cardiologist?

       Yes, in most cases. However, insurance plans vary and each case is handled individually. Your doctor and our International Services staff will be glad to discuss your insurance plan and billing with you. Contact our PPHC Staff


How Does the Cardiologist Work with Other Doctors in My Care?

       A cardiologist usually serves as a consultant to other doctors. Your physician may recommend a cardiologist or you may choose one yourself. As your cardiac care proceeds, your cardiologist will guide your care and plan tests and treatment with the doctors and nurses who are looking after you.


Do All Cardiologists Perform Cardiac Catheterizations?

       No. Many cardiologists are specially trained in this technique, but others specialize in office diagnosis, the performance and interpretation of echocardiograms, ECGs, and exercise tests. Still others have special skill in cholesterol management or cardiac rehabilitation and fitness. All cardiologists know how and when these tests are needed and how to manage cardiac emergencies.


What Kinds of Tests May the Cardiologist Recommend or Perform?

Examples include:
       • Echocardiogram – a sound wave picture to look at the structure and function of the heart.
       • Ambulatory ECG – a recording during activity to look for abnormal heart rhythms.
       • Exercise test – a study to measure your heart’s performance and limitations.
       • Cardiac Catheterization – a test in which a small tube is placed in or near the heart to take pictures, look at how the heart is working, check the electrical system, or help relieve blockage.



Preparing For Your Appointment

Examples include:
       In order to maximize the interaction between you and your cardiologist at your next visit, it is best to come prepared. There are materials you should bring with you and ways you should prepare for your appointment. Here are some tips for a more meaningful visit:


       1.Always bring a list of your current medications. A sheet of paper with all your current medications written out or typed out (including name, dose, and frequency of use) is an invaluable resource for your cardiologist. A list of any medication allergies is also helpful.

       2.Carry a list of your health care providers including name, address, telephone number, and condition being followed. This will help ensure that communication between your cardiologist and all of your other care providers is complete.

       3.Compile a list of your past health history. Important to include are any surgical procedures (with at least approximate dates), a list of any major prior or ongoing illnesses/health issues, and a list of any major tests, especially if performed within the last year. Knowing past health events can help the physician make a diagnosis or prescribe the best course of treatment.

       4.Compile a family health history of close blood relatives. This includes brothers, sisters, parents, grandparents, aunts, uncles, and children. From a cardiology perspective, what you are especially interested in finding out is whether any of your relatives have been diagnosed with heart disease, high blood pressure, high cholesterol, diabetes, or aneurysm. Knowing when any of your relatives passed away and cause of death is also important. A family history of health events can provide clues as to what illnesses/conditions you may be at risk for developing.

       5.If you have them, bring in copies of any recent lab results and any other test results from the past year, especially if the testing took place with a different health care provider. This will help avoid duplicating tests unnecessarily.

       6.Information: Having a better understanding of your condition ahead of time will allow you to have a more meaningful discussion with your physician.

       7.Write down a list of the questions you have about your condition and bring it with you to the appointment. Keep the list realistic in length. You might want to pick the top 3 or 4 concerns you would like to have addressed during your visit. Even though this might seem silly, it is easy to get sidetracked during a medical appointment. Write down ahead of time what pieces of information you want to leave with.

       8.Keep yourself organized. Putting all this data into a folder is a good idea so it’s easy to access during your visit

       9.Don’t take anything for granted. Although information systems are getting better, and communication between systems is improving, you are still the most reliable repository of your health care record. Keep your copy accurate and up-to-date.


How the Heart Works


       The heart is responsible for circulating blood throughout the body. It is about the size of your clenched fist and sits in the chest cavity between your two lungs. Its walls are made up of muscle that can squeeze or pump blood out every time the heart "beats" or contracts. Fresh, oxygen-rich air is brought into the lungs every time you take a breath. The lungs are responsible for delivering oxygen to the blood and the heart circulates the blood through the lungs and out to the different parts of the body.


       The heart is divided into four chambers or "rooms". You can compare it to a duplex apartment that is made up of a right and a left unit, separated from each other by a partition wall known as a septum (pronounced SEP-tum).


       Each "duplex" is subdivided into an upper and a lower chamber. The upper chamber is known as the atrium (pronounced AY-tree-yum) while the lower chamber is referred to as the ventricle (pronounced VEN-trickle). The right atrium (RA) sits on top of the right ventricle (RV) on the right side of the heart while the left atrium (LA) sits atop the left ventricle (LV) on the left side.


       The right side of the heart (RA and RV) is responsible for pumping blood to the lungs, where the blood cells pick up fresh oxygen. This oxygenated blood is then returned to the left side of the heart (LA and LV). From here the oxygenated blood is pumped out to the rest of the body supplying the fuel that the body cells need to function. The cells of the body remove oxygen from the blood, and the oxygen-poor blood is returned to the RA, where the journey began. This round trip is known as the circulation of blood.


       Do you wonder why each side of the heart has two pumping chambers (atrium and ventricle)? Why not just have a ventricle to receive blood and then pump it straight out? The reason is that the atrium serves as a "booster pump" that increases the filling of the ventricle. Filling a normal ventricle to capacity translates to more vigorous contraction or emptying. You can compare this to a strong spring. Within reasonable limits, the more you stretch a spring, the more vigorously will be its contraction or recoil. More complete filling of the ventricles thus translates into more vigorous ventricular contraction (a good thing).



       The figure shown above is a section of the heart, as viewed from the front. It demonstrates the four chambers. You will also notice that there is an opening between the right atrium (RA) and the right ventricle (RV). This is actually a valve known as the tricuspid valve (pronounced try-CUS-pid). It is made of three flexible thin parts, known as leaflets, that open and shut. The figure below shows the tricuspid valve, as seen from above, in the open and shut position (the other valves pictured are discussed below).



       When shut, the edges of the three tricuspid valve leaflets touch each other, preventing blood from going back into the RA when the RV squeezes. Thus, the tricuspid valve serves as a one-way door that allows blood to move only in one direction - from RA to RV. Similarly, the mitral valve (pronounced my-TRULL) allows blood to flow only in one direction from the LA to the LV. Unlike the tricuspid valve, the mitral valve has only two leaflets.


       In the top diagram, you will also notice thin thread like structures attached to the edges of the mitral and tricuspid valves. These chords or strings are known as chordae tendineae (pronounced cord-EYE TEND-in-eye). They connect the edges of the tricuspid and mitral valves to muscle bands or papillary muscles (pronounced PAP-pill-larry). The papillary muscles keep the valve leaflets from flopping back into the atrium. The chords are designed to control the movement of the valve leaflets similar to ropes attached to the sail of a boat. Like ropes, they allow the sail to bulge outwards in the direction of the wind but prevent them from helplessly flapping in the breeze. In other words, they allow the valve to open and shut in a given direction but not beyond a certain point.


       Let’s now follow the circulation of blood more closely. Oxygen-poor blood from the head, neck and arms returns to the right atrium (RA) via the superior vena cava (pronounced VEE-nah CAVE-ah) or SVC. On the other hand, oxygen-poor blood from the lower portion of the body returns to the RA via the inferior vena cava or IVC. When the RA is full, it contracts. This builds up pressure and pushes the tricuspid valve open. Blood now rushes from the RA into the right ventricle (RV). When the RV is filled, the walls of the ventricle begin to contract and the pressure within the RV rises. The increased pressure shuts the tricuspid valve and blood is pumped into the pulmonary artery (pronounced PULL-mun-narey) through the pulmonic valve (pronounced pull-MON-nick). The diagram below once again shows the four heart valves as viewed from the top of the heart, i.e., we are looking down at the two ventricles with the right atrium and left atrium removed.


       The pulmonic valve is made up of three cusps or flexible cup-like structures, capable of holding blood. When the pressure in the right ventricle is low (as is the case when the RV is filling with blood) blood starts to move backward from the lungs toward the RV. The three cusps of the pulmonic valve fill with that blood and their sides touch each other, effectively shutting the valve. This prevents blood from leaking from the pulmonary artery into the right ventricle while the RV is filling. When the RV contracts to empty, the pressure within the RV rises above that of the pulmonary artery. These forces open the three cusps of the pulmonic valve and blood rushes through the pulmonary artery towards the lungs, where the red blood cells pick up oxygen.


       The oxygenated blood from the lungs now returns to the left atrium (LA) via four tubes that are known as pulmonary veins (each draining a separate portion of the lungs). The pulmonary veins empty into the back portion of the LA. When the LA is completely filled it contracts. The mitral valve then opens, and blood is forced into the left ventricle (LV). When the LV is completely filled, it starts to empty its contents by contacting its walls. This increases pressure within the chamber, shuts the mitral valve and opens the aortic valve (AV, pronounced ey-OR-tick). The sequence is similar to that described for the RA, RV and pulmonic valve. The aortic valve also has three cusps.


       The mitral and tricuspid valves open and the aortic and pulmonic valves shut while the ventricles fill with blood. In contrast, the mitral and tricuspid valves shut while the aortic and pulmonic valves open during ventricular contraction. This sequence ensures that the ventricles are filled to capacity before the ventricles start to pump blood and that the blood flows in only one direction.


       After leaving the LV, blood now rushes through the aorta (pronounced a-OR-tah). The aorta is the main "highway" blood vessel that supplies blood to the head, neck, arms, legs, kidneys, etc. Blood is brought to these organs and limbs via branches that originate from the aorta. The cells within each part of the body pick up oxygen and nutrients from the blood. The oxygen-poor blood then returns to the RA, via the superior and inferior vena cava, and the beat goes on!!


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