Unraveling Cardiology

The human heart is respon­si­ble for pump­ing blood and oxy­gen through­out your body, mak­ing it one of the most vital organs. It is com­prised of arter­ies, mus­cles and elec­tri­cal impuls­es that keep us healthy and mov­ing on a dai­ly basis. Due to its com­plex­i­ty and rela­tion­ship with oth­er organs in your body, there are a vari­ety of car­di­ol­o­gists who spe­cial­ize in dif­fer­ent func­tions of your car­diac system.

Under­stand­ing what a spe­cial­ist does and does not do can help you deter­mine the most appro­pri­ate route to take, spe­cif­ic to your heart con­di­tion. Our Car­di­ol­o­gy physi­cians dis­cuss their areas of exper­tise in treat­ing heart conditions.

Car­diac Elec­tro­phys­i­ol­o­gy — Dr. Eugene Green­stein, MD

Car­diac Elec­tro­phys­i­ol­o­gy is a branch of car­di­ol­o­gy that focus­es on diag­nos­ing and treat­ing heart con­di­tions that affect the elec­tri­cal activ­i­ty of your heart. The heart is a com­plex elec­tri­cal sys­tem. When your heart is healthy, the elec­tri­cal impuls­es are respon­si­ble for steady, pre­dictable heart con­trac­tions and nor­mal blood flow. If you have a car­diac rhythm dis­or­der, or arrhyth­mia, the impuls­es don’t spread even­ly through­out your heart, result­ing in an abnor­mal heart beat. Symp­toms of arrhyth­mia may include chron­ic chest pain, a flut­ter­ing sen­sa­tion in your chest, short­ness of breath and/​or a slow (brady­car­dia) or rac­ing (tachy­car­dia) heartbeat.

A car­diac elec­tro­phys­i­ol­o­gist will test the elec­tri­cal activ­i­ty of your heart to under­stand where your abnor­mal heart rhythm is com­ing from. To do this, they will order an elec­tro­phys­i­ol­o­gy (EPS) test that threads small catheters to your heart, through a vein, in order to record your car­diac elec­tri­cal activ­i­ty. Your car­di­ol­o­gist will then sig­nal elec­tric puls­es through the catheters to make your heart beat at dif­fer­ent rhythms. The EPS test is out­pa­tient and usu­al­ly takes one to four hours for imag­ing, and two to three hours for recovery.

Dur­ing your recov­ery, your car­diac elec­tro­phys­i­ol­o­gist will ana­lyze your EPS test results and pro­duce an informed diag­no­sis and rec­om­mend­ed treat­ment plan. Some com­mon treat­ment options for arrhyth­mia, depend­ing on your sever­i­ty, include car­diac abla­tion or a biven­tric­u­lar pace­mak­er or defibrillator.

• Car­diac abla­tion is a min­i­mal­ly inva­sive pro­ce­dure that cre­ates scar tis­sue on your heart in order to stop unwant­ed elec­tri­cal impulses.
• There are many dif­fer­ent types of pace­mak­ers and defib­ril­la­tors but they all work to mon­i­tor changes in your heart­beat and send elec­tri­cal impuls­es to cor­rect it when need­ed. In most cas­es, these devices are implant­ed direct­ly in your heart through a min­i­mal­ly inva­sive procedure.

Inter­ven­tion­al Car­di­ol­o­gy - Dr. Vinay Aro­ra, MD

Inter­ven­tion­al car­di­ol­o­gy is a sub-spe­cial­ty that works with inva­sive treat­ments for heart dis­ease. Inter­ven­tion­al car­di­ol­o­gists receive addi­tion­al train­ing in diag­nos­ing and treat­ing car­dio­vas­cu­lar dis­ease through catheter-based pro­ce­dures such as angio­plas­ty and coro­nary stent­ing. The most com­mon heart con­di­tions treat­ed by inter­ven­tion­al car­di­ol­o­gists include coro­nary artery dis­ease (CAD) and block­ages in oth­er ves­sels of the body.

Coro­nary Artery Disease

CAD is the most com­mon type of heart dis­ease in the Unit­ed States and the lead­ing cause of death in both men and women. CAD is due to a buildup of cho­les­terol on the inner walls of your heart, restrict­ing blood flow through your arter­ies. If left untreat­ed, CAD can cause severe chest pain, irreg­u­lar heart­beats or lead to heart fail­ure or heart attack. If you are sus­pect­ed to have CAD, you will be referred to an inter­ven­tion­al car­di­ol­o­gist who will order diag­nos­tic test­ing. Your test­ing may vary depend­ing on your con­di­tion, but you will most like­ly be rec­om­mend­ed for an echocar­dio­gram, car­diac catheter­i­za­tion and angiogram or a coro­nary com­put­er­ized tomog­ra­phy angiogram (CCTA).

If your CAD is less severe, your inter­ven­tion­al car­di­ol­o­gist may rec­om­mend med­ica­tion such as beta block­ers to decrease blood pres­sure, cho­les­terol mod­i­fy­ing med­ica­tions, cal­ci­um chan­nel block­ers to improve chest pain, nitro­glyc­erin tablets to con­trol chest pain and your heart’s demand for blood or oth­er forms of med­ica­tions to help improve your con­di­tion. If your CAD is more aggres­sive, an angio­plas­ty and stent place­ment or coro­nary bypass surgery may be recommended.

Block­ages

In addi­tion to CAD, inter­ven­tion­al car­di­ol­o­gists also work to treat oth­er con­di­tions that cause accu­mu­lat­ed block­ages in your heart. Clogged arter­ies are usu­al­ly due to a diet high in fat and cho­les­terol, high blood pres­sure, insulin resis­tance, lack of phys­i­cal activ­i­ty, obe­si­ty and smok­ing. Com­mon symp­toms of block­age include chest pain, dizzi­ness, fatigue, heart pal­pi­ta­tions, nau­sea, short­ness of breath and sweat­ing. If left untreat­ed, CAD can lead to heart attack (myocar­dial infarc­tion), con­ges­tive heart fail­ure and even death.

To test for buildup in your arter­ies, your inter­ven­tion­al car­di­ol­o­gist may order one or more of the fol­low­ing diag­nos­tic tests includ­ing an angiogram, com­put­er­ized tomog­ra­phy (CT) scan, cho­les­terol screen­ing, echocar­dio­gram, or mag­net­ic res­o­nance imag­ing (MRI). Once your test results are ana­lyzed by your inter­ven­tion­al car­di­ol­o­gist, they may rec­om­mend sev­er­al dif­fer­ent treat­ment options includ­ing lifestyle mod­i­fi­ca­tions for diet and exer­cise, med­ica­tions to mon­i­tor cho­les­terol and blood pres­sure and/​or sur­gi­cal and inter­ven­tion­al procedures.

An inter­ven­tion­al car­di­ol­o­gist may per­form an angio­plas­ty and stent place­ment to open clogged arter­ies, or in the case of severe or mul­ti­ple block­ages, bypass surgery may be recommended.

Struc­tur­al Car­di­ol­o­gy — Dr. Ethan Koso­va, MD

Struc­tur­al car­di­ol­o­gists diag­nose and treat struc­tur­al heart dis­ease, which is when the tis­sues or valves in your heart have an abnor­mal anato­my and func­tion. Many struc­tur­al heart dis­eases are con­gen­i­tal, or present at birth, but some devel­op lat­er in life. Some risk fac­tors for devel­op­ing a struc­tur­al heart con­di­tion include high blood pres­sure (hyper­ten­sion), high cho­les­terol, kid­ney dis­ease, cer­tain can­cer treat­ments, a his­to­ry of heart attacks or heart fail­ure, and a his­to­ry of heart valve problems. 

The symp­toms of struc­tur­al heart dis­ease vary depend­ing on your type, but the most com­mon indi­ca­tors are short­ness of breath, chest pain, wors­en­ing fatigue, heart pal­pi­ta­tions, swollen feet and ankles, faint­ing and stroke. 

The diag­no­sis of a struc­tur­al heart con­di­tion means that there is a prob­lem with the tis­sues or valves of the heart. The fol­low­ing are some of the most com­mon heart con­di­tions treat­ed by a struc­tur­al cardiologist.

Aor­tic valve steno­sis (AS)

AS occurs when your aor­tic valve open­ing is nar­rowed, result­ing in restrict­ed blood flow from the left ven­tri­cle to the aor­ta. Your struc­tur­al heart doc­tor will order an echocar­dio­gram to help deter­mine the sever­i­ty of your AS con­di­tion. Depend­ing on your diag­no­sis, your car­di­ol­o­gist may rec­om­mend sur­gi­cal valve replace­ment (open-heart surgery) or catheter-based valve replace­ment through a min­i­mal­ly inva­sive pro­ce­dure called tran­scatheter aor­tic valve replace­ment (TAVR)).

Atri­al sep­tal defect (ASD) and patent fora­men ovale (PFO)

ASD and PFO are two types of holes, or defects, which can occur between the upper two cham­bers of your heart. A car­di­ol­o­gist who spe­cial­izes in struc­tur­al heart dis­or­ders will assess your ASD or PFO through car­diac imag­ing and rec­om­mend a treat­ment course. If the hole is small, treat­ments may not be need­ed. How­ev­er, if your ASD is large or asso­ci­at­ed with symp­toms, or if you have had an unex­plained stroke and have a PFO, your car­di­ol­o­gist may rec­om­mend treat­ment with a min­i­mal­ly inva­sive pro­ce­dure that uses a catheter and a clo­sure device to close the hole.

Mitral valve regurgitation

Mitral valve regur­gi­ta­tion occurs when there is abnor­mal clos­ing of your mitral valve caus­ing blood to leak back­wards in the heart. In some cas­es, no symp­toms are present, but oth­er times symp­toms may include heart pal­pi­ta­tions, short­ness of breath, swollen legs or heart fail­ure. Your struc­tur­al car­di­ol­o­gist will order car­diac imag­ing to assess the degree of your leak­age to help deter­mine a rec­om­mend­ed treat­ment plan. If your regur­gi­ta­tion is severe, your car­di­ol­o­gist may rec­om­mend sur­gi­cal mitral valve repair (open-heart surgery) or mitral valve repair with a min­i­mal­ly inva­sive catheter-based procedure. 

Whether you have chron­ic heart fail­ure or would just like to dis­cuss symp­toms you’re expe­ri­enc­ing, our physi­cians have the exper­tise to treat your spe­cif­ic car­diac con­di­tion. To learn more about our Car­di­ol­o­gy depart­ment or to sched­ule an appoint­ment online, vis­it our Car­di­ol­o­gy page.