Department of Cardiology: Guide to Cardiac Symptoms, Diagnosis and Treatment
July 15, 2024
The Department of Cardiology is a specialised branch of medicine focused on diagnosing, treating, and preventing diseases related to the heart and blood vessels. This medical specialty encompasses a wide range of conditions, including coronary artery disease, heart rhythm disorders, heart failure, congenital heart defects, and valvular heart diseases. Cardiologists, the doctors who specialise in this field, use various diagnostic tools such as echocardiograms, electrocardiograms (ECGs), stress tests, and cardiac catheterization to assess heart function and detect abnormalities.
Cardiology is not only about treating heart conditions but also involves a significant amount of preventive care. Cardiologists often work with patients to manage risk factors such as high blood pressure, high cholesterol, obesity, and diabetes, aiming to prevent the development of more severe heart conditions. Treatment options in cardiology can range from lifestyle changes and medications to more invasive procedures like angioplasty, stenting, or even heart surgery.
Sub-Specialties
Depending on the diagnosis of the patient, the treatment could be offered under one of the following subspecialties of cardiology:
General adult cardiology
Interventional cardiology
Pediatric cardiology
Electrophysiology
Symptoms of Cardiac Disorder
Cardiac disorders can manifest through various symptoms, which often indicate an underlying heart problem. Here is an exhaustive list of the most common cardiac symptoms, along with their brief descriptions:
Chest Pain or Discomfort (Angina): A sensation of pressure, tightness, or pain in the chest, often triggered by physical activity or stress. It may also radiate to the arms, neck, jaw, shoulder, or back.
Shortness of Breath (Dyspnea): Difficulty breathing or feeling breathless, which can occur during exertion or at rest, and is often associated with heart failure or coronary artery disease.
Palpitations: An irregular or rapid heartbeat, which can feel like fluttering, pounding, or a racing heart. This may be due to arrhythmias or other heart conditions.
Fatigue: Unusual tiredness or exhaustion, often due to the heart's reduced ability to pump blood efficiently, leading to decreased oxygen supply to the body's tissues.
Swelling (Edema): Accumulation of fluid in the legs, ankles, feet, or abdomen, indicating heart failure or poor circulation.
Dizziness or Lightheadedness: Feeling faint, dizzy, or lightheaded, which can be caused by a drop in blood pressure, arrhythmias, or heart valve problems.
Fainting (Syncope): Sudden loss of consciousness, often due to a temporary decrease in blood flow to the brain, which may result from serious heart conditions like arrhythmias.
Sweating (Diaphoresis): Excessive sweating, especially when accompanied by chest pain or discomfort, can be a sign of a heart attack or other cardiac event.
Nausea or Vomiting: Feeling sick to the stomach or vomiting, which can sometimes accompany heart attacks or severe heart conditions.
Persistent Cough or Wheezing: A chronic cough or wheezing that produces white or pink blood-tinged mucus, which can be a sign of heart failure.
Bluish Skin or Lips (Cyanosis): A bluish tint to the skin, lips, or nails, indicating low oxygen levels in the blood due to poor heart function.
Pain in Other Areas of the Body: Discomfort or pain that radiates to the back, neck, jaw, stomach, or arms can be a symptom of a heart attack.
Heart Murmurs: Unusual sounds heard during a heartbeat, often indicating issues with heart valves that may require further investigation.
Rapid Weight Gain: Sudden weight gain due to fluid retention, which is a common symptom of heart failure.
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Medical Tests For Diagnosis of Cardiac Disorders
When a patient presents with symptoms suggestive of a cardiac disorder, several medical tests may be conducted to diagnose the underlying condition. Some of these basic tests may be prescribed by a GP first, who may further refer you to a cardiologist for complex investigations. An exhaustive list of tests related to cardiology include the following:
Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart to detect abnormalities in heart rhythm, structure, and function. It can help identify conditions such as arrhythmias, heart attacks, and ischemia.
Echocardiogram: An ultrasound of the heart that provides detailed images of heart structures and function. It can diagnose issues such as heart valve problems, cardiomyopathy, and heart failure.
Stress Test (Exercise or Pharmacologic): This test evaluates how the heart functions under stress, either through physical exercise or medication that mimics exercise. It helps identify coronary artery disease and assess the severity of heart conditions.
Chest X-ray: An imaging test that shows the size and shape of the heart and lungs, helping to detect heart failure, fluid buildup, and other heart-related issues.
Blood Tests: Various blood tests can indicate heart problems, including:
a) Troponin: Elevated levels suggest heart muscle damage, often due to a heart attack.
b) BNP or NT-proBNP: High levels indicate heart failure.
c) Cholesterol and Lipid Profile: Measures cholesterol levels to assess the risk of coronary artery disease.
d) Electrolytes and Kidney Function Tests: Assess overall health and the effects of heart disease on other organs.
Coronary Angiography: An invasive test that uses contrast dye and X-rays to visualise the coronary arteries. It helps detect blockages or narrowing that can lead to heart attacks.
Cardiac CT Scan: A non-invasive imaging test that provides detailed pictures of the heart and blood vessels. It can detect coronary artery disease, heart defects, and other structural issues.
Cardiac MRI: Uses magnetic fields and radio waves to create detailed images of the heart. It helps diagnose conditions such as cardiomyopathy, heart valve disease, and congenital heart defects.
Holter Monitor: A portable device worn for 24-48 hours to continuously record the heart's electrical activity. It helps detect intermittent arrhythmias and other heart rhythm issues.
Event Monitor: Similar to a Holter monitor but worn for a longer period (weeks to months). Patients activate it when they experience symptoms, recording heart activity at those times.
Tilt Table Test: Evaluates how the body responds to changes in position, helping diagnose conditions like syncope or fainting related to heart problems.
Nuclear Cardiology Tests: Such as a myocardial perfusion scan, use small amounts of radioactive material to assess blood flow to the heart muscle, identifying areas of reduced blood flow and damage.
These tests, often used in combination, provide a comprehensive assessment of heart health, helping cardiologists diagnose, manage, and treat cardiac disorders effectively.
Conditions Treated by Cardiology Department
The Department of Cardiology treats a wide range of heart and vascular conditions. Here are the primary types of conditions managed under this specialty:
Coronary Artery Disease (CAD): This involves the narrowing or blockage of the coronary arteries, usually due to atherosclerosis. It can lead to angina (chest pain), heart attacks, and heart failure. Heart bypass surgery is the one of the method of treatments for such cases.
Heart Attacks (Myocardial Infarction): Occur when blood flow to a part of the heart muscle is blocked for an extended period, causing damage or death to the heart muscle tissue.
Heart Failure: A condition where the heart cannot pump enough blood to meet the body's needs. It can be due to weakened heart muscle, stiff heart muscle, or other underlying heart conditions.
Arrhythmias: Abnormal heart rhythms, including atrial fibrillation, ventricular tachycardia, and bradycardia. These can cause palpitations, dizziness, fainting, or even sudden cardiac arrest.
Hypertension (High Blood Pressure): Chronic high blood pressure can damage the heart and arteries, leading to other cardiovascular diseases like stroke, heart attack, and heart failure.
Cardiomyopathy: Diseases of the heart muscle that can lead to heart failure. Types include dilated, hypertrophic, and restrictive cardiomyopathy.
Valvular Heart Disease: Disorders involving one or more of the heart valves, such as aortic stenosis, mitral valve prolapse, and valve regurgitation. These can cause symptoms like chest pain, shortness of breath, and fatigue.
Congenital Heart Defects: Structural heart problems present from birth, including conditions like atrial septal defect, ventricular septal defect, and Tetralogy of Fallot.
Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, which can cause chest pain and other symptoms.
Endocarditis: An infection of the inner lining of the heart chambers and valves, which can lead to severe complications if not treated promptly.
Aortic Aneurysms and Dissections: Bulging or tearing of the aorta, the main artery leaving the heart, which can be life-threatening and requires immediate medical attention.
Peripheral Artery Disease (PAD): Narrowing of the peripheral arteries, usually in the legs, leading to pain and mobility issues.
Pulmonary Hypertension: High blood pressure in the arteries of the lungs, which can strain the right side of the heart and lead to heart failure.
Hyperlipidemia (High Cholesterol): Elevated levels of cholesterol in the blood increase the risk of coronary artery disease and other cardiovascular problems.
Sudden Cardiac Arrest: A sudden, unexpected loss of heart function, often due to arrhythmias. Immediate medical intervention is crucial.
Cardiac Tumours: Rare growths in the heart that can be benign or malignant, requiring specialised treatment.
The cardiology department uses a variety of diagnostic tools, medications, lifestyle interventions, and surgical procedures to manage these conditions and improve patient outcomes.
Several disorders can indirectly cause cardiac issues by affecting the heart or the cardiovascular system. These conditions can lead to or exacerbate heart problems. Here are some of the key disorders:
Diabetes: High blood sugar levels can damage blood vessels and nerves that control the heart, increasing the risk of coronary artery disease, heart failure, and other heart conditions.
Chronic Kidney Disease: Poor kidney function can lead to high blood pressure and an imbalance of electrolytes, both of which can strain the heart and lead to cardiovascular diseases.
Obesity: Excess body weight can increase the risk of developing hypertension, diabetes, and high cholesterol, all of which are major risk factors for heart disease.
Thyroid Disorders: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can lead to heart problems. Hyperthyroidism can cause rapid or irregular heartbeats, while hypothyroidism can lead to a slow heart rate and elevated cholesterol levels.
Sleep Apnea: This disorder, characterised by repeated interruptions in breathing during sleep, can lead to high blood pressure, arrhythmias, and increased risk of heart failure and stroke.
Chronic Inflammatory Conditions: Diseases such as rheumatoid arthritis, lupus, and psoriasis involve chronic inflammation, which can damage the heart and blood vessels, increasing the risk of atherosclerosis and heart attacks.
Chronic Obstructive Pulmonary Disease (COPD): This lung condition can strain the heart, particularly the right side, leading to a condition known as cor pulmonale (right-sided heart failure).
Anaemia: A lack of red blood cells or haemoglobin can lead to inadequate oxygen supply to the heart, causing it to work harder and potentially leading to heart failure.
Infections: Certain infections, like rheumatic fever and viral infections, can directly affect the heart, leading to conditions like myocarditis (inflammation of the heart muscle) or endocarditis (infection of the heart's inner lining).
Chronic Stress and Mental Health Disorders: Conditions like chronic stress, anxiety, and depression can contribute to heart disease by leading to unhealthy behaviours, such as poor diet, smoking, and lack of exercise, as well as direct physiological effects like increased blood pressure and inflammation.
Liver Disease: Conditions like cirrhosis can lead to fluid retention and an increased workload on the heart, potentially causing heart failure.
Metabolic Syndrome: A cluster of conditions, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, that together increase the risk of heart disease, stroke, and diabetes.
Treatments Offered By Cardiology Department
The Cardiology Department offers a variety of treatments to manage and treat cardiovascular disorders. These treatments can range from lifestyle modifications and medications to advanced procedures and surgeries. Here’s an exhaustive list:
Lifestyle Modifications:
Dietary Changes: Adopting a heart-healthy diet, such as the DASH diet or Mediterranean diet, to manage weight, cholesterol, and blood pressure.
Exercise: Regular physical activity to improve cardiovascular health and overall fitness.
Smoking Cessation: Programs and support to help patients quit smoking.
Alcohol Moderation: Guidance on reducing alcohol consumption to lower blood pressure and improve heart health.
Stress Management: Techniques like meditation, yoga, and counselling to reduce stress and its impact on the heart.
Medications:
Antihypertensives: Drugs to lower blood pressure, including ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and diuretics.
Antiplatelets and Anticoagulants: Medications like aspirin, clopidogrel, warfarin, and newer anticoagulants to prevent blood clots.
Statins and Other Lipid-Lowering Agents: Drugs to reduce cholesterol levels and manage dyslipidemia.
Diuretics: Medications to reduce fluid buildup in the body, often used in heart failure treatment.
Antiarrhythmics: Drugs to control heart rhythm disorders, such as amiodarone and beta-blockers.
Nitrates: Medications like nitroglycerin to relieve chest pain (angina).
Digitalis: Drugs like digoxin to improve heart function in heart failure and atrial fibrillation.
Angiotensin-Converting Enzyme (ACE) Inhibitors: To relax blood vessels and reduce the workload on the heart.
Angiotensin II Receptor Blockers (ARBs): To relax blood vessels and lower blood pressure.
Non-Invasive Procedures:
Echocardiogram: An ultrasound of the heart to assess its structure and function.
Electrocardiogram (ECG): A test to measure the electrical activity of the heart.
Holter Monitoring: Continuous ECG monitoring over 24-48 hours to detect arrhythmias.
Stress Testing: Exercise or pharmacologic tests to evaluate heart function under stress.
Cardiac CT and MRI: Advanced imaging techniques to visualise heart structures and blood flow.
Invasive Procedures:
Cardiac Catheterization: A procedure to diagnose and treat heart conditions by inserting a catheter into the heart through blood vessels.
Coronary Angiography: Imaging to detect blockages in the coronary arteries.
Percutaneous Coronary Intervention (PCI): Procedures like angioplasty and stent placement to open blocked arteries.
Electrophysiology Studies (EPS): Tests to evaluate the heart’s electrical system and diagnose arrhythmias.
Surgical Treatments:
Coronary Artery Bypass Grafting (CABG): Surgery to bypass blocked coronary arteries.
Heart Valve Repair or Replacement: Procedures to fix or replace damaged heart valves.
Heart Transplant: Replacing a diseased heart with a healthy donor heart.
Left Ventricular Assist Device (LVAD) Implantation: A mechanical pump to support heart function in patients with severe heart failure.
Aneurysm Repair: Surgery to repair or remove a weakened section of an artery.
Device-Based Treatments:
Pacemakers: Devices to regulate heart rhythm in patients with bradycardia (slow heart rate).
Implantable Cardioverter-Defibrillators (ICDs): Devices to prevent sudden cardiac arrest by correcting life-threatening arrhythmias.
Cardiac Resynchronization Therapy (CRT): Devices to improve heart function in heart failure patients by coordinating the contractions of the heart’s chambers.
Advanced Therapies:
Catheter Ablation: A procedure to destroy small areas of heart tissue causing arrhythmias.
Transcatheter Aortic Valve Replacement (TAVR): A minimally invasive procedure to replace a narrowed aortic valve.
MitraClip Procedure: A minimally invasive treatment for mitral valve regurgitation.
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