Cardiology

Cardiology is the branch of science that studies heart and circulatory system diseases.

Major Areas of Interest of Cardiology

Heart Rhythm disturbances (Arrhythmia)

Arrhythmia means a deterioration in rhythmic operation of the heart. In arrhythmia, heart beat becomes so fast that the person can easily feel. Moreover, heart rhtym can be irregular but slow. Skipping is felt during heart beat.

Most patients are treated with medications. Apart from these, cardiac defibrillators are used. Defibrillator is a tool that ensures return of abnormal heart beat back to a normal heart rhythm. The device is implanted inside a muscle in the chest area and heart rhythm is kept under control in this manner. It gives an electrical shock if necessary and corrects the arrhythmia. Another feature of this device is that it can distinguish a serious arrhythmia from a life-threatening one. Its treatment methods include medication, surgery, pacemaker, and ICD.

Moreover, a method we call radio waves is used to treat tachycardia for which medication treatment has been ineffective. In this method, the point which causes palpitations is burnt by a special tube. Thus, palpitations and high pulse are eliminated. After this procedure, aspirin is used for some time and clot formation is inhibited. Patients would be spared from a lifetime drug use.

Heart Attack

A heart attack occurs as a result of damage to a certain part of heart muscle due to inadequate blood flow to that region. One of every 5 sudden deaths is caused by heart attack. Heart attack is one of the main causes of sudden death in adults.

Most heart attacks result from clots in the arteries carrying blood and oxygen to the heart muscle. A clot in the coronary artery prevents blood and oxygen flow to the heart muscle, and this in turn causes death of heart cells in that area. A damaged heart muscle loses its ability to contract and the remainder of the heart becomes obliged to perform the job of this damaged part.

Causes of heart attack include hypertension, hypercholesterolemia, diabetes, smoking, and family history of early coronary heart disease. Most of these risk factors are associated with being overweight. Formation of a clot on a narrow vein can be caused by anything. Sometimes it can be caused by a sudden and overwhelming stress.

The main complaint of patients having a heart attack is chest pain.

A heart attack is an emergency. It requires hospitalization and intensive care because fatal rhythm disturbance is the leading cause of death during the first few hours of a heart attack.

The goals of treatment are to stop the progression of heart attack, keep heart damage at a minimum level, reduce the demands of the heart, and prevent complications so that it can heal.

Myocarditis (Inflammation of Heart Muscle)

It is inflammation of the heart muscle developing in connection with various diseases. In severe cases of rheumatism, flu, smallpox, diphtheria, typhoid, and scarlet fever, disease-causing bacteria may also cause inflammation of the heart muscle.

In the treatment of inflammation of the heart muscle, healing can be achieved by use of antibiotics and rest. If one fails to follow the advice on resting during treatment period, serious side effects may develop as well as patients with flue who are exhausted and do heavy exercise are at risk of arrhythmia induced sudden death. It is essential to treat dental caries and ailments such as tonsillitis, which cause acute rheumatic fever, without delay.

In the treatment, the primary disease which causes inflammation of the heart muscle should be identified and treated.

Pericarditis (Inflammation of pericardium)

Pericarditis is inflammation of the pericardium. It is usually acute, i.e. it develops suddenly and may continue for several months. You could see that this membrane surrounding the heart is irritated and swollen just like an inflamed cut on your skin. It sometimes causes accumulation of excess fluid around the heart.

Pericardium is a thin, bilayer and fluid-filled sac that covers outer surface of the heart. It protects the heart from infection and malignancy, and allows the heart to stay in the chest wall. In addition, when blood volume is increased, it prevents excessive expansion of the heart, ensuring that the heart continues to function effectively.

In most patients with pericarditis, medication therapy is sufficient and does not require surgery in general.

Sometimes build-up of fluid in the pericardium causes a heart spasm. In such a case, excess fluid must be drained.

Some patients with constrictive pericarditis may require surgery. Pericardiectomy is a surgery in which a portion of the pericardium is removed. Recurrent pericarditis rarely involves surgery to control pain.

Coronary Artery Disease

Coronary arteries are arteries that surround the heart and supply blood to the heart. Old age and many other factors cause hardening of these soft and flexible arteries. These grow into veins over time and then called plaques. Because of these plaques, the vessels lose their flexibility; the vessels expand at times of demand and fail to supply blood to the heart muscle. The plaques also distub straight and smooth vessel surface and cause it to have a rough surface. These rough surfaces may cause clot formation and such clots may prevent blood flow over time and cause sudden blockage of the vessel. This condition which emerges with advancing age is called arteriosclerosis.

A patient’s condition also determines the method of treatment. Drug therapy or surgical treatment can be applied.

The first preferred method is usually drug treatment. If the disease has a chronic course, treatment takes a long time. The aim of drug therapy is to prevent chest pain, expand blood vessels and reduce the heart’s need for oxygen. Drugs are also used to eliminate factors causing this disease. In case of diabetes, high cholesterol, drugs are also used to prevent these conditions. Moreover, possible heart attack risk is reduced by using drugs like aspirin, which increase the viscosity of blood and inhibit clot formation in the vessel.

In advanced stage of the disease, surgery, including bypass surgery and angioplasty, is performed to unblock heart vessels.

Heart Valve Diseases

Heart valve diseases can be congenital or they may arise from rheumatic diseases experienced in childhood, senile calcification, various infections, and degeneration of the valve.

In heart valve condition, the first treatment option is repair of the valve. However, if repair is not possible, artificial heart valves are implanted into the patients. If medical condition of the patient doesn’t allow open surgery, the valve can be implanted by entering through groin artery called TAVİ.

Aortic Aneurysm

It means ballooning of the aorta. Diameter of the aorta reaches a width above normal values as a result of deteriorations in its wall structure.

Aneurysm repair by endovascular method is also a frequently preferred method of treatment. In endovascular treatment, aorta region where aneurysm is found is repaired via a stent guided through a catheter introduced from the groin. However, endovascular method may not be suitable for every patient. The patient’s vessel structure needs to be suitable for treatment of aneurysm by endovascular method. Open surgery method is utilized in patients who are not suitable.

Congenital Heart Diseases in Children

Congenital heart diseases are anomalies that occur during prenatal development of the unborn baby in mother’s womb and the majority of heart problems occurring in children are congenital problems. These anomalies can be classified as follows:

Holes in the heart
Anomalies that cause stenosis or regurgitation in heart valves,
Anomalies in vessels going into or coming out of the heart,
Congestive Heart Failure: It is a condition encountered in many heart anomalies. Heart pump doesn’t work as powerful as necessary so fluid begins to build up in lungs and other organs and causes edema (swelling). Children with congestive heart failure get tired quickly, and they have fast and troubled breathing. Diuretic drugs help remove excess fluid that accumulates while implementation of a low-salt diet may be necessary. Feeding infants with congestive heart failure often proves to be problematic.
Heart Rhythm Problems Sometimes the heartbeat may be too fast(tachycardia ) or too slow (bradycardia). One may have to use medication to bring heartbeat rate back to normal level.

Congenital heart disease is a rare disorder and in most cases, the cause of the disease is unknown. However, the following factors are known to be effective in congenital anomalies:

Certain viral diseases. For example, rubella, etc. during pregnancy,
Genetic factors
Medicines used during pregnancy, alcohol, drugs, exposure to x-ray beam,
Consanguineous marriage,
Diabetic mother

Some of the children with cardiac anomaly can be adequately treated with medications. Where drug therapy is not enough, a series of invasive therapies by catheterization and surgical treatment are applied.

Invasive therapies by catheterization include:

Baloon septostomy: In some cardiac abnormalities, adequate mixing of clean and dirty blood inside the heart is essential for survival of the baby. For this, a baloon-tipped catheter is introduced into the heart and a hole is made in upper chambers of the heart.
Valvotomy: Some narrow heart valves can also be opened by a balloon during catheterization without surgery.
Coil Embolization and Umbrella Implementation: Some heart holes and vessel openings which do not close can be closed during catheterization.
Electrophysiology and Ablation: In children with certain rhythm problems, cardiac catheterization can be utilized to find focuses that cause this problem and rhythm problem can be treated by burning these focuses by a method called “ablation” during the catheterization.

Diagnostic Methods Used in Cardiology

Cardiac MR

MR is a very old procedure that can display internal organs and tissues in a clear and detailed manner. However, its use in cardiology has improved in recent years.

Echocardiography (ECHO)

Echocardiography is an imaging method performed by using sound waves. It shows how the heart muscle and valves work. It also provides information about how wide is your heart.

Exercise Testing

Exercise Testing is a test applied by a cardiologist or a corresponding technician to test effects of exercise on the heart.

During the test, electrical activity of the patient’s heart is recorded and analyzed on a computer, while the patient is walking or running on a treadmill. This test measures reaction of the heart to increasing need of the body for oxygen. The test is continued until targeted heart rate is reached or the moment when the patient says s/he can no longer continue.

Holter

Holter test is a diagnostic method implemented in patients thought to have a tension problem or heart diseases such as arrhythmia. There are 2 types of holter:

Tension holter
Rhytm holter

In tension holter, blood pressure is measured and recorded at certain intervals for 24 hours. The device consists of a wristband and a recorder. Data received from holter device are uploaded to a computer and analyzed and blood pressure is monitored daily.

Rhythm Holter

Rhythm Holter is performed using a portable ECG recorder. Its purpose is to monitor heart rhythm of a person during his daily life. The procedure involves recording electrical activity of the heart to a cassette for minimum 24 hrs.

ECG (Electrocardiography)

The heart works by electrical impulses from sinoatrial node. The procedure of recording these electrical currents created in the heart on paper is called Electrocardiography (ECG).

Thallium Scintigraphy

Thallium scintigraphy is based on whether radioactive substances such as thallium are taken up by heart muscle or not. The radiation dose which the patient is exposed to during the test is no more than having a normal chest x-ray.

Coronary Angiography

Coronary Angiography is a diagnosis method, rather than a treatment as opposed to popular belief. Coronary angiography is a procedure utilizing x-rays, which allows imaging

In this procedure, a thin plastic tube is placed in arm or groin vessel. Then, a long, thinner and flexible plastic tube called a catheter is passed through this and guided through the artery. When coronary arteries are reached, an agent called an X-ray dye is injected into the arteries. Thus, motion picture images of coronary arteries which have become visible are created at that moment. Then this angiography motion picture image is watched to reveal the problem in your coronary arteries.

Treatment Methods Used in Cardiology

Temporary Pacemakers

The patient’s heart rate slows down dramatically because of the fact that impulse center in his heart can not create impulses at satisfactory rate or the impulse is interrupted for various reasons, and a normal heart rate should be re-established so that the patient maintains a normal life. An artificial pacemaker is needed to bring heart rate to a normal level.

Temporary pacemakers are utilized in emergencies or if the underlying cause of abnormal heart rhythm is expected to improve (e.g. drug-induced slowing down of heart’s operation, etc.) or until a permanent pacemaker is implanted.

Temporary cardiac pacing may be required in heart attack patients, patients with tachycardia after an open-heart surgery.

Pacemakers

Pacemakers are used for persistent rhythm disorders. Millions of people use pacemakers worldwide.

The procedure is conducted by a local anesthesia. An incision is made on subcutaneous region which is 1-2 cm below either right or left collar bone to create a small pocket wide enough to house the pacemaker. Leads, which are passed through large vessels to the heart and will ensure transmission between the heart and generator, are placed in one of or both ventricles. Then these electrodes are connected to the generator to be inserted subcutaneously. Generator is introduced into the subcutaneous pocket in the chest or abdomen.

Permanent pacemakers are highly developed technology products, and they constantly check the operation of the heart and intervene when necessary. They eliminate the patient’s complaints, including fainting, dizziness, and shortness of breath because of slow down of the heart rate and provide significant contribution to the quality of life.

Electrophysiology Study

Electrophysiology study is an invasive method in which fine wires, called electrode catheters, are passed through fine sheaths placed in groin or neck vessels, and then placed in the heart. Electrical signals directly received from inside the heart are evaluated with advanced computers and any deviations from normal are determined. Rapid heart beat, which is mostly the cause of complaints in patients with rapid heart beat, palpitations, is created by impulses given by these wires placed inside the heart by special techniques, and their causes are investigated. When presence of short circuits is detected, tachycardia can be completely treated by applying a special current point energy consisting of radio waves.

In this way, today, it has become possible to permanently heal most palpitations in the form of rapid heart beat.

Catheter Ablation

Catheter ablation is an arrhythmia therapy performed by burning the region causing palpitations using radio waves. The procedure is often done under local anesthesia.

This method is administered in the case of arrhythmias which cannot be controlled by medications or of patients unwilling to take lifelong medications. Direct ablation method can also be applied in patients with certain life-threatening severe arrhythmias.

Mitral Balloon (Valvuloplasty)

Mitral stenosis is a disease having symptoms in advanced stages induced by involvement of heart valves in “Acute Rheumatic fever”, a childhood disease. Mitral stenosis is a narrowing that makes it difficult for the blood to pass from one of the chambers inside the heart to another. For this reason, blood accumulates in the lungs. This causes the person to feel shortness of breath. In the case of mild stenosis, drug treatment is sufficient, but in the case of moderate and severe stenosis, mitral Valvuloplasty or open-heart surgery is performed.

Mitral Valvuloplasty is a system performed by entering from the groin using a catheter and which is based on remedying the stenosis by positioning a balloon at the place of stenosis. The procedure is performed under local anesthesia.

Stent

Stent is a cylindrical mesh knitted using very fine metallic wires, inserted into a vessel wall to reduce possibility of re-narrowing of a vessel which has been opened by balloon procedure.

This fine tube is guided through groin artery. By monitoring on the screen, it is ensured that deflated balloon on its tip and deflated stent on it is placed inside the stenosis in the vessel.

The largest difference between stents in terms of reducing the possibility of re-narrowing of the dilation created is whether it is covered by a medication or not.

Normal stents (without medication) are partially helpful against such re-narrowing. In the case of stents with medication, special medications prevent cells from multiplying on vessel wall and re-narrowing it. This release is definitely not permanent. However, release of the medication during initial stages when re-narrowing occurs most frequently proves to be adequate.