Editing Cardiology (section)

===Adult cardiology===
Cardiology is a specialty of [[internal medicine]].

To become 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 U.S. by the [[Accreditation Council for Graduate Medical Education]] are [[clinical cardiac electrophysiology]], [[interventional cardiology]], adult congenital heart disease, and advanced heart failure and transplant cardiology. Cardiologists may further become certified in echocardiography by the National Board of Echocardiography,<ref>echoboards.org</ref> in nuclear cardiology by the Certification Board of Nuclear Cardiology, in cardiovascular computed tomography by the Certification Board of Cardiovascular Computed Tomography in cardiovascular MRI by the Certification Board of Cardiovascular Magnetic Resonance.<ref>apca.org/certifications-examinations/cbnc-and-cbcct/</ref> Recognized subspecialties in the U.S. by the [[American Osteopathic Association Bureau of Osteopathic Specialists]] include [[clinical cardiac electrophysiology]] and [[interventional cardiology]].<ref>{{cite web|title=Specialties & Subspecialties|url=http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/specialty-subspecialty-certification.aspx|publisher=American Osteopathic Association|access-date=23 September 2012|archive-url=https://web.archive.org/web/20150813083503/http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/specialty-subspecialty-certification.aspx|archive-date=2015-08-13|url-status=dead}}</ref>

In India, a three-year residency in General Medicine or Pediatrics after [[M.B.B.S.]] and then three years of residency in cardiology are needed to be a D.M. (holder of a Doctorate of Medicine [D.M.])/[[Diplomate of National Board]] (DNB) in Cardiology.{{citation needed|date=April 2021}}

Per [[Doximity]], adult cardiologists earn an average of $436,849 per year in the U.S.<ref name=r1>Hamblin, James (January 27, 2015) [https://www.theatlantic.com/health/archive/2015/01/physician-salaries/384846/ What Doctors Make]. theatlantic.com</ref>

==== Cardiac electrophysiology ====
{{Main|Cardiac electrophysiology}}

Cardiac electrophysiology is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to describe studies of such phenomena by invasive (intracardiac) [[Cardiac catheterization|catheter]] recording of spontaneous activity as well as of cardiac responses to [[programmed electrical stimulation]] (PES). These studies are performed to assess complex [[arrhythmia]]s, elucidate symptoms, evaluate abnormal [[electrocardiograms]], assess risk of developing arrhythmias in the future, and design treatment.  These procedures increasingly include therapeutic methods (typically [[radiofrequency ablation]], or [[cryoablation]]) in addition to diagnostic and prognostic procedures.

Other therapeutic modalities employed in this field include [[antiarrhythmic drug]] therapy and implantation of [[artificial pacemaker|pacemakers]] and automatic [[implantable cardioverter-defibrillators]] (AICD).<ref name=Fauci>Fauci, Anthony, et al. ''Harrison's Textbook of Medicine''. New York: McGraw Hill, 2009.</ref><ref>Braunwald, Eugene, ed. ''Heart Disease, 6th edition.'' Philadelphia: Saunders, 2011.</ref>

The cardiac [[electrophysiology study]] typically measures the response of the injured or cardiomyopathic myocardium to PES on specific pharmacological regimens in order to assess the likelihood that the regimen will successfully prevent potentially fatal sustained [[ventricular tachycardia]] (VT) or [[ventricular fibrillation]] (VF) in the future. Sometimes a ''series'' of electrophysiology-study drug trials must be conducted to enable the cardiologist to select the one regimen for long-term treatment that best prevents or slows the development of VT or VF following PES. Such studies may also be conducted in the presence of a newly implanted or newly replaced cardiac pacemaker or AICD.<ref name=Fauci />

==== Clinical cardiac electrophysiology ====
{{Main|Clinical cardiac electrophysiology}}

Clinical cardiac electrophysiology is a branch of the medical specialty of cardiology and is concerned with the study and treatment of rhythm disorders of the heart. Cardiologists with expertise in this area are usually referred to as electrophysiologists. Electrophysiologists are trained in the mechanism, function, and performance of the electrical activities of the heart. Electrophysiologists work closely with other cardiologists and cardiac surgeons to assist or guide therapy for heart rhythm disturbances (arrhythmias). They are trained to perform interventional and surgical procedures to treat cardiac arrhythmia.<ref name="pmid35695795">{{cite journal | vauthors = Cox JL, Churyla A, Malaisrie SC, Kruse J, Kislitsina ON, McCarthy PM | title = A history of collaboration between electrophysiologists and arrhythmia surgeons | journal = J Cardiovasc Electrophysiol | volume = 33 | issue = 8 | pages = 1966–1977 | date = August 2022 | pmid = 35695795 | pmc = 9543838 | doi = 10.1111/jce.15598 }}</ref>

The training required to become an electrophysiologist is long and requires eight years after medical school (within the U.S.). Three years of internal medicine residency, three years of cardiology fellowship, and two years of clinical cardiac electrophysiology.<ref name="pmid30566044">{{cite journal | vauthors = DeMazumder D | title = The Path of an Early Career Physician and Scientist in Cardiac Electrophysiology | journal = Circ Res | volume = 123 | issue = 12 | pages = 1269–1271 | date = December 2018 | pmid = 30566044 | pmc = 6338224 | doi = 10.1161/CIRCRESAHA.118.314016 }}</ref>

==== Cardiogeriatrics ====
{{Main|Cardiogeriatrics}}

Cardiogeriatrics, or geriatric cardiology, is the branch of cardiology and geriatric medicine that deals with the cardiovascular disorders in elderly people.

Cardiac disorders such as [[coronary heart disease]], including [[myocardial infarction]], [[heart failure]], [[cardiomyopathy]], and arrhythmias such as [[atrial fibrillation]], are common and are a major cause of mortality in elderly people.<ref>{{Cite web|url=https://www.cdc.gov/nchs/data/ahcd/agingtrends/06olderpersons.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.cdc.gov/nchs/data/ahcd/agingtrends/06olderpersons.pdf |archive-date=2022-10-09 |url-status=live|title=Trends in Causes of Death among Older Persons in the United States}}</ref><ref>{{cite journal | vauthors = Dodson JA | title = Geriatric Cardiology: An Emerging Discipline | journal = Canadian Journal of Cardiology | date=September 2016 | doi = 10.1016/j.cjca.2016.03.019 |volume=32|issue=9| pages = 1056–1064 | pmid = 27476988| pmc = 5581937 }}</ref> Vascular disorders such as [[atherosclerosis]] and [[peripheral arterial disease]] cause significant morbidity and mortality in aged people.<ref>{{Cite journal|last1=Golomb Beatrice A.|last2=Dang Tram T.|last3=Criqui Michael H.|date=2006-08-15|title=Peripheral Arterial Disease|journal=Circulation|volume=114|issue=7|pages=688–699|doi=10.1161/CIRCULATIONAHA.105.593442|pmid=16908785|s2cid=5364055|doi-access=free}}</ref><ref>{{Cite journal|last1=Yazdanyar|first1=Ali|last2=Newman|first2=Anne B.|date=2010-11-01|title=The Burden of Cardiovascular Disease in the Elderly: Morbidity, Mortality, and Costs|journal=Clinics in Geriatric Medicine|volume=25|issue=4|pages=563–vii|doi=10.1016/j.cger.2009.07.007|issn=0749-0690|pmc=2797320|pmid=19944261}}</ref>

==== Imaging ====
{{further|Echocardiography|Cardiac magnetic resonance imaging|Computed tomography of the heart}}

Cardiac imaging includes echocardiography (echo), cardiac magnetic resonance imaging (CMR), and computed tomography of the heart.
Those who specialize in cardiac imaging may undergo more training in all imaging modes or focus on a single imaging modality.

Echocardiography (or "echo") uses standard two-dimensional, three-dimensional, and [[Doppler ultrasound]] to create images of the heart. It is used to evaluate and quantify cardiac size and function, valvular function, and can assist with diagnosis and treatment of conditions including heart failure, heart attack, valvular heart disease, congenital heart defects, pericardial disease, and aortic disease. 
Those who specialize in echo may spend a significant amount of their clinical time reading echos and performing transesophageal echo, in particular using the latter during procedures such as insertion of a left atrial appendage occlusion device. Transesophageal echo provides higher spatial resolution than trans thoracic echocardiography and because the probe is located in the esophagus, it is not limited by attenuation due to anterior chest structures such as the ribs, chest wall, breasts, lungs that can hinder the quality of trans thoracic echocardiography. It is generally indicated for a variety of indications including: when the standard transthoracic echocardiogram is non diagnostic, for detailed evaluation of abnormalities that are typically in the far field, such as the aorta, left atrial appendage, evaluation of native or prosthetic heart valves, evaluation of cardiac masses, evaluation of endocarditis, valvular abscesses, or for the evaluation of cardiac source of embolus. It is frequently used in the setting of atrial fibrillation or atrial flutter to facilitate the clinical decision with regard to anticoagulation, cardioversion and/or radio frequency ablation.<ref>aseecho.org</ref>

Cardiac MRI utilizes special protocols to image heart structure and function with specific sequences for certain diseases such as [[hemochromatosis]] and [[amyloidosis]].

Cardiac CT utilizes special protocols to image heart structure and function with particular emphasis on coronary arteries.

==== Interventional cardiology ====
{{Main|Interventional cardiology}}

Interventional cardiology is a branch of cardiology that deals specifically with the [[catheter]] based treatment of structural heart diseases.<ref>{{Cite journal |last=King |first=Spencer B |date=March 1998 |title=The Development of Interventional Cardiology |url=https://doi.org/10.1016/S0735-1097(97)00558-5 |journal=Journal of the American College of Cardiology |volume=31 |issue=4 |pages=64B–88B |doi=10.1016/s0735-1097(97)00558-5 |pmid=9530288 |issn=0735-1097|url-access=subscription }}</ref> A large number of procedures can be performed on the heart by catheterization, including angiogram, angioplasty, atherectomy, and stent implantation. These procedures all involve insertion of a sheath into the [[femoral artery]] or radial artery (but, in practice, any large peripheral artery or vein) and [[cannula]]ting the heart under {{Nowrap|X-ray}} visualization (most commonly [[fluoroscopy]]). This cannulation allows indirect access to the heart, bypassing the trauma caused by surgical opening of the chest.

The main advantages of using the interventional cardiology or radiology approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary [[angioplasty]] is now the gold standard of care for an acute myocardial infarction. This procedure can also be done proactively, when areas of the vascular system become occluded from [[atherosclerosis]]. The Cardiologist will thread this sheath through the vascular system to access the heart. This sheath has a balloon and a tiny wire mesh tube wrapped around it, and if the cardiologist finds a blockage or [[stenosis]], they can inflate the balloon at the occlusion site in the vascular system to flatten or compress the plaque against the vascular wall. Once that is complete a [[stent]] is placed as a type of scaffold to hold the vasculature open permanently.

====Cardiomyopathy/heart failure====
A relatively newer specialization of cardiology is in the field of heart failure and heart transplant. Cardiomyopathy is a disease of the heart muscle that make it larger or stiffer, sometimes making the heart worse at pumping blood.<ref>{{Cite web |title=Cardiomyopathy |url=https://medlineplus.gov/cardiomyopathy.html |access-date=2024-06-03 |website=medlineplus.gov}}</ref> Specialization of general cardiology to just that of the [[cardiomyopathy|cardiomyopathies]] leads to also specializing in [[heart transplant]] and [[pulmonary hypertension]].

====Cardiooncology====
{{main|Cardiooncology}}
A recent specialization of cardiology is that of cardiooncology.
This area specializes in the cardiac management in those with cancer and in particular those with plans for [[chemotherapy]] or those who have experienced cardiac complications of chemotherapy.