You might be familiar with cardiology, which is the medical specialty dealing with heart ailments. But what is interventional cardiology? Interventional cardiology is a subspecialty of cardiology that involves specialized imaging and other diagnostic techniques to check blood flow in the coronary arteries and chambers of the heart, as well as catheter-based procedures and medications to treat problems in the cardiovascular system. Interventional cardiology specialists diagnose and treat coronary artery disease, vascular disease and acquired structural heart disease. Pediatric interventional cardiologists focus mainly on the diagnosis and treatment of congenital heart defects.
But how are interventional cardiologists different from general cardiologists or cardiac surgeons? Let’s dive further to understand this unique field.
What Is Interventional Cardiology, And How Is It Different From Other Cardiological Subspecialties?
Interventional cardiologists are trained to perform specific catheter-based procedures for heart ailments which general cardiologists are not trained to do. Interventional cardiologists perform procedures such as placing stents in clogged arteries, repairing holes in the heart, and placing special devices in the heart to help it function properly.
General cardiologists treat patients with conditions such as hypertension, high cholesterol, and elevated risk of heart attack or stroke, but they are not trained to perform open-heart surgeries or endoscopic procedures.
Cardiac surgeons are qualified to perform open-heart surgeries, such as coronary artery bypass surgery. They are referred to when the procedures of interventional cardiology or general cardiology are not enough to treat the disease, as neither general cardiologists nor interventional cardiologists perform surgery.
What Conditions Do Interventional Cardiologists Treat?
Interventional cardiologists treat a wide range of conditions, such as:
- Acute coronary syndromes
- Aortic aneurysm
- Aortic diseases and dissection
- Atrial septal defect (ASD)
- Cardiovascular disease
- Carotid artery disease
- Congenital heart disease
- Congestive heart failure
- Coronary artery disease
- Diabetes and heart disease
- Heart attack
- Peripheral artery disease (PAD)
- Peripheral vascular disease (PVD)
- Renovascular disease
What Types Of Interventional Cardiology Procedures Are Done?
Interventional cardiologists prescribe imaging tests for a detailed view of the structure and functioning of the heart. Some of the types of imaging procedures they perform are:
- Cardiac computed tomography (CCT): Interventional cardiologists use CCT to look at the cross-sectional views of the heart’s anatomy, circulation, and the greater vessels of the cardiovascular system to check for and treat many cardiovascular issues, including aortic disease, cardiac masses, pericardial disease, and problems with the myocardium, coronary arteries, and pulmonary veins.
- Coronary angiography: A contrast dye is injected into the bloodstream through a catheter and is visible in X-ray images as blood flows through the arteries. Doctors use this technique to find any blockages in the heart.
- Digital subtraction angiography (DSA): This fluoroscopic imaging method makes blood vessels more clearly visible by digitally “subtracting” bones from the images.
- Echocardiogram: This method creates images of the heart’s chambers, valves, walls, and blood vessels using ultrasound. An echocardiogram shows the movement of the heart, how strong the pumping is, valve function, if there is blood leakage through the valves, if the valves are too narrow (stenosis), or if there are any tumors or infectious growths. Doctors use this method to determine if a patient has had a heart attack, predict if one is developing, and monitor changes in the heart rhythm.
- Intravascular ultrasound: This is a catheter-based diagnostic method that creates images of the inside of blood vessels using sound waves, which doctors use to evaluate the coronary arteries.
- Magnetic resonance imaging (MRI): Cardiac MRI creates detailed images of the structures in and around the heart. These images are then used to monitor the heart’s structure and functioning amid a heart disease. The images are generated using a magnetic field, radio waves, and a computer, but without radiation.
- Myocardial perfusion imaging (MPI): A radioactive substance called thallium is injected into the bloodstream, and the patient is made to exercise to increase their heart rate. The imaging shows the patient’s heart functioning when the patient is at rest and when exercising. Doctors then use the readings to determine the size of the coronary artery blockage, the extent of damage caused by a heart attack, the cause of chest pain, and a safe level of exercise for patients.
Interventional cardiologists perform a variety of procedures, such as:
- Alcohol septal ablation: This catheter-based procedure is a non-surgical way to treat hypertrophic cardiomyopathy (HCM), which is the thickening of the heart muscle.
- Angioplasty: This procedure is used to open up a blocked artery by using a device like a balloon or a stent.
- Cardiac catheterization: This method involves inserting into a large blood vessel that leads into the heart.
- Atrial septal defect (ASD) closure: Doctors use this procedure to treat atrial septal defects, which are holes in the heart present at birth.
- Aortic balloon valvuloplasty and mitral balloon valvuloplasty: Doctors use this procedure to increase blood flow when the patient has a narrowing of the aortic valve or the mitral valve.
- Directional coronary atherectomy (DCA): This endovascular procedure is used to remove blockages from coronary arteries, improving blood flow to the heart muscle and relieving pain (angina).
- Endovascular thrombectomy: This procedure is performed when a blood clot (thrombus) that is blocking an artery has to be removed.
- Exercise stress test: Patients are made to walk on a treadmill with electrodes attached to their test, and information about the heart is recorded through the electrodes.
- Percutaneous valve repair: Doctors can repair diseased heart valves using minimally invasive techniques.
- Rotational atherectomy: This is a catheter-based procedure that removes complex calcified lesions in the coronary arteries.
- Stenting: Doctors insert a stent, which is a tiny device, in the coronary artery to widen a blocked coronary artery.
- Transcatheter aortic valve replacement (TAVR): A narrowed aortic valve that doesn’t open and closes properly is replaced using this endoscopic procedure.
How To Become An Interventional Cardiologist?
To become an interventional cardiologist, aspiring doctors must first complete four years of pre-med, followed by four years of med school. They must then complete a residency in general cardiology and then a minimum one-year interventional cardiology fellowship in addition to the specialized training required for cardiology. Some doctors choose to complete an additional nonaccredited year of interventional catheterization to be qualified to perform pediatric interventional catheterization.
Those with an inclination towards biotechnology, physics and hydrodynamics will find interventional cardiology fascinating as this field of medicine is based on device-based research and innovation. Becoming a successful specialist in this field requires additional years of career preparation and a lifelong commitment to learning, including maintenance of certification.
What Else To Know About Interventional Cardiology?
It is very common in an interventional cardiologist’s workday to attend to emergency situations, for which they have many on-call shifts. The job description includes performing X-rays for which they are required to wear heavy lead protection gear. They can find work in cardiology and multispecialty private practices; private, government and military hospitals; and medical schools and universities. An interventional cardiologist possesses other traits such as strong communication skills, confidence, technical skills, empathy, and determination to be a successful specialist. Doctors may face stiff competition while pursuing a career in this field, and while it certainly can be a stressful job, it is a highly rewarding career as many of the treatments they perform are lifesaving.