Interventional Cardiology in the Elderly

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Cockburn stressed that this risk score should not be used to base decisions on whether to take very elderly patients to the cardiac catheterization laboratory. Discussants were emphatic in their agreement with Dr. Skip to main content. Conference Coverage. New risk score predicts PCI outcomes in octogenarians.

New risk score predicts PCI outcomes in octogenarians | MDedge Cardiology

By Bruce Jancin. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Free Preview. Buy eBook. Buy Hardcover. Buy Softcover. FAQ Policy. To become a pediatric cardiologist in the United States , one must complete a three-year residency in pediatrics, followed by a three-year fellowship in pediatric cardiology. As the center focus of cardiology, the heart has numerous anatomical features e.

Disorders of the heart lead to heart disease and cardiovascular disease and can lead to a significant number of deaths: cardiovascular disease is the leading cause of death in the United States and caused The primary responsibility of the heart is to pump blood throughout the body. It pumps blood from the body — called the systemic circulation — through the lungs — called the pulmonary circulation — and then back out to the body. This means that the heart is connected to and affects the entirety of the body.

Simplified, the heart is a circuit of the Circulation. While plenty is known about the healthy heart, the bulk of study in cardiology is in disorders of the heart and restoration, and where possible, of function.

The heart is a muscle that squeezes blood and functions like a pump. Each part of the heart is susceptible to failure or dysfunction and the heart can be divided into the mechanical and the electrical parts. The electrical part of the heart is centered on the periodic contraction squeezing of the muscle cells that is caused by the cardiac pacemaker located in the sinoatrial node. The action potentials generated in the pacemaker propagate throughout the heart in a specific pattern.

The system that carries this potential is called the electrical conduction system. Dysfunction of the electrical system manifests in many ways and may include Wolff—Parkinson—White syndrome , ventricular fibrillation , and heart block. The mechanical part of the heart is centered on the fluidic movement of blood and the functionality of the heart as a pump.

The mechanical part is ultimately the purpose of the heart and many of the disorders of the heart disrupt the ability to move blood. Failure to move sufficient blood can result in failure in other organs and may result in death if severe. Heart failure is one condition in which the mechanical properties of the heart have failed or are failing, which means insufficient blood is being circulated. Coronary circulation is the circulation of blood in the blood vessels of the heart muscle myocardium. The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries. The vessels that remove the deoxygenated blood from the heart muscle are known as cardiac veins.

New risk score predicts PCI outcomes in octogenarians

These include the great cardiac vein , the middle cardiac vein , the small cardiac vein and the anterior cardiac veins. As the left and right coronary arteries run on the surface of the heart, they can be called epicardial coronary arteries. These arteries, when healthy, are capable of autoregulation to maintain coronary blood flow at levels appropriate to the needs of the heart muscle. These relatively narrow vessels are commonly affected by atherosclerosis and can become blocked, causing angina or a heart attack.

See also: circulatory system. The coronary arteries that run deep within the myocardium are referred to as subendocardial.


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The coronary arteries are classified as "end circulation", since they represent the only source of blood supply to the myocardium; there is very little redundant blood supply, which is why blockage of these vessels can be so critical. The cardiac examination also called the "precordial exam" , is performed as part of a physical examination , or when a patient presents with chest pain suggestive of a cardiovascular pathology.

It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation. Cardiology is concerned with the normal functionality of the heart and the deviation from a healthy heart. Many disorders involve the heart itself but some are outside of the heart and in the vascular system.

Collectively, the two together are termed the cardiovascular system and diseases of one part tend to affect the other. Hypertension , also known as "high blood pressure"", is a long term medical condition in which the blood pressure in the arteries is persistently elevated. Lifestyle factors can increase the risk of hypertension. These include excess salt in the diet, excess body weight , smoking , and alcohol. Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively.

Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications. Essential hypertension is the form of hypertension that by definition has no identifiable cause. Prevalence of essential hypertension increases with age , and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension. Hypertension can increase the risk of cerebral , cardiac , and renal events. Secondary hypertension is a type of hypertension which is caused by an identifiable underlying secondary cause.

It has many different causes including endocrine diseases , kidney diseases , and tumors.

It also can be a side effect of many medications. Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure. Cardiac arrhythmia , also known as "cardiac dysrhythmia" or "irregular heartbeat", is a group of conditions in which the heartbeat is irregular, too fast, or too slow.

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A heart rate that is too fast — above beats per minute in adults — is called tachycardia and a heart rate that is too slow — below 60 beats per minute — is called bradycardia. When symptoms are present these may include palpitations or feeling a pause between heartbeats. More seriously there may be lightheadedness , passing out , shortness of breath , or chest pain. There are four main types of arrhythmia: extra beats , supraventricular tachycardias , ventricular arrhythmias , and bradyarrhythmias.

Extra beats include premature atrial contractions , premature ventricular contractions , and premature junctional contractions. Supraventricular tachycardias include atrial fibrillation , atrial flutter , and paroxysmal supraventricular tachycardia. Ventricular arrhythmias include ventricular fibrillation and ventricular tachycardia. Most arrhythmias can be effectively treated. Medications for a fast heart rate may include beta blockers or agents that attempt to restore a normal heart rhythm such as procainamide.

Parin Parikh, M.D., Interventional Cardiology and Cardiovascular Medicine

This later group may have more significant side effects especially if taken for a long period of time. Pacemakers are often used for slow heart rates.

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Those with an irregular heartbeat are often treated with blood thinners to reduce the risk of complications. Those who have severe symptoms from an arrhythmia may receive urgent treatment with a jolt of electricity in the form of cardioversion or defibrillation. Arrhythmia affects millions of people.

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