history of cardiology

2. The field includes medical diagnosis and treatment
of congenital heart defects, coronary artery
disease, heartfailure, valvular heart disease and
electrophysiology

4. Heart :
its function was first defined by William Harvey, a
British physician
In his publication in 1628,De Motu Cordis, Harvey
stated: “It has been shown by reason and experiment
that by the beat of the ventricles blood flows through the
lungs and it is pumped to the whole body. There it
passes through pores in the flesh into the veins through
which it returns from the periphery finally coming to the
vena cava and right auricle. It must then be concluded
that the blood in the animal body moves around in a
circle continuously, and that the action or function of the
heart is to accomplish this by pumping. This is the only
reason for the motion and beat of the heart”

7. Einthoven, a professor of physiology in the small
Dutch town of Leiden, first recorded a human
electrocardiogram and gave birth to a new specialty
Einthoven devised the first string galvanometer to
record the electrical activity of the heart
won a Nobel Prize in 1924 for his contributions to
the field of electrocardiography
Einthoven himself described various arrhythmias,
including bigeminy, atrial flutter and fibrillation, and
“P mitrale,” as well as left and right ventricular
hypertrophy.

11. 19th-century: French physiologist Claude Bernard
catheterized and measured pressures in the various
cardiac chambers and great vessels of the animal heart
first catheterization of the living human heart was
performed by a young surgeon, Werner Forssman, (on
himself!) in 1929 in Eberswald, Germany
Forssman's goal was to find a safe way to inject drugs
and contrast material into the right atrium for cardiac
resuscitation

12. In 1941, Andre Cournand and Dickinson
Richards at Columbia University and Bellevue
Hospital in New York began the systematic
exploration of normal and abnormal
hemodynamics
They recorded intracardiac pressures and
cardiac output in normal subjects and in
patients with many forms of congenital and
acquired heart disease
Forssman, Cournand, and Richards were also
awarded the Nobel Prize.

13. Werner Forßmann
Werner Forßmann
Born 29 August 1904
Berlin
Died 1 June 1979 (aged 74)
Nationality Germany
Fields Medicine
Alma mater University of Berlin
Known for Cardiac catheterization

14. First performed by mason sones at the cleveland clinic
in 1958
Coronary arteriography, when combined with left
ventriculography, led to the diagnosis and then the
elucidation of the natural history of coronary artery
disease

16. Modern cardiovascular surgery was first applied in
1938, by Robert Gross at Harvard and Boston's
Children's Hospital successfully closed a patent
ductus arteriosus
In 1953, John Gibbon at Thomas Jefferson Hospital in
Philadelphia performed the first open-heart operation
using cardiopulmonary bypass .He successfully closed
an atrial septal defect in an 18-year-old girl
Gibbon’s design led to the construction of the heart-lung
machine by IBM engineers.

17. Balloon angioplasty was followed by stenting with bare
metal stents, which are now being replaced by drug-
eluting stents.
In addition to coronary stenosis, almost any abnormal
obstruction in the heart and circulation can now be
successfully opened, and many abnormal openings can
be successfully closed using catheter-based
techniques.

18. Before 1961:patients with acute myocardial infarction were
treated largely with benign neglect
In 1961:Desmond Julian, then a registrar in cardiology at
the Royal Infirmary in Edinburgh, Scotland, articulated the
concept of the coronary care unit
This important development rested on four pillars:
1) continuous electrocardiographic monitoring with
arrhythmia alarms;
2) cardiopulmonary resuscitation with external ventricular
defibrillation;
3) the clustering of myocardial infarction patients in a
discrete unit of the hospital where skilled personnel, drugs,
and equipment were available; and
4) a change in policy that permitted, indeed mandated,
trained nurses to initiate resuscitation.

19. In the 1960s:James Black developed beta-blockers
In the 1970s: The first angiotensin-converting enzyme
inhibitor, captopril, was isolated by Cushman and
Ondetti, working at the Squibb (now Bristol Myers
Squibb) laboratories
Angiotensin-converting enzyme inhibitors have become
cornerstones in the management of heart failure and
hypertension

20. In 1976: The first HMG-CoA reductase inhibitor (statin) was
isolated by Akira Endo of Sankyo Pharmaceuticals, and was
built on the Nobel Prize-winning work on the low density
lipoprotein cholesterol pathway by Brown and Goldstein

21. In 1944, Dr. Paul Dudley White at Harvard and the
Massachusetts General Hospital, often referred to as
the father of American cardiology, pioneered the
concept of cardiovascular prevention
In 1948 the National Heart Institute (now the National
Heart, Lung, and Blood Institute) established the
Framingham Heart Study, the first prospective
population-based cohort study that focused on heart
disease

22. Inge Edler, a Swedish cardiologist, and Helmuth Hertz,
a Swedish physicist(1952): launched the field of
echocardiography
These investigators provided continuous recordings of
the movements of the heart walls and of the normal and
diseased mitral valve
Noninvasive imaging represents an enormous advance
both in the diagnosis of heart disease and in the care of
cardiac patients.

23. 1842 – Johann Christian Doppler discovers the Doppler sound effects – begins
the premise for sonographic imagery.
1881 – Jacques and Pierre (husband of Marie) Curie discover the principle of
piezoelectricity – another stepping stone to creating the ultrasound.
1903 – Willem Einthoven records the first ECG waves, thus developing the
very first electrocardiogram. This discovery heralds cardiology's status as a
medical specialty.
1917 – Paul Langevin is the first to attempt to use the piezoelectric effect as
sonar, to detect U-boats
1941 – Karl T. Dussikwasthe becomes the first to use an ultrasound machine,
using it to examine the brain.
1950 – WD Keidel is the first to use an ultrasound to examine the heart.
1952 – JJ Wilde, JM Reid, D. Howry and W. Bliss develop the first two-
dimensional ultrasound system, but didn't attempt to use it on the heart.
1953 – Physician Inge Edler and engineer C. Hellmuth Hertz borrow a shipyard
sonar machine to conduct the first human echocardiogram.

24. 1956 – S. Satumora, Yoshida, Nimura are the first to apply
the Doppler principle to the use of ultrasound to detect
cardiac motion (but not blood flow).
1957 – Sputnik, JJ Wild, JM Reid identify a myocardial
infarction in vitro using both M mode and 2D echo in the
US, and publish their images in the American Heart
Journal
1960 – Echocardiography becomes more widely accepted
as a method of cardiovascular research.
1963 – Dr. Harvey Feigenbaum, hailed as the "Father of
Echocardiography" takes an unused
echoencephalography machine and uses it to record
cardiac images, rather than its original intent, to record
images of the brain.
1965 – Chuck Haine, a physician at Indiana University,
becomes the first cardiac sonographer.
1971 – N. Born and Paul Hugenholtz introduce the first
two-dimensional scanner to produce multi-dimensional
echocardiography.

25. 1973 – Echocardiography is included as a searchable
term in Index Medicus.
1975 – Feigenbaum founds the American Society of
Echocardiography.
1978 – N Bom and J Roelandt introduce the first hand
held echo machine. While not commercially produced
for another twenty years, this invention moved echo out
of the laboratory to the patient's bedside and out of the
hands of cardiologists to all physicians
1984 – Dr Feigenbaum's laboratory at Indiana
University becomes the first all-digital lab, with echos
stored on floppy disks

28. In 1959, Elmquist and Senning at the university of
zurich reported on the first successful use of an internal
pacemaker
In 1970, Michel Mirowski, an Israeli cardiologist with
training in electrical engineering working at Sinai
Hospital in Baltimore, invented the implanted
cardioverter-defibrillator

30. A series of
pacemakers from the
1960s to the 1990s
(top left to bottom
right) demonstrating
the remarkable
progress in the
miniaturization of the
pacemaker. Since
1960 the weight of the
pacemaker has
decreased from 170 to
less than 20 grams.

31. cardiac stimulation
leads considered the
weak point in
pacemaker systems,
the Wireless Cardiac
Stimulation system
(WiCS) uses a leadless
electrode to convert
mechanical energy,
wirelessly transmitted
from an ultrasonic
pulse generator, into
electrical energy which
is used to pace the
heart as part of Cardiac
Resynchronization
Therapy (CRT).

32. Hybrid Long-term Temporary
Pacing
The lead was
tunnelled
subcutaneou
sly for 6cm,
and the
proximal end
was
connected to
a standard
single
chamber
pulse
generator.
The
procedure
was well
tolerated and
over a period
of four
months there
were no
complication
s or infection.

35. Contemporary cardiology is composed of multiple
subspecialties
Adult medical cardiology :Electro physiologists,
subspecialists in extra cardiac vascular disease,
hypertension, lipidology, care of patients with acute
coronary syndromes, and heart failure, as well as in
prevention and rehabilitation
Pediatric cardiology
cardiovascular surgery
cardiovascular radiology

36. Leads to greater expertise
Improves patient care, teaching, and research
Skilled subspecialists can perform complicated
procedures successfully and at relatively low risk

37.  Disease prevention
 Costs of cardiac care
costs of care are spiraling out of control

39. Continuing subspecialization in the pursuit of
technical virtuosity and clinical excellence
Preventive measures based on patient
characteristics, such as phenotypes, will expand
Heart failure is the last great battleground in
cardiology
 The near-term future of therapy for advanced heart
failure.
• Art. Ht. = artificial heart
• BMSC = bone marrow stem cells
• ICD = implantable cardioverter-defibrillator
• LVAD = left ventricular assist device
• Cardiac xenotransplantation

40. gene-informed therapy: genetic identification of the
future development of risk factors will lead to gene-
informed personalized prevention
Eg:Alpha-adducin-leads to excessive sodium re-
absorption by distal renal tubule cells-prophylactically
with a salt-restricted diet or even a diuretic, leading to
gene-informed prevention.
The presence of specific variants of the genes for
connexin 37 (resulting in changes in endothelial gap
junctions) in men and in the genes for plasminogen
activator inhibitor-1 (altered inhibition of fibrinolysis)
and stromelysin-1 (associated with altered matrix
metabolism) in women are associated with increased
risk of myocardial infarction

41. Intervention versus prevention
Greater focus on prevention, using
progressively greater refinements of markers
of inflammation and of plaque instability

43. In1711:developmentof cardiac catheterization
Stephen Hales placed catheters into the right and left
ventricles of a living horse
in 1840s: formal study of cardiac physiology being
performed by Claude Bernard

44. In 1927: The technique of angiography itself was first
developed by the Portuguese physician Egas Moniz at
the University of Lisbon for cerebral angiography
In 1929: Coronary catheterization was first performed
by Werner Forssmann, created an incision in one of his
left antecubital veins and inserted a catheter into his
venous system
He then guided the catheter by fluoroscopy into his right
atrium

45. In 1958 Dr. Charles Dotter began working on methods
to visualize the coronary anatomy via sequential
radiographic films.
He invented a method known as occlusive aortography
in an animal model
Occlusive aortography - the transient occlusion of the
aorta and subsequent injection of a small amount of
radiographic contrast agent into the aortic root and
subsequent serial x-rays to visualize the coronary
arteries

46. Mason Sones, a pediatric cardiologist at the Cleveland
Clinic: while performing an aortic root aortography, ,
noted that the catheter had accidentally entered the
patient's right coronary artery.
Before the catheter could be removed 30cc of contrast
agent had been injected.
While the patient went into ventricular fibrillation, the
dangerous arrhythmia was terminated by Dr. Sones
promptly performing a precordial thump which restored
sinus rhythm

47. Until the 1950s: placing a catheter into either the
arterial or venous system involved a "cut down"
procedure, in which the soft tissues were dissected
out of the way until the artery or vein was directly
visualized and subsequently punctured by a
catheter; this was known as the Sones technique.

48. In 1953 :The percutaneous approach that is
widely used today was developed by
radiologist Sven-Ivar Seldinger . This method
was used initially for the visualization of the
peripheral arteries. Percutaneous access of the
artery or vein is still commonly known as the
Seldinger technique

49. By the late 1960s: Melvin Judkins had begun
work on creating catheters that were specially
shaped to reach the coronary arteries to
perform selective coronary angiography
His work was documented in 1967, and by
1968 the Judkins catheters were manufactured
in a limited number of fixed tip shapes.
Catheters in these shapes carry his name and
are still used to this day for selective coronary
angiography

51. The use of a balloon-tipped catheter for the
treatment of atherosclerotic vascular disease
was first described in 1964 by two interventional
radiologists, Charles Dotter and Melvin Judkins
to treat a case of atherosclerotic disease in
the superficial femoral artery of the left leg

52. Andreas Gruentzig performed the first
successful PTCA or percutaneous coronary
intervention (PCI)) on a human on
September 16, 1977 at University Hospital,
Zurich
By the mid 1980s, over 300,000 PTCAs
were being performed on a yearly basis,
equalling the number of bypass
surgeries being performed for coronary
artery disease.

54. In 1986: first intracoronary stents were
successfully deployed in coronary arteries
The first stents used were self-expanding
Wallstents
Restenosis rates were significantly lower in
individuals who received an intracoronary
stent when compared to those who
underwent just balloon angioplasty

55. In 1989: the Palmaz-Schatz balloon-
expandable intracoronary stent was
developed
By 1999 nearly 85% of all PCI procedures
included intracoronary stenting

56. Four early endovascular stents.
Ruygrok P N , and Serruys P W Circulation 1996;94:882-
890
Copyright © American Heart Association
• The upper left panels
show Dotter's early
nitinol coil wire stent
•The zig zag expanding
stainless steel stent
described by Wright et
alshown in the upper
right panels in both its
sheathed and
unsheathed forms.
• The lower left panel
shows the stents
developed by Maass et
al.
• The lower right panel
shows the balloon
expandable stainless
steel Palmaz stent.

57. Seven coronary stents, clockwise from bottom left: Wallstent, Palmaz-Schatz stent, Wiktor
stent, Gianturco-Roubin stent, Cordis stent, AVE stent, and multilink stent.
Ruygrok P N , and Serruys P W Circulation 1996;94:882-
890
Copyright © American Heart Association
Seven coronary stents,
clockwise from bottom
left: Wallstent
Palmaz-Schatz stent
Wiktor stent
Gianturco-Roubin stent
Cordis stent
AVE stent
multilink stent

58. Stent manufacturers experimented with a
number of chemical agents to prevent the
neointimal hyperplasia that is the cause of in-
stent restenosis.
One of the first products of the new focus on
preventing stent restenosis and late thrombosis
was the heparin coated Palmaz-Schatz stent
At approximately the same time, Cordis was
developing the Cypher stent, a stent that would
release sirolimus (a chemotherapeutic agent)
over time

59. FDA approved the use of the Cypher stent as the
first drug-eluting stent for use in the general population
in the United States
Concurrent with the development of the Cypher
stent, Boston Scientific started development of
the Taxus stent
The Taxus stent was the Express2 metal stent, which
was in general use for a number of years, with
a copolymer coating of paclitaxel that inhibited cell
replication

60. Taxus stent was approved for use in Europe in 2003
With further study, the FDA approved the use of the
Taxus stent in the United States in March 2004.
By the end of 2004, drug eluting stents were used in
nearly 80 percent of all percutaneous coronary
interventions

61. Dr. B. Soma Raju and his team have performed
the first PTCA (Percutaneous Transluminal
Coronory Angioplasty) in India on 1985
He has been involved in various research
projects during the last 20 years individually
Development of India’s first Coronary Stent,
which has been named the Kalam Raju Stent
after Professor A.P.J Kalam and Dr. Raju
This stent was first implanted in December
1996

62. The development of the stent resulted in reducing the
cost of stents in the country and brought it within the
reach of the people
In October 1998 the second research product of Dr.
Raju’s endeavor, India’s first Coronary Balloon Catheter
was released

63. Medical College Trivandrum
ACHIEVEMENTS
First government hospital in kerala done
coronary angioplasty in 1998.
First government hospital in kerala done ICD
Inplantation
First government hospital in kerala done by
ventrical pacing for heart failure.
First government hospital in kerala to have a
round the clock angioplasty program

64. Medical College Trivandrum
Department of Cardiology started functioning in
1972. It started with 4 bed Intensive care unit.
The first Colour Doppler Echo in the state was
started in the department in 1992.
The cardiac catheterisation Laboratory (cath
lab) was started in 1997.
A second cathlab under the PMSSY Scheme
was started in 2010.
Electrophysiology station was established in
2009

66. In the 19th century: The earliest operations on
the pericardium took place and were performed
by Francisco Romero, Dominique Jean Larrey, Henry
Dalton and Daniel Hale Williams
4 September 1895: The first surgery on the heart was
performed by Norwegian surgeon Axel Cappelen in
Kristiania, now Oslo
He ligated a bleeding coronary artery in a 24 year old
man stabbed in the left axillae and was in
deep shock upon arrival. Access was through a
left thoracotomy. The patient awoke and seemed fine
for 24 hours, he died from mediastinitis on the third
postoperative day

67. September 7, 1896: The first successful
surgery of the heart, performed without any
complications, was by Dr. Ludwig
Rehn of Frankfurt, Germany, who repaired a
stab wound to the right ventricle

68. In 1925: Henry Souttar operated successfully on a
young woman with mitral stenosis
He made an opening in the appendage of the left atrium
and inserted a finger into this chamber in order to
palpate and explore the damaged mitral valve.
The patient survived for several years but Souttar’s
physician colleagues at that time decided the procedure
was not justified and he could not continue.

69. In 1948: four surgeons carried out successful operations
for mitral stenosis resulting from rheumatic fever
In 1947 thomas holmes sellors (1902–1987) of
the middlesex hospital operated on a fallot’s
tetralogy patient with pulmonary stenosis and
successfully divided the stenosed pulmonary valve
In 1948, russell brock, used a specially designed dilator
in three cases of pulmonary stenosis

70. September 2, 1952: The first successful intracardiac
correction of a congenital heart
defect using hypothermia was performed by Dr. C.
Walton Lillehei and Dr. F. John Lewis at the University of
Minnesota
Dr. John Heysham Gibbon at Jefferson Medical School
in Philadelphia reported in 1953 the first successful use
of extracorporeal circulation by means of an oxygenator

71. In March, 1961, Zuhdi, Carey, and Greer,
performed open heart surgery on a child,
age 3½, using the total intentional
hemodilution machine

72. Norman shumway the father of heart transplantation
world's first adult human heart transplant was
performed by christiaan barnard in south africa utilizing
the techniques developed and perfected by shumway
and richard lower.
Barnard performed the first transplant on louis
washkansky on december 3, 1967 at the groote schuur
hospital in cape town south africa.
Adrian kantrowitz performed the first pediatric heart
transplant in the world on december 6, 1967
at maimonides hospital in brooklyn, new york
Norman shumway performed the first adult heart
transplant in the united states on january 6, 1968 at
the stanford university hospital.

73. Since the 1990s, surgeons have begun to
perform "off-pump bypass surgery
In these operations, the heart is beating
during surgery, but is stabilized to provide an
almost still work area in which to connect the
conduit vessel that bypasses the blockage

74. Robot-assisted heart surgery:
Machine is used to perform surgery while being
controlled by the heart surgeon.
The main advantage to this is the size of the
incision made in the patient. Instead of an
incision being at least big enough for the
surgeon to put his hands inside, it does not
have to be bigger than 3 small holes for the
robot's much smaller hands to get through.

75. Russell M. Nelson performed the first
successful pediatric cardiac operation at
the Salt Lake General Hospital in March
1956, a total repair of tetralogy of Fallot in a
four-year-old girl

76. Dr K M Cherian: performed the first coronary
artery bypass surgery in India in 1975.
He also performed the country's second heart
transplant, first infant cardiac surgery and the first
heart and lung transplant (1999)
Cherian has performed more than 27,000
operations.
the first Auto transplant;
He is the first Indian member of the American
Association for Thoracic Surgery, as well as a
Fellow of the Royal Society of Medicine, London,
and an honorary member of the Malaysian
Association for Thoracic and Cardiovascular
Surgery

77. Padmashri Dr. Jose Chacko Periappuram
performed the first successful human-to-
human heart transplant
He was the first heart surgeon to commence a
beating heart surgical program in kerala
He is also the first surgeon in kerala to perform
bypass surgery using arterial grafts
Awake bypass :patients who due to lung
diseases could not have their surgeries done
were helped by a very novel technique called
awake bypass surgery

79. Cardiac nursing is a nursing specialty that
works with patients who suffer from various
conditions of the cardiovascular system.
Cardiac nurses help treat conditions
unstable angina,cardiomyopathy, coronary
artery disease, congestive heart failure
myocardial infarction and cardiac
dysrhythmia under the direction of a
cardiologist

80. Cardiac nurses work in many different
environments, including coronary care
units (CCU), cardia catheterization,
inte nsive care units (ICU), operating
theatres, cardiac rehabilitation
centers,clinical research, cardiac
surgery wards, cardiovascular intensive care
units (CVICU), and cardiac medical wards

81. Cardiac nursing has become a specialty in
the past 50 years
Cardiac nursing continues to grow as more
understanding is gained of heart disease and
how to prolong life.

82. The first CCU was founded at the royal
infirmary in scotland, by dr. Desmond G.
Julian to deal with heart attack, sudden
cardiac arrest and heart arrhythmias
He recommended all staff, including nurses,
be trained in CPR in order to treat patients
with suspected heart attack as rapidly as
possible
Other cardiac care units were founded
shortly thereafter AND the need for skilled
cardiac nurses increses rapidly

83. Coronary care units had reduced mortality
from heart attack and sudden cardiac arrest
by up to 20 percent in the previous decade
CCU and departments continued to be added to
larger hospitals, driving the need for more
trained cardiac nurses skilled in CPR, cardiac
monitoring and the administration of cardiac
medicines.

84. The society for peripheral vascular nursing
(SPVN), founded in boston in 1982
Renamed the society for vascular nursing
(SVN) in 1990, helped highlight cardiac nursing
as an established nursing specialty.
American association of cardiovascular and
pulmonary rehabilitation was founded in 1985:.
Provides education and training for cardiac
nurses and other heart care professionals, as
well as certification for cardiac rehabilitation
facilities.

85. The Preventive Cardiovascular Nurses
Association (PCNA) was founded in the United
States in 1992 by a small group of nurses in
California
As membership expanded, the organization
began to encompass evidence-based study of a
wider array of cardiovascular disorders and
pass this information along to its members.

86. The American Nurses Credentialing Center (ANCC)
is the world's largest nurse credentialing
organization, and a subsidiary of the American
Nurses Association (ANA)
The first Cardiac and Vascular Nurse examinations
were administered by the PCNA in May 2001 in
conjunction with the ANCC.
The PCNA continues to offer the certification
exams as well as continuing education courses
online and live seminars and training events.
In addition to the ANCC Cardiac/Vascular Nurse
Certification, the PCNA supports the Accreditation
Council for Clinical Lipidology (ACCL) certification
examination. Cardiac nursing continues to grow as
nursing becomes more specialized

88. Recent progress in biomedical engineering
and imaging technology is providing an ever-
increasing body of knowledge on the origins
and onset of cardiac disease, with new
options for its detection and treatment

89. Improved treatment of CAD has resulted in
an increased survival rate
Increasing incidence of patients with severe
myocardial scars caused by previous
infarction
Increase in the number of patients suffering
from congestive heart failure (CHF), who will
form an increasingly important group
A third group of patients that is expected to
become increasingly important is that of
patients with cardiac arrythmias

90. A discernable shift from diagnosing disease at a
late stage, after symptoms occur, to
asymptomatic diagnosis
An important recent development is the
realization that the vast majority of heart attacks
are not due to progressive atherosclerosis, but
to sudden rupture of non-occlusive, vulnerable
plaque
Replacement of open-chest surgical
procedures by less invasive percutaneous
approaches such as percutaneous transluminal
interventions and minimally invasive surgery
(MIS) or even endoscopic surgery, will continue.

91. In percutaneous CAD treatment the trends
will be towards more accurate assessment of
coronary lesion dimensions, accurate
assessment of plaque morphology and
pathology, and more accurate guiding of the
intervention device
Drug-eluting stents

92. Non-invasive assessment of the cardiac
function in terms of perfusion, local
contraction, and myocardial apoptosis and
viability will become more and more
important
An increased use of bi-ventricular pacing for
improving cardiac function and implantation
of cardioverter defibrillators (ICD) for the
reduction of related sudden cardiac death

93. Increased use of local myocardial treatment,
such as local delivery of angiogenetic agents
or stem cells
Growth in the use of personal monitoring
devices such as automatic ecg recorders for
long-term disease progress monitoring

94. pacemaker implantation for bradycardias,
and endocardial mapping of re-entry circuits
and ectopic foci followed by ablation
Percutaneous ablation of areas around the
pulmonary veins in the left atrium is an
effective procedure for the treatment of atrial
fibrillation in the majority of patients
Bi-ventricular pacing and implanted
defibrillators -CHF and ischemic ventricular
tachycardia

95. X-ray imaging
X-ray imaging is still the most widely used
imaging technique
Computed Tomography (CT)
• 3D or even 4D data sets provide three
dimensional insights into the anatomy
• CT is a promising candidate for replacing
invasive diagnostic coronary angiography by a
non-invasive procedure.

96. Magnetic Resonance (MR) imaging
MR is the only technique capable of providing all major cardiac
diagnostic, anatomical and functional information, and is
therefore an attractive option for a ‘one-stop shop’ solution
Nuclear medicine imaging
• The radioactive substance can be used to label a molecular
imaging agent that will bind to a particular biological molecule,
such as phosphatidyl serine which is released by dying cells.
• In cases of acute myocardial infarction, the resulting images
will show the location and extent of cell death
• The use of a molecular imaging agent to bind to macrophages
in the fibrous cap of vulnerable plaque, which would provide a
valuable early warning system

97. Ultrasound
Modern systems can provide real-time 3D images,
giving a valuable insight into the structure and
functioning of organs such as the heart
The image data also serves as a basis for quantitative
analysis, such as the wall-motion analysis and the
quantification of left and right ventricular volumes,
pericardial effusion, intracardiac masses, defects and
endocardial surfaces.
Examination of vessel wall motion abnormalities can
provide early indication of plaque deposition

99. The radial vs. femoral artery approach
80 percent reduction in complication rates and an
accompanying increase in patient satisfaction
Structural repair trends
 A minimally invasive percutaneous approach to repair
structural defects and move away from open surgical
procedures.
 The percutaneous aortic valve, which is on the market
for treatment of aortic stenosis and aortic insufficiency.
 The mitral valve clip placement is being use for
treatment of mitral regurgitation

100. Vascular repair trends
› Improved stents, which have evolved from polymer-
coated, metal drug-eluting stents to drug-eluting
bioabsorbable stents, potentially reducing restenosis.
› Expansion of vascular services to improve not only
heart health but also extremity health, which greatly
benefits patients overall.
› Perhaps some of the most exciting research is being
studied in clinical trials on drug-eluting balloons,
drug-eluting stents for the periphery, and using
different forms of atherectomy in combination with
other forms of therapy.

102. A robotically mediated, minimally invasive bypass of the left
anterior descending coronary artery is performed using the
left internal mammary artery
This is performed without a median sternotomy and without
cardiopulmonary bypass
Shortly thereafter, the patient undergoes stenting of either
the right or circumflex coronary arteries
Within the very near future, the entire procedure will be
able to be carried out in one session- incorporating the full
surgical capabilities of an operating room and the full
imaging and interventional capabilities of the cath lab

103. A percutaneous, rather than surgical approach to aortic
valve replacement and mitral valve repair.
These technologies are currently undergoing clinical trials
and if successful, should be available clinically in the next
3-5 years.

104. An expeditious approach is mandatory in quickly
incorporating aggressive pharmacologic management
with judicious implantation of heart assist devices to
address these critically ill patients and impact their high
mortality rates

106. Cardiovascular Nurses play a key role in the evaluation of
Cardiovascular Status, Monitoring the Hemodynamic
Functions and Disease Management.
Nursing interventions have been shown to reduce patient
stress.
Recent research findings suggest that morbidity and
mortality in cardiac patients can be improved with a
comprehensive treatment plan which has a Nurse
Managed Stress Reduction Plan

107. Randomised controlled trials have also demonstrated
the benefit of Nurse-run Clinics for secondary
prevention of Coronary Heart Disease (Riley, 2003)
Nurse-Provided or Nurse-Coordinated Care
Management programs using an integrated or
multifactor approach have been shown to be highly
effective in reducing morbidity and mortality of high-risk
patients (Haskell, 2003)
Cardiovascular Nurses play a very important role at
different levels, ie the technical level, where the nurses
carry out diagnostic examinations and risk
assessments; psychological level where the nurse
informs, acts as a health counsellor and helps in the
patient self care process (Riccio et.al, 2004)

108. A study to observe secondary prevention practice in a
cardiovascular department in a sample of two hundred
and twenty patients discharged from the Intensive
Coronary Care Unit, Cardiac Surgery Unit and Vascular
Surgery Unit has shown that nurses play a vital role in
the implementation of guidelines, risk assessment, drug
treatment and effective patient education (Steffenino
et.al, 2003)