Diseases & Conditions Treated by a Cardiologist

Coronary Artery Disease

The heart is a muscle. It is supplied with blood by three main arteries called the coronary arteries. Coronary Artery disease is caused by narrowing or blockage of these arteries with cholesterol and calcium build-up or plaque.

As the arteries become narrower, less blood is able to get to the heart. At first, this may happen only when the heart is working harder than normal and requires more blood. For example, the heart works harder when a person exercises. If the heart does not receive enough blood, individuals may experience chest pain, shortness of breath, arm, neck or jaw pain. These symptoms are referred to as angina. Some people, such as diabetics, may have no symptoms at all.

Diseases of the Aortic and Mitral Valves

The heart has four, one-way valves that keep the blood moving in the proper direction as the heart pumps blood.

In adults, one or more of the valves may not function properly as the result of a disease (such as rheumatic fever) or thickening and calcium build up due to age. The aortic and mitral valves in the adult are the most likely ones to need attention from a cardiac surgeon. Valves that don't work normally often create a noise or a heart murmur.

The Aortic Valve
The aortic valve prevents blood that has been pumped out of the heart from returning to the pumping chamber after each heart beat. If the valve leaks (or is "insufficient") it allows blood to leak back into the heart after each beat. This causes the heart to enlarge as it needs to pump larger volumes of blood. If the valve is too tight (or is "stenotic") the heart must work extra hard to empty itself with each beat as it forces blood through a tight valve.

Once the valve leaks enough or becomes so tight that it causes symptoms such as fainting, shortness of breath or even chest pain, it must be replaced with valve surgery. A new aortic valve may be made of metal and plastic, tissue from a cow or pig, or it may be a human valve. Each of these types of valves has advantages and disadvantages over the others. You and your surgeon can discuss the best valve choice for you.

The Mitral Valve
The mitral valve keeps blood from washing back into the lungs as the heart beats. This valve looks like the sail on a ship with cords that hold it in place. If these cords become too long or break, the valve billows outward ("prolapses") and allows blood to leak back into the lungs with the heart beat. Many people, particularly women, have a small amount of mitral valve prolapse. This condition is usually quite benign and does not necessarily require surgery if the valve leaks only a small amount. If the valve does leak substantially, it can sometimes be repaired instead of replaced.

If the mitral valve is too tight ("stenotic"), it can cause the blood pressure in the lungs to become elevated as blood must be forced through a too small valve. During valve surgery these stenotic valves are replaced with a valve made of metal and plastic or one of pig tissue.

Congenital Defects of the Adult Heart

The most common congenital defect (a condition present since birth) is an atrial septal defect or ASD. This is a small hole between the two collecting chambers of the heart. With surgery it can be repaired to prevent blood from traveling from the left to the right side of the heart or vice versa. An ASD may also allow small blood clots which would normally be filtered by the lungs to pass directly to the left side of the heart where they can be pumped to the brain and cause a stroke.

Aneurysms of the Thoracic Aorta

An aneurysm is a ballooning out of a portion of a blood vessel, usually due to a weakened area in the wall of the blood vessel.

A small aneurysm can be treated by carefully controlling blood pressure to help keep it from expanding. As the aneurysm becomes large, there is a risk of rupture. Aneurysm surgery may be needed to remove the weakened area and replace it with an artificial blood vessel.

If the aneurysm involves the aortic valve (the valve which keeps blood from flowing back into the heart once it has been pumped out to the body), the ballooning out of the vessel may cause the valve to leak and valve surgery may be needed to replace the valve.

Tumors of the Heart

The most common tumor in the adult heart is called a myxoma. It is usually located in one of the collecting chambers of the heart. It usually looks like a mushroom, with a stalk attaching it to the heart and a cap that waves in the collecting chamber with each heart beat. These may be found accidentally when an echocardiogram or ultrasound study of the heart is done for some other reason. They may cause symptoms such as dizziness or palpitations, especially if the tumor interferes with the function of one of the valves. They also may cause a stroke if part of the tumor breaks off and goes to the brain. These tumors are usually benign, but because they can interfere with the function of the heart or occasionally cause a stroke, they should be removed with surgery soon after they are discovered.