He was an Associate Professor of Cardiovascular Medicine and Genetics at the Perelman School of Medicine at the University of Pennsylvania, as well as the scientific director of the Center for Inherited Cardiovascular Disease. [ 3 ] [ 12 ]  He is now a Professor of Medicine at the University of Pennsylvania Perelman School of Medicine. [ 1 ]  As of 2021, he serves on the board of directors of the American Society of Human Genetics, in addition to serving on its Diversity and Inclusion Task force. [ 13 ]


Musunuru is the author of The CRISPR Generation: The Story of the World's First Gene-Edited Babies, in which he delves into the scientific breakthroughs that enabled  He Jiankui  to create the world's first  gene-edited babies , a scandal Musunuru describes as a "historic ethical fiasco, a deeply flawed experiment". [ 14 ] [ 2 ]  He was one of the independent experts who reviewed He's manuscript. [ 2 ]


He has an  h-index  of 57 according to  Semantic Scholar . [ 15 ]


Frits F.W. Prinzen  is an expert on  cardiac pacing  therapies, both for  bradycardia  and for heart failure ( cardiac resynchronisation therapy , CRT).


He was born July 2, 1954, in  Hilversum .  He earned a master's degree in medical biology from  Utrecht University  in 1978, and a PhD in physiology from  Maastricht University  in 1982. [ 1 ]


Prinzen works on cardiac  pacing therapies , both for  bradycardia  and for  heart failure  ( cardiac resynchronisation therapy , CRT). His main research topic is cardiac mechanics and long-term structural and functional adaptations to various conditions, with emphasis on asynchronous electrical activation and cardiac resynchronisation. [ 2 ]


In 1995, he took a sabbatical year during which he worked at the  Johns Hopkins University  in Baltimore, MD, USA, where he dove into the world of MRI tagging of the heart. This work was published in a well-cited article in the  Journal of the American College of Cardiology . [ 3 ]


His work led to improved cardiological treatments, especially in the field of cardiac pacing. Together with cardiologists and industrial partners he improved and developed pacemakers, pacing wires, and implantation methods. [ 4 ]  An  example is published in NEJM in 2007, [ 5 ]  describing the case of a child with heart failure who directly benefited by changing the site of the pacemaker wire. This theory was later confirmed in a large clinical trial, published in 2013 in Circulation. [ 6 ]  In his lab of it was shown for the first time that pacing the left side of the interventricular septum maintained cardiac function. [ 7 ] [ 8 ]  This pacing strategy has been adopted in clinical practice. [ 9 ]  Frits was awarded the CARIM commitment award in 2016. [ 10 ]


Frits Prinzen is co-author of over 280 scientific articles, with over 16,000 citations and an all time H-index of 70. [ 11 ]


He contributed to  Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy . [ 12 ]


Harvard Medical School


Massachusetts General Hospital


Toronto General Hospital


John D. Puskas  is an American researcher, author, inventor and cardiovascular surgeon. As of 2022, he is Professor,  Cardiovascular  Surgery,  Icahn School of Medicine  at Mount Sinai, [ 1 ]  and chairman, Department of Cardiovascular Surgery at  Mount Sinai Morningside ,  Mount Sinai Beth Israel  and  Mount Sinai West . He holds 11 U.S. patents and co-founded the International Coronary Congress and the International Society for Coronary Artery Surgery. [ 2 ]  He is credited by  ResearchGate  with 330 publications and 15,234 citations [ 3 ]  and as of 2022  Scopus  reports an  h-index  of  62. [ 4 ]  Puskas is known for advancing  coronary artery bypass  ( CABG ) surgery by refining surgical techniques for all-arterial, off-pump CABG and inventing finer instruments to be used for advanced coronary bypass surgical procedures. [ 5 ]  He is credited with performing the first totally thoracoscopic bilateral  pulmonary vein isolation  procedure. [ 6 ]  He is the co-editor of  State of the Art Surgical Coronary  Revascularization , [ 7 ] [ 8 ]  the first textbook solely devoted to coronary artery surgery. [ 9 ]


In 2021, Puskas ran the  New York City Marathon  with his patient who, in 2018, suffered cardiac arrest and was clinically dead for five minutes, but recovered after all-arterial CABG. [ 10 ]  Their trainer, John Garlepp was another CABG patient of Puskas. [ 11 ]


Born in 1960, Puskas received his MD at  Harvard Medical School  in 1986 and in 1991, a Master of Science in Surgical Science ( MSc ) at the  University of Toronto . Post-graduate training included a general surgery internship and residency, department of surgery,  Massachusetts General Hospital ; fellowship in  cardiothoracic surgery  at  Emory University Hospitals ,  Atlanta ,  a  lung transplantation  research fellowship, division of  thoracic  surgery,  Toronto General Hospital ; and an advanced fellowship in  tracheal  surgery,  Massachusetts General Hospital , Division of General  Thoracic Surgery . [ 1 ] [ 12 ] [ 13 ]


Puskas research concentrations include arterial bypass grafting, robotic and hybrid coronary bypass grafting, novel designs and materials for artificial heart valves, mitral and aortic valve repair and replacement, surgical and medical treatments for people with atrial fibrillation and surgical instruments for adult cardiac surgery. [ 14 ]


He founded the  Emory University   Cardiothoracic  Clinical Research Unit in 2005 and was a founding investigator in the creation of the  NIH  Cardiothoracic Surgery Trials Network in 2007; he has served on the steering committee of that NIH Network since that time. As of 2022, he has served as the  principal investigator  (PI) of five multi-center  FDA  investigatory drug/device exemption trials in cardiovascular surgery. At  Mount Sinai Health System , he founded and directs the Cardiovascular Clinical Research Unit at Mount Sinai Morningside and Mount Sinai Beth Israel Hospitals to create a multidisciplinary collaborative clinical research infrastructure allowing clinical cardiologists and surgeons to enroll patients in multiple trials. He led 47 clinical sites nationwide to conduct the first  RCT  of hybrid coronary revascularization. [ 15 ]  He is listed on NIH RePORTER with 12 NHLBI PI roles. [ 16 ]


Puskas performs cardiovascular surgical procedures including all-arterial coronary bypass grafting, minimally invasive robotic coronary bypass surgery, hybrid coronary  revascularization ,  off-pump  coronary artery bypass surgery,  ablation  surgery for the treatment of  atrial fibrillation ,  mitral valve  repair/replacement,  aortic valve  replacement, valve-sparing aortic root replacement and surgery for  aortic dissection . [ 17 ]  He performed the first triple off-pump bypass surgery using minimally invasive coronary artery bypass graft instrumentation in 1997. [ 18 ]  Between 1996 and 2022, he performed approximately 300 cardiac surgical cases annually, specializing in multiple arterial  CABG  and robotic CABG. [ 18 ]  In 2019, Puskas, with Gianluca Torregrossa, MD, successfully performed two totally endoscopic coronary arterial bypass surgeries ( TECABs ) making Mount Sinai the only New York State health system qualified to make the procedure available. [ 19 ]  As of 2022, Puskas has served as President of the International Society for Minimally Invasive Cardiothoracic Surgery (2009) and the International Society for Coronary Artery Surgery.


*Present indicates 2022


As of 2022, Puskas is a reviewer and editorial contributor to nine journals, including  The Annals of Thoracic Surgery ,  Journal of Thoracic and Cardiovascular Surgery , Heart Surgery Forum, The  Lancet , The  Journal of Cardiac Surgery ,  Circulation ,  Innovations ,  American College of Cardiology ,  European Association for Cardiothoracic Surgery .


PubMed lists 320 publications as of 2022. [ 20 ]  A short list ranked by citations include:


Smith, P. K., Puskas, J. D., Ascheim, D. D., Voisine, P., Gelijns, A. C., Moskowitz, A. J., ... & Michler, R. E. (2014).  Surgical treatment of moderate ischemic mitral regurgitation .  New England Journal of Medicine ,  371 (23), 2178–2188; 273 citations [ 21 ]


Puskas, J. D., Thourani, V. H., Marshall, J. J., Dempsey, S. J., Steiner, M. A., Sammons, B. H., ... & Guyton, R. A. (2001).  Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients .  The Annals of thoracic surgery ,  71 (5), 1477–1484; 324 citations [ 22 ]


Gaudino, M., Benedetto, U., Fremes, S., Biondi-Zoccai, G., Sedrakyan, A., Puskas, J. D., ... & Taggart, D. P. (2018).  Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery .  New England Journal of Medicine ,  378 (22), 2069–2077; 295 citations [ 23 ]


Gillinov, A. M., Gelijns, A. C., Parides, M. K., DeRose Jr, J. J., Moskowitz, A. J., Voisine, P., ... & Argenziano, M. (2015).  Surgical ablation of atrial fibrillation during mitral-valve surgery .  New England Journal of Medicine ,  372 (15), 1399–1409; 261 citations [ 24 ]


El-Chami, M. F., Kilgo, P., Thourani, V., Lattouf, O. M., Delurgio, D. B., Guyton, R. A., ... & Puskas, J. D. (2010).  New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft .  Journal of the American College of Cardiology ,  55 (13), 1370–1376; 338 citations [ 25 ]


State of the Art Surgical Coronary Revascularization .  ISBN   0198758782


Winston AD and Puskas JD. " Techniques for Multivessel OPCAB ". Minimally Invasive Cardiac Surgery. 2ndEdition, edited by Oz MC and Goldstein DJ, Humana Press, 2003. [ 26 ]


Sharoni E and Puskas JD. " Techniques in Multivessel OPCAB ". Operative Cardiac Surgery, edited by Gardner T J and Spray TL, Arnold Publishers, 2004.


Thourani VH and Puskas JD. " Coronary Artery Bypass Procedures·Medical Management of the Surgical Patient ." Fourth Edition, edited by Lubin MF, Walker HK, Smith RB III, 2006. [ 27 ]


Song HK and Puskas JD. " Off-pump Coronary Artery Bypass Surgery ". Mastery of Cardiothoracic Surgery, 2nd Edition, Lippincott Williams and Wilkins, New York, 2007. [ 28 ]


Richard J. Myung and John D. Puskas. " Off-Pump Coronary Artery Bypass Grafting for Repeat Coronary Revascularization ", Redo Cardiac Surgery in Adults, 2nd Edition, Edited by Venkat R. Machiraju, Hartzell V. Schaff and Lars G. Svensson. Springer. 2011. [ 29 ]


Michael E. Halkos, John D. Puskas. " Minimally Invasive Coronary Artery Bypass Graft to Cardiac Surgery: Recent Advances and Techniques ", 2012. [ 30 ]


Yanagawa B and Puskas JD. “ Off-Pump Coronary Artery Bypass Grafting ”, in Mastery of Techniques in Cardiac Surgery, 2016.


Michael E. Halkos, Emmanuel Moss, and John D. Puskas. “ Chapter 2 Off-pump versus on-pump coronary artery bypass grafting ”, in Core Concepts in Cardiac Surgery, Edited by David Taggart and Yasir Abu-Omar, Oxford University Press, 2018.


Bobby Yanagawa, Michael E. Halkos, John D. Puskas. “ Chapter 21: Myocardial Revascularization Without Cardiopulmonary Bypass ”, in Cardiac Surgery in the Adult, 5e, Edited by Lawrence H. Cohn, David H. Adams, Cenveo® Publisher Services, 2018.


Tom J. Quinn  was the UK's first Professor of  cardiac nursing , and is a Fellow of the  Royal College of Nursing  (RCN) for his outstanding contribution to research and practice of cardiac nursing. [ 1 ] [ 2 ]


He currently [ when? ]  works at the  Kingston University  covering research, development and consultancy in cardiovascular care issues, particularly emergency and critical cardiac care and policy. [ 3 ]  He was previously Professor of Cardiac Nursing at  Coventry University . [ 4 ]  His NHS experience over almost three decades included periods at  St Bartholomew's Hospital , the  National Heart Hospital  and  York Hospital  and at regional office, Strategic Health Authority, the Department of Health [ 5 ]  and NHS Modernisation Agency, and the ambulance service. He is clinical lead in the National Library for Health covering the cardiovascular, stroke and vascular specialist libraries. [ 6 ] [ 7 ]


He was instrumental in developing and writing the  Department of Health's  National Service Framework on heart disease and is a fellow of the  European Society of Cardiology .


He has also published more than 60 papers focusing on the care of patients with cardiac disease or developing nursing practice. [ 8 ]


Naveed Amjid Sattar  is a Scottish medical researcher and Professor of Metabolic Medicine at the  Institute of Cardiovascular & Medical Sciences  at the  University of Glasgow , as well as an Honorary Consultant in Metabolic Medicine at the  Glasgow Royal Infirmary . [ 1 ]  He was described by the  BBC  as "a leading expert in  diabetes  and  cardio-vascular disease  research". [ 2 ]  He has been an  ISI Highly Cited Researcher  since 2014. [ 1 ]  In 2016, he was elected a fellow of the  Academy of Medical Sciences . [ 3 ]  He is also a Fellow of the  Royal College of Pathologists , the  Royal College of Physicians and Surgeons of Glasgow , and the  Royal Society of Edinburgh . [ 1 ]


This biography of a Scottish academic is a  stub . You can help Wikipedia by  expanding it .


Katja Schenke-Layland  (born  Eisenach, Germany , March 21, 1977) is the Professor of Medical Technologies and Regenerative Medicine, Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine at the  University of Tübingen . [ 1 ]  She is the Director of the NMI Natural and Medical Sciences Institute at the University Tübingen in Reutlingen, [ 2 ]  Study Dean of Medical Technologies at the University of Tübingen, and Founding Director of the Institute of Biomedical Engineering at the Medical Faculty of the University Tübingen. She is also the Founding Director of the 3R Center for In Vitro Models and Alternatives to Animal Testing Tübingen.


Katja Schenke-Layland began her doctoral work in the area of heart valve  tissue engineering  and non-invasive imaging at the  University of Jena , Germany. Her specific interest was the effect of cryopreservation, decellularization/recellularization and biomechanical forces on heart valve extracellular matrix (ECM) structures and cells. [ 3 ] [ 4 ] [ 5 ]  She helped develop the use of multiphoton laser-based confocal microscopy and second harmonic generation as non-invasive tissue imaging tools. [ 6 ]  For her post-doctoral work, she focused on cardiac stem cell biology and biomaterials. Here, her seminal work was to be the first scientist to demonstrate that  induced pluripotent stem cells  (iPSCs) differentiate towards the cardiovascular and hematopoietic lineages, showing that beating cardiomyocytes could be derived from iPSCs. [ 7 ] [ 8 ]  She then returned to Germany to join the Fraunhofer IGB in Stuttgart, Germany as a group leader, which was then followed by her appointment as Professor in the Medical Faculty of the University of Tübingen, and promotion to Department Head and later Director of the Fraunhofer IGB. She remained focused on cardiovascular development [ 9 ] [ 10 ]  and biomaterials, [ 11 ]  and moved into the areas of in vitro test systems [ 12 ] [ 13 ]  and Raman microspectroscopy, [ 14 ] [ 15 ]  with a focus on ECM proteins.


Currently, her research lab at the University Tübingen focuses on the translation of human development into clinically relevant biomaterials and regenerative therapies, and the development of diagnostic tools to assess (stem) cell states, discover therapeutic candidates and diagnose diseases. [ 24 ]  She leverages her appointments to bridge the gaps between science and industry to drive viable health care solutions, particularly at the NMI where they focus on supporting local SMEs [ 25 ]


Katja Schenke-Layland is currently the Co-Editor-In-Chief of Tissue Engineering Part B (Mary Ann Liebert) and Executive Editor of  Advanced Drug Delivery Reviews [ 26 ]  ( Elsevier ), as well as on the editorial boards of  Matrix Biology (journal) [ 27 ]  (Elsevier), Current Opinion in Biomedical Engineering (Elsevier),  Journal of 3D Printing  in Medicine (Future Medicine) and  Scientific Reports  ( Nature Research ). She is a fellow/ board member of the German National Academy of Science and Engineering, [ 28 ]  German Central Ethics Committee for Stem Cell Research, [ 29 ]  International and German Societies of Matrix Biology and the European Alliance for Medical and Biological Engineering and Science.


Filip Swirski  is a Polish-Canadian-American scientist and educator serving as the Arthur and Janet C. Ross Professor of Medicine, Cardiology and Professor of  Radiology  at the  Icahn School of Medicine at Mount Sinai  and is the Director of the  Cardiovascular  Research Institute. He is also a member of the Biomedical Engineering and Imaging Institute (BMEII), the Marc and Jennifer Lipschultz Precision Immunology Institute (PrIISM), and The Friedman Brain Institutes (FBI) at Mount Sinai. His research partly focuses on innate and  inflammatory  mechanisms in cardiovascular disease. He is known for his work in cardioimmunology and notably for linking  atherosclerosis  with blood  monocytosis . [ 1 ] [ 2 ] [ 3 ]


Swirski earned his  Bachelor of Arts and Science  specializing in  biochemistry  and a Ph.D. in  immunology  at  McMaster University ,  Hamilton , Canada. He received an honorary  MS  from  Harvard Medical School  in 2020 for accomplishing a full professorship. He was professor at the Center for  Systems Biology  at  Massachusetts General Hospital  and at Harvard Medical School. [ 4 ] [ 5 ]


Swirski focuses on understanding how  leukocytes  shape and are shaped by inflammation. His research uses  in vivo  models of acute and chronic inflammation relevant to cardiovascular,  neurodegenerative , infectious, and metabolic diseases. [ 5 ]  His writings reflect  translational  and fundamental cardiovascular and  neurodegenerative  science research, including  cell development , mind-marrow communication, and function. [ 6 ] [ 7 ]


Partial list:


As of 2024, Swirski is credited with 38,923 citations and has an h-index of 95. [ 36 ]   His most cited contributions to date are on myocardial infarction, ventricular remodeling, inflammation,  stem cell  niche, hematopoiesis and hematopoietic stem cells. [ 37 ]  Between 2018 and 2019, articles reportedly focused mostly on inflammation (43.72%), bone marrow (17.21%) and immune system (17.21%). [ 38 ]


Five most-cited peer-reviewed publications as of 2024 include: [ 36 ]


Jennifer Eileen Van Eyk  is the Erika Glazer Chair in Women's Heart Health, the Director of Advanced Clinical Biosystems Institute in the Department of Biomedical Sciences, the Director of Basic Science Research in the Women's Heart Center, a Professor in Medicine and in Biomedical Sciences at Cedars-Sinai. [ 1 ]  She is a renowned scientist in the field of clinical proteomics.


Jennifer E. Van Eyk was born in  Northern Ontario , Canada. [ 2 ]  She obtained a bachelor of science in biology and chemistry from the  University of Waterloo  in 1982. [ 3 ]  She received a PhD in biochemistry under the direction of  Robert S. Hodges  from  University of Alberta  in 1991. [ 4 ]  She conducted post-doctoral research at  University of Heidelberg , University of Alberta, and  University of Illinois at Chicago  with R. John Solaro. [ 1 ]


Van Eyk began her academic career in 1996 as an assistant professor in the Department of Physiology at  Queen's University , Kingston, Canada, and she was promoted to associate professor and received tenure in 2001. [ 3 ] [ 5 ]  She then left Canada to join  Johns Hopkins University  as the Director of the Proteomics Innovation Center in Heart Failure in 2003, and later Cedars-Sinai in 2014. [ 1 ] [ 5 ] [ 2 ]


Van Eyk is a member-at-large and a council member of  Human Proteome Organization , [ 6 ]  and the president of US Human Proteome Organization. [ 7 ]  She was a technical briefs editor at  Proteomics . [ 8 ]  She served on the editorial board of Proteomics: clinical application and Journal of Physiology and Circulation Research. [ 9 ]  She currently serves on the editorial board of  Clinical Proteomics . [ 10 ]  She is a Fellow of the  International Society for Heart Research . [ 11 ]  and is a Fellow of the  American Heart Association.


She is an international leading scientist in clinical proteomics. [ 12 ]  She is the founding director of Cedars-Sinai Advanced Clinical Biosystems Research Institute, [ 13 ]  whose motto is “from discovery to patient care”. [ 14 ]


She is co-editor of  Clinical Proteomics: From Diagnosis to Therapy, [ 15 ]  an essential, important and impressive book in clinical proteomics and translational medicine. [ 16 ]


Her list of publications:  https://www.ncbi.nlm.nih.gov/sites/myncbi/1VsYqQYH8535l/bibliography/48183272/public/ .


Kenneth Walsh  is an American medical researcher specializing in the study of  cardiovascular medicine . He is a professor of medicine at the  University of Virginia School of Medicine . He was formerly a professor at  Tufts University . [ 1 ]
Along with  Mark T. Nelson , he succeeded  David Julius  in 2021 as the co- editor  of the peer-reviewed journal the  Annual Review of Physiology . [ 2 ]


Walsh has received an Established Investigator Award from the  American Heart Association  and the Irwin F. Page Investigator Award from the  Council on Arteriosclerosis . [ 3 ]  In 2011, he was one of five researchers named as Distinguished Scientists that year by the American Heart Association. [ 4 ]


This biographical article related to medicine in the United States is a  stub . You can help Wikipedia by  expanding it .


Earl Howard Wood  (January 1, 1912 – March 18, 2009) was an American cardiopulmonary physiologist who helped invent the  G-suit , brought heart catheterization into a clinical reality and introduced dynamic volumetric computed tomography for the study of the heart and lungs. [ 2 ] [ 3 ] [ 4 ] [ 5 ]


Shortly after receiving an  M.D.  and  PhD  in physiology from the  University of Minnesota  medical school under the mentorship of Professor  Maurice B. Visscher , MD, [ 6 ]  Wood became a key member of a team, working in a laboratory at the  Mayo Clinic , tasked with helping military pilots and flight crew survive and function in high  G-force  environments. Based upon extensive physiologic testing via use of the human centrifuge installed at the Mayo Clinic, it was determined that blackout and then unconsciousness was caused by reduction of blood flow to the eyes first and then the brain. [ 7 ]  The solutions the team arrived at were the M-1 breath hold maneuver [ 8 ] [ 9 ]  and the  G-suit . [ 10 ] [ 11 ]  The M-1 maneuver consisted of a strained exhalation effort against a closed glottis designed to increase left ventricular pressure. (Although the references given are dated 1946-7, the work was performed much before then.  In, [ 7 ]  see the acknowledgments section [ 7 ] : 342   explaining the closed nature of the research with restrictions placed on publication during the war.   During the war effort the Mayo Clinic laboratory  was operating with government  Confidential  secrecy.)  The G suit was a garment, produced by the  David Clark Company , which has air bladders situated at the calves, thighs, and abdomen of the wearer. The bladders inflate as the G-force acting on the aircraft increase, constricting the wearer's arteries, hence increasing blood pressure and blood flow to the brain.


The G-suit was a superior solution to another alternative (a water-filled suit) being tested at the time, which was considered impractically heavy and cumbersome. The water-filled, pulsatile pressure suits were developed to effect venous return.  However, Wood and colleagues' detailed physiologic measurements demonstrated that what was required was augmentation of arterial pressure.


Wood himself regularly tested the flight suits, taking many turns in a human centrifuge and plane dubbed the "G-wiz". He calculated that during more than a thousand rides, he had lost consciousness for an aggregate of at least fifteen minutes (without any observed lasting damage). Wood was awarded a Presidential Certificate of Merit by Harry Truman in 1947.


The G-suit was adopted in the 1940s. The current models are based on the pattern Wood and his colleagues designed. Following World War II, Wood was recruited to participate in what was known as " Operation Paperclip " [ 12 ]  The goal was to keep the top German scientists away from Russia and working for the United States.


In 1962, Wood was the tenth scientist to be named "Career Investigator," of the American Heart Association. [ 13 ]  These funds allowed Wood considerable flexibility in regards to the directions of his research.


After his work on the G-Suit, Wood worked on techniques for measuring cardiac blood flow. He was granted a  patent  for the ear oximeter, an optical instrument that measures blood oxygen levels without taking blood by examining the variation of light absorption as a function of oxygen saturation of hemoglobin. Integral to the work leading to the development of the G suit was the perfection of vascular catheterization methods needed to understand the distribution of blood pressure and flow.  Shortly after the end of World War II, open-heart surgery emerged with the Mayo contribution [ 14 ]  to the development of the heart-lung bypass machine initially developed by Gibbons [ 15 ]  and perfected by Wood and colleagues. [ 14 ] [ 16 ]  Wood's work at the Mayo Clinic lead to the development of many technologies [ 5 ]  allowing for the assessment of the heart and lungs including dye dilution methods serving to characterize cardiac output, [ 17 ]  methods for the assessment of central blood volume, [ 18 ]  the calculation of  pulmonary vascular resistance  (known as the "Wood Unit" and calculated by subtracting pulmonary capillary wedge pressure from the mean pulmonary arterial pressure and dividing by the cardiac output), [ 19 ] [ 20 ] [ 21 ]  analog subtraction angiography, and eventually the Dynamic Spatial Reconstructor (DSR), a predecessor to modern high speed volumetric  computed tomography  (CT) allowing for the evaluation of the beating heart and breathing lungs.  The DSR comprised 14 X-ray tubes and a hemicylindrical fluorescent screen imaged by 14 associated television cameras. [ 22 ] [ 23 ]


In all, Wood is noted for his contributions (together with members of the Biodynamics Research Unit (BRU), under his direction, within the physiology and biophysics department at the  Mayo Clinic ) in the following areas:


Wood's publication list, with more than 700 entries, is a testament to the number of fellows who trained under him and who became prominent researchers in their own right.


Earl Wood was born to Inez Goff and William Clark Wood in Mankato, Minnesota on January 1, 1912 and started life on a subsistence farm. [ 4 ]   William Wood, in addition to farming, was a real estate businessman. Earl Wood earned a B.A. in Mathematics and Chemistry from Macalester College in 1934, and his MD degree and a PhD degree in physiology from the University of Minnesota. Earl was one of 5 brothers (Earl, Chester, Delbert, Harland and Abe) and a sister, Louise.


All of Earl Wood's siblings grew up to be highly accomplished. [ 13 ]  Louise A. Wood was awarded the  Medal of Freedom  by President Truman for her services as overseas director of the American Red Cross during World War II. and became the executive director of the  Girl Scouts of the USA  from 1961 to 1972.  Harland G. Wood  was the first director of the department of biochemistry at the school of medicine and dean of sciences, Case Western Reserve University. As a biochemist, he was notable for proving in 1935 that animals, humans and bacteria utilized carbon dioxide [ 54 ]  and received the National Medal of Science. Chester was a teacher and a university administrator; Delbert was, in succession, a lawyer, a Federal Bureau of Investigation agent, and a railway executive; Abe was an internist and founder of a Colorado-based medical clinic. Not surprisingly, in 1950, Earl Wood's mother, Inez, was awarded the title of "Minnesota Mother of the Year." [ 13 ]   Earl and his wife, Ada, had a daughter, Phoebe and three sons, Mark, Guy and E. Andrew.


Rapid Interpretation of EKG's  is a best-selling textbook for over 30 years [ 1 ]  that teaches the basics of interpreting  electrocardiograms . It adopts a simplistic fill-in-the-blank style [ 2 ]  and is suited for medical students and junior residents. [ 1 ]  The book was written by  Dale Dubin ,  M.D. , a  plastic surgeon  and convicted felon, [ 3 ]  who has written several books on  cardiology  including  Ion Adventure in the Heartland: Exploring the Heart's Ionic-Molecular Microcosm [ 4 ]  and  Understanding Cardio-pulmonary Resuscitation . [ 5 ]


The large yellow book was originally published in 1972; the sixth and most recent edition was published in 2000. In the fiftieth printing, the author hid within the  copyright notice  an offer to give his prized 1965  Ford Thunderbird  (which was featured in several photographs in the book) to anyone who actually read the message and responded. Out of 60,000 copies in that printing, only 5 readers noticed and responded, and Dubin's own daughter delivered the car to the winner, a  Yale  medical student, as selected by a random drawing. [ 6 ] [ 7 ]


Cardiology  (from  Ancient Greek     καρδίᾱ  (kardiā)  'heart' and   - λογία  ( -logia )  'study') is the study of the heart. Cardiology is a branch of  medicine  that deals with disorders of the  heart  and the  cardiovascular system . The field includes  medical diagnosis  and treatment of  congenital heart defects ,  coronary artery disease ,  heart failure ,  valvular heart disease , and  electrophysiology .  Physicians  who specialize in this field of medicine are called  cardiologists , a sub-specialty of  internal medicine . Pediatric cardiologists are  pediatricians  who specialize in cardiology. Physicians who specialize in cardiac surgery are called  cardiothoracic surgeons  or  cardiac surgeons , a specialty of  general surgery . [ 1 ]


All cardiologists in the branch of medicine study the disorders of the heart, but the study of adult and child heart disorders each require different training pathways. Therefore, an adult cardiologist (often simply called "cardiologist") is inadequately trained to take care of children, and pediatric cardiologists are not trained to treat adult heart disease. Surgical aspects outside of cardiac rhythm device implant are not included in cardiology and are in the domain of  cardiothoracic surgery . For example,  coronary artery bypass surgery  (CABG),  cardiopulmonary bypass  and  valve replacement  are surgical procedures performed by surgeons, not cardiologists. Typically a cardiologist would first identify who is in need of cardiac surgery and refer them to a cardiac surgeon for the procedure. However, some invasive procedures such as  cardiac catheterization  and  pacemaker implantation  are performed by cardiologists.


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, [ 2 ]  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. [ 3 ]  Recognized subspecialties in the U.S. by the  American Osteopathic Association Bureau of Osteopathic Specialists  include  clinical cardiac electrophysiology  and  interventional cardiology . [ 4 ]


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 ]


Per  Doximity , adult cardiologists earn an average of $436,849 per year in the U.S. [ 5 ]


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)  catheter  recording of spontaneous activity as well as of cardiac responses to  programmed electrical stimulation  (PES). These studies are performed to assess complex  arrhythmias , 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  pacemakers  and automatic  implantable cardioverter-defibrillators  (AICD). [ 6 ] [ 7 ]


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. [ 6 ]


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. [ 8 ]


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. [ 9 ]


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. [ 10 ] [ 11 ]  Vascular disorders such as  atherosclerosis  and  peripheral arterial disease  cause significant morbidity and mortality in aged people. [ 12 ] [ 13 ]


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. [ 14 ]


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 is a branch of cardiology that deals specifically with the  catheter  based treatment of structural heart diseases. [ 15 ]  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  cannulating  the heart under  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.


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. [ 16 ]  Specialization of general cardiology to just that of the  cardiomyopathies  leads to also specializing in  heart transplant  and  pulmonary hypertension .


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.


In recent times, the focus is gradually shifting to preventive cardiology due to increased  cardiovascular disease  burden at an early age. According to the WHO, 37% of all premature deaths are due to cardiovascular diseases and out of this, 82% are in low and middle income countries. [ 17 ]  Clinical cardiology is the sub specialty of cardiology which looks after preventive cardiology and cardiac rehabilitation. Preventive cardiology also deals with routine preventive checkup though noninvasive tests, specifically electrocardiography,  fasegraphy , stress tests,  lipid profile  and general physical examination to detect any cardiovascular diseases at an early age, while cardiac rehabilitation is the upcoming branch of cardiology which helps a person regain their overall strength and live a normal life after a cardiovascular event. A subspecialty of preventive cardiology is  sports cardiology . Because heart disease is the leading cause of death in the world including United States (cdc.gov), national health campaigns and randomized control research has developed to improve heart health.


Helen B. Taussig  is known as the founder of pediatric cardiology. She became famous through her work with  Tetralogy  congenital heart defect in which  oxygenated and deoxygenated blood  enters the circulatory system resulting from a  ventricular septal defect  (VSD) right beneath the aorta. This condition causes newborns to have a bluish-tint,  cyanosis , and have a deficiency of oxygen to their tissues,  hypoxemia . She worked with  Alfred Blalock  and  Vivien Thomas  at the  Johns Hopkins Hospital  where they experimented with dogs to look at how they would attempt to surgically cure these "blue babies". They eventually figured out how to do just that by the  anastomosis  of the systemic artery to the pulmonary artery and called this the  Blalock-Taussig Shunt . [ 18 ]


Tetralogy of Fallot ,  pulmonary atresia ,  double outlet right ventricle ,  transposition of the great arteries ,  persistent truncus arteriosus , and  Ebstein's anomaly  are various congenital cyanotic heart diseases, in which the  blood  of the newborn is not oxygenated efficiently, due to the heart defect.


As more children with congenital heart disease are surviving into adulthood, a hybrid of adult and pediatric cardiology has emerged called adult congenital heart disease (ACHD).
This field can be entered as either adult or pediatric cardiology.
ACHD specializes in congenital diseases in the setting of adult diseases (e.g., coronary artery disease, COPD, diabetes) that is, otherwise, atypical for adult or pediatric cardiology.


As the center focus of cardiology, the heart has numerous anatomical features (e.g.,  atria ,  ventricles ,  heart valves ) and numerous physiological features (e.g.,  systole ,  heart sounds ,  afterload ) that have been encyclopedically documented for many centuries. The heart is located in the middle of the abdomen with its tip slightly towards the left side of the abdomen.


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 U.S. and caused 24.95% of total deaths in 2008. [ 19 ]


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 . [ citation needed ]  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. The heart's systems can be classified as either electrical or mechanical, and both of these systems are susceptible to failure or dysfunction.


The electrical system 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 study of the electrical aspects is a sub-field of  electrophysiology  called  cardiac electrophysiology  and is epitomized with the electrocardiogram (ECG/EKG).
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 . [ 20 ]


The mechanical system 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.
 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. Failure to move a sufficient amount of blood through the body can cause damage or failure of other organs and may result in death if severe. [ 21 ]


Coronary circulation is the circulation of blood in the  blood vessels  of the  heart muscle  (the 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. 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 myocardial infarction (a.k.a., a heart attack). The coronary arteries that run deep within the myocardium are referred to as subendocardial.


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 . [ citation needed ]


Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation. [ 22 ] [ 23 ]


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 are jointly termed the cardiovascular system, and diseases of one part tend to affect the other.


Coronary artery disease, also known as "ischemic heart disease", [ 24 ]  is a group of diseases that includes:  stable angina ,  unstable angina , myocardial infarction, and is one of the causes of  sudden cardiac death . [ 25 ]  It is within the group of cardiovascular diseases of which it is the most common type. [ 26 ]  A common symptom is  chest pain  or discomfort which may travel into the shoulder, arm, back, neck, or jaw. [ 27 ]  Occasionally it may feel like  heartburn . Usually symptoms occur with exercise or emotional  stress , last less than a few minutes, and get better with rest. [ 27 ]   Shortness of breath  may also occur and sometimes no symptoms are present. [ 27 ]  The first sign is occasionally a heart attack. [ 28 ]  Other complications include  heart failure  or an  irregular heartbeat . [ 28 ]


Risk factors include:  high blood pressure ,  smoking ,  diabetes , lack of exercise,  obesity ,  high blood cholesterol , poor diet, and excessive  alcohol , among others. [ 29 ] [ 30 ]  Other risks include  depression . [ 31 ]  The underlying mechanism involves  atherosclerosis  of the  arteries of the heart . A number of tests may help with diagnoses including: electrocardiogram,  cardiac stress testing ,  coronary computed tomographic angiography , and  coronary angiogram , among others. [ 32 ]


Prevention is by eating a healthy diet, regular exercise, maintaining a healthy weight and not smoking. [ 33 ]  Sometimes medication for diabetes, high cholesterol, or high blood pressure are also used. [ 33 ]  There is limited evidence for screening people who are at low risk and do not have symptoms. [ 34 ]  Treatment involves the same measures as prevention. [ 35 ] [ 36 ]  Additional medications such as  antiplatelets  including  aspirin ,  beta blockers , or  nitroglycerin  may be recommended. [ 36 ]  Procedures such as  percutaneous coronary intervention  (PCI) or  coronary artery bypass surgery  (CABG) may be used in severe disease. [ 36 ] [ 37 ]  In those with stable CAD it is unclear if PCI or CABG in addition to the other treatments improve  life expectancy  or decreases heart attack risk. [ 38 ]


In 2013 CAD was the  most common cause of death  globally, resulting in 8.14 million deaths (16.8%) up from 5.74 million deaths (12%) in 1990. [ 26 ]  The risk of death from CAD for a given age has decreased between 1980 and 2010 especially in  developed countries . [ 39 ]  The number of cases of CAD for a given age has also decreased between 1990 and 2010. [ 40 ]  In the U.S. in 2010 about 20% of those over 65 had CAD, while it was present in 7% of those 45 to 64, and 1.3% of those 18 to 45. [ 41 ]  Rates are higher among men than women of a given age. [ 41 ]


Heart failure, or formally cardiomyopathy, is the impaired function of the heart, and there are numerous causes and forms of heart failure.


The causes of cardiomyopathy can be  genetic , viral, or lifestyle-related. Key symptoms of cardiomyopathy include shortness of breath, fatigue, and irregular heartbeats. Understanding the specific function of cardiac muscle is crucial, as the heart muscle's main role is to pump blood throughout the body efficiently. [ 42 ]


Cardiac arrhythmia, also known as "cardiac dysrhythmia" or "irregular heartbeat", is a group of conditions in which the  heartbeat  is too fast, too slow, or irregular in its rhythm. A  heart rate  that is too fast – above 100 beats per minute in adults – is called  tachycardia . A heart rate that is too slow – below 60 beats per minute – is called  bradycardia . [ 43 ]  Many types of arrhythmia present no symptoms. When symptoms are present, they may include  palpitations , or feeling a pause between heartbeats. More serious symptoms may include  lightheadedness ,  passing out ,  shortness of breath , or  chest pain . [ 44 ]  While most types of arrhythmia are not serious, some predispose a person to complications such as  stroke  or  heart failure . [ 43 ] [ 45 ]  Others may result in  cardiac arrest . [ 45 ]


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 . [ 45 ] [ 46 ]  Arrhythmias are due to problems with the  electrical conduction system of the heart . [ 43 ]  Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. [ 45 ]  A number of tests can help diagnose arrhythmia, including an electrocardiogram and  Holter monitor . [ 47 ]


Most arrhythmias can be effectively treated. [ 43 ]  Treatments may include medications, medical procedures such as a  pacemaker , and surgery. Medications for a fast heart rate may include  beta blockers  or  agents that attempt to restore a normal heart rhythm  such as  procainamide . 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. 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 . [ 48 ]


Arrhythmia affects millions of people. [ 49 ]  In Europe and North America, as of 2014, atrial fibrillation affects about 2% to 3% of the population. [ 50 ]  Atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, up from 29,000 in 1990. [ 26 ]   Sudden cardiac death  is the cause of about half of deaths due to cardiovascular disease or about 15% of all deaths globally. [ 51 ]  About 80% of sudden cardiac death is the result of ventricular arrhythmias. [ 51 ]  Arrhythmias may occur at any age but are more common among older people. [ 49 ]


Cardiac arrest is a sudden stop in effective  blood flow  due to the failure of the heart to contract effectively. [ 52 ]  Symptoms include  loss of consciousness  and  abnormal or absent breathing . [ 53 ] [ 54 ]  Some people may have  chest pain ,  shortness of breath , or  nausea  before this occurs. [ 54 ]  If not treated within minutes,  death  usually occurs. [ 52 ]


The most common cause of cardiac arrest is  coronary artery disease . Less common causes include  major blood loss , lack of oxygen,  very low potassium ,  heart failure , and intense physical exercise. A number of inherited disorders may also increase the risk including  long QT syndrome . The initial heart rhythm is most often  ventricular fibrillation . [ 55 ]  The diagnosis is confirmed by finding no pulse. [ 53 ]  While a cardiac arrest may be caused by heart attack or heart failure these are not the same. [ 52 ]


Prevention includes not smoking, physical activity, and maintaining a healthy weight. [ 56 ]  Treatment for cardiac arrest is immediate  cardiopulmonary resuscitation  (CPR) and, if a  shockable rhythm  is present,  defibrillation . [ 57 ]  Among those who survive  targeted temperature management  may improve outcomes. [ 58 ]  An  implantable cardiac defibrillator  may be placed to reduce the chance of death from recurrence. [ 56 ]


In the  United States , cardiac arrest outside of  hospital  occurs in about 13 per 10,000 people per year (326,000 cases). In hospital cardiac arrest occurs in an additional 209,000 [ 59 ]  Cardiac arrest becomes more common with age. It affects males more often than females. [ 60 ]  The percentage of people who survive with treatment is about 8%. Many who survive have significant  disability . Many U.S. television shows, however, have portrayed unrealistically high survival rates of 67%. [ 61 ]


Hypertension , also known as "high blood pressure", is a  long term   medical condition  in which the  blood pressure  in the  arteries  is persistently elevated. [ 62 ]  High blood pressure usually does not cause symptoms. [ 63 ]  Long term high blood pressure, however, is a major risk factor for  coronary artery disease ,  stroke ,  heart failure ,  peripheral vascular disease ,  vision loss , and  chronic kidney disease . [ 64 ] [ 65 ]


Lifestyle factors can increase the risk of hypertension. These include  excess salt  in the diet,  excess body weight ,  smoking , and alcohol consumption. [ 63 ] [ 66 ]  Hypertension can also be caused by other diseases, or occur as a side-effect of drugs. [ 67 ]


Blood pressure is expressed by two measurements, the  systolic  and  diastolic  pressures, which are the maximum and minimum pressures, respectively. [ 63 ]  Normal blood pressure when at rest is within the range of 100–140  millimeters mercury  (mmHg) systolic and 60–90 mmHg diastolic. [ 68 ]  High blood pressure is present if the resting blood pressure is persistently at or above 140/90 mmHg for most adults. [ 66 ]  Different numbers apply to children. [ 69 ]  When diagnosing high blood pressure,  ambulatory blood pressure monitoring  over a 24-hour period appears to be more accurate than "in-office"  blood pressure measurement  at a physician's office or other blood pressure screening location. [ 62 ] [ 66 ] [ 70 ]


Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications. [ 71 ]  Lifestyle changes include weight loss, decreased salt intake, physical exercise, and a healthy diet. [ 66 ]  If changes in lifestyle are insufficient,  blood pressure medications  may be used. [ 71 ]  A regimen of up to three medications effectively controls blood pressure in 90% of people. [ 66 ]  The treatment of moderate to severe high arterial blood pressure (defined as >160/100 mmHg) with medication is associated with an improved  life expectancy  and reduced  morbidity . [ 72 ]  The effect of treatment for blood pressure between 140/90 mmHg and 160/100 mmHg is less clear, with some studies finding benefits [ 73 ] [ 74 ]  while others do not. [ 75 ]  High blood pressure affects between 16% and 37% of the population globally. [ 66 ]  In 2010, hypertension was believed to have been a factor in 18% (9.4 million) deaths. [ 76 ]


Essential hypertension is the form of  hypertension  that by definition has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, [ 77 ] [ 78 ] [ 79 ] [ 80 ]  it tends to be familial and is likely to be the consequence of an interaction between  environmental  and  genetic  factors.  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. [ 81 ]


Secondary hypertension  is a type of  hypertension  which is caused by an identifiable underlying secondary cause. It is much less common than essential hypertension, affecting only 5% of hypertensive patients. It has many different causes including  endocrine diseases ,  kidney diseases , and  tumors . It also can be a  side effect  of many  medications . [ 82 ]


Complications of hypertension  are clinical outcomes that result from  persistent elevation  of blood pressure. [ 83 ]  Hypertension is a risk factor for all clinical manifestations of  atherosclerosis  since it is a risk factor for atherosclerosis itself. [ 84 ] [ 85 ] [ 86 ] [ 87 ] [ 88 ]  It is an independent predisposing factor for  heart failure , [ 89 ] [ 90 ]   coronary artery disease , [ 91 ] [ 92 ]   stroke , [ 83 ]   renal disease , [ 93 ] [ 94 ] [ 95 ]  and  peripheral arterial disease . [ 96 ] [ 97 ]  It is the most important  risk factor  for  cardiovascular   morbidity  and  mortality , in  industrialized countries . [ 98 ]


A congenital heart defect, also known as a "congenital heart anomaly" or "congenital heart disease", is a problem in the structure of the heart that is present at  birth . [ 99 ]  Signs and symptoms depend on the specific type of problem. [ 100 ]  Symptoms can vary from none to life-threatening. [ 99 ]  When present they may include rapid breathing,  bluish skin , poor weight gain, and feeling tired. [ 101 ]  It does not cause chest pain. [ 101 ]  Most congenital heart problems do not occur with other diseases. [ 100 ]  Complications that can result from heart defects include  heart failure . [ 101 ]


The cause of a congenital heart defect is often unknown. [ 102 ]  Certain cases may be due to infections during  pregnancy  such as  rubella , use of certain medications or drugs such as  alcohol  or  tobacco , parents being closely related, or poor nutritional status or  obesity  in the mother. [ 100 ] [ 103 ]  Having a parent with a congenital heart defect is also a risk factor. [ 104 ]  A number of genetic conditions are associated with heart defects including  Down syndrome ,  Turner syndrome , and  Marfan syndrome . [ 100 ]  Congenital heart defects are divided into two main groups:  cyanotic heart defects  and  non-cyanotic heart defects , depending on whether the child has the potential to turn bluish in color. [ 100 ]  The problems may involve the interior walls of the heart, the  heart valves , or the large blood vessels that lead to and from the heart. [ 99 ]


Congenital heart defects are partly preventable through  rubella vaccination , the adding of  iodine  to salt, and the adding of  folic acid  to certain food products. [ 100 ]  Some defects do not need treatment. [ 99 ]  Other may be effectively treated with  catheter based procedures  or  heart surgery . [ 105 ]  Occasionally a number of operations may be needed. [ 105 ]  Occasionally  heart transplantation  is required. [ 105 ]  With appropriate treatment outcomes, even with complex problems, are generally good. [ 99 ]


Heart defects are the most common  birth defect . [ 100 ] [ 106 ]  In 2013 they were present in 34.3 million people globally. [ 106 ]  They affect between 4 and 75 per 1,000 live births depending upon how they are diagnosed. [ 100 ] [ 104 ]  About 6 to 19 per 1,000 cause a moderate to severe degree of problems. [ 104 ]  Congenital heart defects are the leading cause of birth defect-related deaths. [ 100 ]  In 2013 they resulted in 323,000 deaths down from 366,000 deaths in 1990. [ 26 ]


Tetralogy of Fallot  is the most common congenital heart disease arising in 1–3 cases per 1,000 births. The cause of this defect is a  ventricular septal defect  (VSD) and an  overriding aorta . These two defects combined causes deoxygenated blood to bypass the lungs and going right back into the circulatory system. The  modified Blalock-Taussig shunt  is usually used to fix the circulation. This procedure is done by placing a graft between the subclavian artery and the ipsilateral pulmonary artery to restore the correct blood flow.


Pulmonary atresia  happens in 7–8 per 100,000 births and is characterized by the aorta branching out of the right ventricle. This causes the deoxygenated blood to bypass the lungs and enter the circulatory system. Surgeries can fix this by redirecting the aorta and fixing the right ventricle and pulmonary artery connection.


There are two types of pulmonary atresia, classified by whether or not the baby also has a  ventricular septal defect . [ 107 ] [ 108 ]


Double outlet right ventricle  (DORV) is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. There is usually a VSD in different particular places depending on the variations of DORV, typically 50% are subaortic and 30%. The surgeries that can be done to fix this defect can vary due to the different physiology and blood flow in the defected heart. One way it can be cured is by a VSD closure and placing conduits to restart the blood flow between the left ventricle and the aorta and between the right ventricle and the pulmonary artery. Another way is systemic-to-pulmonary artery shunt in cases associated with  pulmonary stenosis . Also, a  balloon atrial septostomy  can be done to relieve hypoxemia caused by DORV with the Taussig-Bing anomaly while surgical correction is awaited. [ 109 ]


There are two different types of  transposition of the great arteries ,  Dextro-transposition of the great arteries  and  Levo-transposition of the great arteries , depending on where the chambers and vessels connect. Dextro-transposition happens in about 1 in 4,000 newborns and is when the right ventricle pumps blood into the aorta and deoxygenated blood enters the bloodstream. The temporary procedure is to create an  atrial septal defect . A permanent fix is more complicated and involves redirecting the pulmonary return to the right atrium and the systemic return to the left atrium, which is known as the  Senning procedure . The  Rastelli procedure  can also be done by rerouting the left ventricular outflow, dividing the pulmonary trunk, and placing a conduit in between the right ventricle and pulmonary trunk. Levo-transposition happens in about 1 in 13,000 newborns and is characterized by the left ventricle pumping blood into the lungs and the right ventricle pumping the blood into the aorta. This may not produce problems at the beginning, but will eventually due to the different pressures each ventricle uses to pump blood. Switching the left ventricle to be the systemic ventricle and the right ventricle to pump blood into the pulmonary artery can repair levo-transposition. [ citation needed ]


Persistent truncus arteriosus  is when the  truncus arteriosus  fails to split into the aorta and pulmonary trunk. This occurs in about 1 in 11,000 live births and allows both oxygenated and deoxygenated blood into the body. The repair consists of a VSD closure and the Rastelli procedure. [ 110 ] [ 111 ]


Ebstein's anomaly  is characterized by a right atrium that is significantly enlarged and a heart that is shaped like a box. This is very rare and happens in less than 1% of congenital heart disease cases. The surgical repair varies depending on the severity of the disease. [ 112 ]


Pediatric cardiology is a sub-specialty of  pediatrics . To become a pediatric cardiologist in the U.S., one must complete a three-year residency in pediatrics, followed by a three-year fellowship in pediatric cardiology. Per  doximity , pediatric cardiologists make an average of $303,917 in the U.S. [ 5 ]


Diagnostic tests in cardiology  are the methods of identifying heart conditions associated with healthy vs. unhealthy,  pathologic  heart function. The starting point is obtaining a  medical history , followed by  Auscultation . Then  blood tests ,  electrophysiological procedures , and  cardiac imaging  can be ordered for further analysis. Electrophysiological procedures include electrocardiogram,  cardiac monitoring ,  cardiac stress testing , and the  electrophysiology study . [ citation needed ]


Cardiology is known for  randomized controlled trials  that guide clinical treatment of cardiac diseases. While dozens are published every year, there are landmark trials that shift treatment significantly. Trials often have an acronym of the trial name, and this acronym is used to reference the trial and its results. Some of these landmark trials include:


Cardiophysics  is an  interdisciplinary   science  that stands at the junction of  cardiology  and  medical physics , with researchers using the methods of, and theories from,  physics  to study  cardiovascular system  at different levels of its organisation, from the molecular scale to whole organisms. Being formed historically as part of  systems biology ,  cardiophysics  designed to reveal connections between the physical mechanisms, underlying the organization of the cardiovascular system, and biological features of its functioning.


Zbigniew R. Struzik seems to be a first author who used the term in a scientific publication in 2004.


One can use interchangeably also the terms  cardiovascular physics .


The following  outline  is provided as an overview of and topical guide to  cardiology , the branch of medicine dealing with disorders of the human heart. [ 1 ]  The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.


Cardiology can be described as all of the following:


Heart  –


The cardiac  physical exam  focuses on portions of the physical exam that elucidate information about diseases and disorders outlined below.
Clinical judgment, of course, should guide the physical exam but the following are pertinent things related to a general / broad cardiac exam.


Coronary artery disease  is not currently reversible and eventually requires surgical management if it progresses.


Various  cardiology diagnostic tests and procedures .


There are several classes of  pharmaceutical drugs  used in cardiology to manage various diseases and many of them have cardiovascular side effects.


Drugs that manipulate the cardiovascular system do so through several ways.
The first is  ion channels , which are often manipulated to manage  arrhythmias .
The second is  receptors  of various types.
The third is manipulation of  enzymes .


Ion channels are responsible for  cell membrane  voltage, depolarization, and repolarization.
These actions lead to conduction of signals down nerves and contraction of cardiomyocytes.
Perhaps the most prominent manipulation of ion channels is through  antiarrhythmic agents .
These agents are commonly classified by the type of ion they manipulate and named the  Vaughan Williams classification :


Specifically, types I, III, & IV manipulate ion channels while the others are not.


The  adrenergic receptor  is a set of receptors that are commonly manipulated.
Four properties of the heart —  chronotropy ,  dromotropy ,  inotropy , &  lusitropy  — are manipulated by adrenergic receptors.
For example, the  β1 receptor  increases all four of these properties: chronotropy at the  SA node , dromotropy through the  AV node , inotropy of the cardiomyocytes through increased calcium, and lusitropy through phosphorylation of  phospholamban .  Catecholamines  are a set of drugs and hormones that manipulate the adrenergic receptors. The natural catecholamines are  norepinephrine ,  epinephrine , and  dopamine . There are numerous other drugs (e.g.,  dobutamine ,  ephedrine ,  isoproterenol ) that manipulate the adrenergic receptors and have variable specificity for the receptors and are, thus, used for various reasons.


Angiotensin II receptor antagonists  (ARBs) block the  angiotensin II receptors  that are linked to hypertension and heart failure, mainly through vasodilation & heart remodeling inhibition.


ACE inhibitors  works upstream from angiotensin II receptor antagonists and have similar effects on management of hypertension and heart failure.


Sodium nitroprusside  and  nitroglycerin  function by causing vasodilation through  nitric oxide , which manipulates  cGMP  levels through  guanylate cyclase .


COX inhibitors  (namely  aspirin ),  warfarin ,  direct Xa inhibitors ,  direct thrombin inhibitors ,  heparin ,  low-molecular weight heparins , antibodies (e.g.,  abciximab ), and a few others are used for  anticoagulation therapy .
This is important in those predisposed to blood clots (e.g.,  Factor V Leiden ) but also for thrombus formation when an  atherosclerotic  plaque rupture that would, otherwise, lead to  myocardial infarction .


Numerous drug classes have well-known cardiovascular side effects.


This is a  list of  cardiology   mnemonics , categorized and alphabetized. For mnemonics in other medical specialities, see this  list of medical mnemonics .


CREAM :


C ongenital


R heumatic damage


E ndocarditis


A ortic dissection/  A ortic root dilatation


M arfan’s


SAD : [ 1 ] p. 29


S yncope


A ngina


D yspnoea


ABC'S [ 1 ] p. 1


A ortic arch gives rise to:


B rachiocephalic trunk


Left  C ommon  C arotid


Left  S ubclavian


T oilet  P aper  M y  A ss, or  T hey  P ay  M e  A lcohol, or "T"hugs "P"ush "Me" "A"round.  [ 2 ]


T ricuspid valve


P ulmonary semilunar valve


M itral (bicuspid) valve


A ortic semilunar valve


HILT : [ 1 ] p. 29


H eaving


I mpalpable


L aterally displaced


T hrusting/  T apping


If it's impalpable, causes are  COPD : [ 1 ] p. 29


C OPD


O besity


P leural,  P ericardial effusion


D extrocardia


A nticoagulants: To prevent embolization.


B eta blockers: To block the effects of certain hormones on the heart to slow the heart rate.


C alcium Channel Blockers: Help slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the lower heart chambers (ventricles).


D igoxin: Helps slow the heart rate by blocking the number of electrical impulses that pass through the AV node into the lower heart chambers (ventricles).


E lectrocardioversion: A procedure in which electric currents are used to reset the heart's rhythm back to regular pattern. [ 3 ]


Pirates : [ 1 ] p. 3


P ulmonary: PE, COPD


I atrogenic


R heumatic heart: mitral regurgitation


A therosclerotic: MI, CAD


T hyroid: hyperthyroid


S ick sinus syndrome


ABCD : [ 1 ] p. 30


A nti-coagulate


B eta-block to control rate


C ardiovert


D igoxin


3 D's: [ 1 ] p. 30


D iminished heart sounds


D istended jugular veins


D ecreased arterial pressure


B etablockers  A cting  E xclusively  A t  M yocardium: [ 1 ] p. 30


B etaxolol


A cebutelol


E smolol


A tenolol


M etoprolol


LMNOP


L asix


M orphine


N itrites


O xygen


Vasso P ressors [ 4 ]


FAILURE [ 1 ] p. 30


F orgot medication


A rrhythmia/  A naemia


I schemia/ Infarction/ Infection


L ifestyle: taken too much salt


U pregulation of CO: pregnancy, hyperthyroidism


R enal failure


E mbolism: pulmonary


Darth Vader


D eath


A rrhythmia


R upture(free ventricular wall/ ventricular septum/ papillary muscles)


T amponade


H eart failure (acute or chronic)


V alve disease


A neurysm of Ventricles


D ressler's Syndrome


thrombo E mbolism (mural thrombus)


R ecurrence/ mitral  R egurgitation [ 5 ]


DUST : [ 1 ] p. 31


D epressed ventricular function


U nstable angina


S tenosis of the left main stem


T riple vessel disease


W i LL ia M   M a RR o W : [ 1 ] p. 31


W  pattern in V1-V2 and  M  pattern in V3-V6 is  L eft bundle block.


M  pattern in V1-V2 and  W  in V3-V6 is  R ight bundle block.


RAMP : [ 1 ] p. 31


R ecent MI


A ortic stenosis


M I in the last 7 days


P ulmonary hypertension


FROM JANE :


F ever


R oth's spots


O sler's nodes


M urmur of heart


J aneway lesions


A nemia


E mboli


Try   Pul ing  My   Aorta : [ 1 ] p. 3


Tri cuspid


Pul monary


Mi tral (bicuspid)


Aorta


If the  R  is far from  P ,
then you have a  First Degree .


Longer, longer, longer, drop!
Then you have a  Wenkebach .


if some  P' s don't get through,
then you have  Mobitz II .


If  P' s and  Q' s don't agree, then you have a  Third Degree . [ 6 ]


INFARCTIONS [ 1 ] p. 34


I V access


N arcotic analgesics (e.g. morphine, pethidine)


F acilities for defibrillation (DF)


A spirin/ Anticoagulant (heparin)


R est


C onverting enzyme inhibitor


T hrombolysis


I V beta blocker


O xygen 60%


N itrates


S tool Softeners


ASK ME [ 1 ] p. 32


A trial contraction


S ystole (ventricular contraction)


K losure (closure) of tricuspid valve, so atrial filling


M aximal atrial filling


E mptying of atrium


BOOMAR : [ 1 ] p. 32


B ed rest


O piate


M onitor


A nticoagulate


R educe clot size


PULSE : [ 1 ] p. 32


P ersistent chest pains


U pset stomach


L ightheadedness


S hortness of breath


E xcessive sweating


O BATMAN! [ 1 ] p. 32


B eta blocker


A SA


T hrombolytics (e.g. heparin)


A ce prn


N itroglycerin


COAG : [ 1 ] p. 32


C yclomorph


A spirin


G lycerol trinitrate


"IL PQRST"  (person has ill PQRST heart waves): [ 1 ] p. 32


I ntensity


L occasion


P itch


Q uality


R adiation


S hape


T iming


8 S's : [ 1 ] p. 32


S oft


S ystolic


S hort


S ounds (S1 & S2) normal


S ymptomless


S pecial tests normal (X-ray, EKG)


S tanding/  S itting (vary with position)


S ternal depression


L E ft sided murmurs louder with  E xpiration


R I ght sided murmurs louder with  I nspiration. [ 1 ] p. 32


SCRIPT : [ 1 ] p. 32


S ite


C haracter (e.g. harsh, soft, blowing)


PASS : P ulmonic &  A ortic


S tenosis= S ystolic.


PAID :  P ulmonic &  A ortic


I nsufficiency= D iastolic. [ 1 ] p. 32


CARDIAC RIND : [ 1 ] p. 34


C ollagen vascular disease


A ortic aneurysm


D rugs (such as hydralazine)


I nfections


A cute renal failure


C ardiac infarction


R heumatic fever


I njury


N eoplasms


D ressler's syndrome


P ericarditi S : [ 1 ] p. 34


P R depression in  p recordial leads.


S T elevation.


SICVD : [ 1 ] p. 34


S ymmetry of leg musculature


I ntegrity of skin


C olor of toenails


V aricose veins


D istribution of hair


PATCH MED : [ 1 ] p. 34


P ulmonary embolus


A cidosis


T ension pneumothorax


C ardiac tamponade


H ypokalemia/  H yperkalemia/  H ypoxia/  H ypothermia/  H ypovolemia


M yocardial infarction


E lectrolyte derangements


D rugs


ELEVATION: [ 1 ] p. 34


E lectrolytes


L BBB


E arly repolarization


V entricular hypertrophy


A neurysm


T reatment (e.g. pericardiocentesis)


I njury (AMI, contusion)


O sborne waves (hypothermia)


N on-occlusive vasospasm


ABCDE: [ 1 ] p. 35


A denosine


B eta-blocker


C alcium channel antagonist


E xcitation (vagal stimulation)


LAMB: [ 1 ] p. 35


L idocaine


A miodarone


M exiltene/ Magnesium


N ever  l et  m onkeys  e at  b ananas:


N eutrophils


l ymphocytes


m onocytes


e osinophils


b asophils [ 7 ]


The  abdominojugular test , also known as  abdominojugular reflux  ( AJR ), is a physical examination test useful in diagnosing  right ventricle  dysfunction, particularly  right ventricular failure . [ 1 ]


AJR is a test for measuring  jugular venous pressure  (JVP) through the  distention  of the  internal jugular vein . A positive AJR test correlates with the  pulmonary artery pressure  and thus is a marker for right heart dysfunction, [ 2 ]  specifically  right ventricular failure . [ 1 ]


Reflux  in this context means backup of the circulatory system and is not to be confused with  reflex . [ 3 ]


The clinician presses firmly over either the  right upper quadrant  of the abdomen (i.e., over the  liver ) or over the center of the abdomen  [ 2 ]  for 10 seconds with a pressure of 20 to 35 mm Hg while observing the swelling of the  internal jugular vein  in the  neck  and also observing to be sure the patient does not perform a  Valsalva maneuver . [ 4 ]


On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a  heartbeat  or two, before returning to normal. This  negative result  would be indicated by a lack of swelling of the jugular vein. Negative abdominojugular reflux is seen in  Budd-Chiari syndrome .


A  positive result  is variously defined as either a sustained rise in the JVP of at least 3 cm or more  [ 4 ]  or a fall of 4 cm or more  [ 2 ]  after the examiner releases pressure. The AJR has a reported  sensitivity  of 24%  [ 5 ]  to 72%  [ 2 ]  and a  specificity  of 93% to 96%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency department.


AbioCor   was a total  artificial heart  (TAH) developed by the  Massachusetts -based company  AbioMed . It was fully implantable within a patient, due to a combination of advances in miniaturization, biosensors,  plastics  and energy transfer. The AbioCor ran on a  rechargeable source of power . The internal battery was charged by a  transcutaneous energy transmission  (TET) system, meaning that no wires or tubes penetrated the skin, reducing the risk of infection. However, because of its size, this heart was only compatible with men who had a large frame. It had a product life expectancy of 18 months. [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]


AbioCor was surgically introduced into 15 total patients, 14 of them during a clinical trial and one after FDA approval. However, due to insufficient evidence of its efficacy, AbioMed abandoned further development of the product. [ 6 ] [ 7 ] [ 8 ]


AbioMed was founded by Param Singh and  David Lederman . The company began development of the AbioCor device in the 1990s, beginning animal studies in 1998 in preparation to demonstrate readiness for formal clinical trials in humans. [ 5 ]  On January 30, 2001, the FDA granted AbioMed an investigational device exemption (IDE) for implantation into humans via a clinical trial. [ 9 ]  This opened the door for the first implantation of the AbioCor into  Robert Tools  on July 2, 2001. He lived for 151 days before having a fatal  cerebrovascular accident . [ 3 ] [ 10 ] [ 11 ]   Time  magazine awarded the AbioCor its Invention of the Year award in late 2001. [ 11 ]


The second patient, Tom Christerson, who was given less than a 20 percent chance of surviving 30 days at the time of his surgery, lived for 512 days after receiving the AbioCor, dying on February 7, 2003, due to the wearing out of an internal membrane of the AbioCor. [ 12 ]  An additional 12 patients had the device implanted into 2004, resulting in an average life span of less than five months among all 14 patients. In some cases the device extended survival by several months, allowing the patients to spend valuable time with family and friends. In two cases, the device extended survival by 10 and 17 months respectively, and one patient was discharged from the hospital to go home. For a patient to be eligible for implantation with the AbioCor, the person must have had severe  heart failure  (with failure of both  ventricles ) and had to be likely to die within two weeks without  transplantation . [ 1 ] [ 2 ]


Though the device was initially rejected by FDA Circulatory System Devices Panel in 2005 for  Humanitarian Device Exemption  (HDE) status, [ 1 ]  it was eventually approved by the  Food and Drug Administration  on September 5, 2006, for HDE status. [ 13 ]  However, only one patient received the AbioCor after approval, a "76-year-old man with congestive heart failure, who did not qualify for a heart transplant." [ 14 ]


In August 2012, key AbioCor researcher and developer David Lederman died from pancreatic cancer. [ 15 ]


The company also had plans to improve the AbioCor with a second version based upon the AbioCor ventricles and the  Penn State  energy converter. It was expected to last for five years, more than triple the life expectancy of AbioCor. The company stated it would be 30 percent smaller than the original model, and it could be implanted in smaller men and women. Additional modifications were planned to reduce the patient's risk of stroke, which was a concern of the FDA. [ 10 ] [ 16 ]  As of March 2016 [update] , AbioCor II has not come to fruition, however. Additionally, the AbioCor product has been removed from the AbioMed website, with several news agencies reporting in 2015 that the company had quietly abandoned further development of the device. [ 6 ] [ 7 ]


In 2019, Abiomed was marketing the  Impella  Ventricular Support Systems, left-side heart pump models "intended to help pump blood in patients who need short-term support (up to 6 days)". [ 17 ]


The AbioCor heart is featured in the 2009 film  Crank: High Voltage , when it is transplanted into the main character  Chev Chelios 's ( Jason Statham ) chest after he had been abducted by Chinese mobsters in the very beginning of the movie. However, the heart depicted in the film has a much lower battery life but gives Chev  superhuman  athleticism when fully charged (for dramatic purposes). [ 18 ]  The model of the heart in the movie is called AviCor.


Accelerated idioventricular rhythm  is a ventricular rhythm with a rate of between 40 and 120 beats per minute. Idioventricular means “relating to or affecting the cardiac ventricle alone” and refers to any ectopic ventricular arrhythmia. [ 1 ]   Accelerated idioventricular arrhythmias are distinguished from ventricular rhythms with rates less than 40 ( ventricular escape ) and those faster than 120 ( ventricular tachycardia ). [ 2 ]  Though some other references limit to between 60 and 100 beats per minute. [ 3 ]   It is also referred to as AIVR and "slow ventricular tachycardia."


It can be present at birth, [ 4 ]  however, it is more commonly associated with  reperfusion after myocardial injury . [ 2 ]  AIVR is generally considered to be a benign abnormal heart rhythm. It is typically temporary and does not require treatment.


The  accelerated idioventricular rhythm  occurs when depolarization rate of a normally suppressed focus increases to above that of the "higher order" focuses (the sinoatrial node and the  atrioventricular node ). This most commonly occurs in the setting of a  sinus bradycardia . [ 5 ]


Accelerated idioventricular rhythm is the most common reperfusion arrhythmia in humans. However, ventricular tachycardia and ventricular fibrillation remain the most important causes of sudden death following spontaneous restoration of antegrade flow. [ 6 ]  Prior to the modern practice of  percutaneous coronary intervention  for  acute coronary syndrome , pharmacologic  thrombolysis  was more common and accelerated idioventricular rhythms were used as a sign of successful reperfusion. [ 7 ]  It is considered a benign arrhythmia especially in the setting of STEMI(where it is conventionally thought to be an indicator of reperfusion) that does not require intervention, though atrioventricular dyssynchrony can cause hemodynamic instability, which can be treated through overdrive pacing or  atropine . [ 2 ]


AIVR appears similar to  ventricular tachycardia  with wide QRS complexes (QRS >0.12s) and a regular rhythm. It can most easily be distinguished from VT in that the rate is less than 120 and usually less than 100 bpm. There may or may not be AV dissociation depending on whether it is due to ventricular escape or AV block. [ 8 ]


There is an established practice of using the  electrical conductance  of blood ( PV loops ) in heart  ventricles  to determine the instantaneous volume of the ventricle. This technique involves inserting a tetra-polar catheter into the ventricle and measuring conductance. This measured conductance is a combination of blood and muscle and various techniques are used to identify the blood conductance from the total measured conductance. Blood conductance can then be converted to volume using a linear (Baan) or a non-linear (Wei) relationship that relates conductance to volume.


This approach is based on the idea that the total conductance, G, of a fluid between two electrodes is a function of the fluid's conductivity (reciprocal of resistivity) and volume. [ citation needed ]


In  cardiology , a tetra-polar  catheter  is inserted into the ventricle and a constant current (I) is applied across the two outer  electrodes . This generates an electrical field within the ventricle and the two inner electrodes measure a  voltage  generated due to the electric field. This measured voltage (V) is used to determine conductance through a modified version of  Ohm's Law . Conductance (G) is the reciprocal of resistance (R) which changes the standard Ohm's equation from V=IR to V=I/G. [ citation needed ]


Conductance is then related to blood volume though Baan's equation. [ 1 ]  When used in cardiology, the electric field generated is not limited to the blood (the fluid of interest) but also penetrates the heart wall, giving rise to additional conductance often called "parallel conductance" or "muscle conductance", G m  which must be removed. [ citation needed ]


Various techniques have been attempted to remove the G m  contribution with varying degrees of success. The most common method is the  hypertonic saline  technique which involves injecting a bolus of hypertonic saline into the ventricle to alter blood conductivity without affecting the surrounding muscle. Another less commonly used technique involves evacuating the ventricle of blood and measuring muscle conductance alone with a conductance catheter. Clearly both techniques are unreliable, somewhat invasive and fail to account for the continuous variation in G m  over the  cardiac cycle . [ 2 ]


The  Admittance  technique is an improvement over the  Conductance  technique for the real-time removal of muscle conductance G m . Blood and muscle respond to alternating (AC) electrical currents very differently. Blood is purely resistive while muscle has both resistive and capacitive properties. The fixed charges in muscle cells create a significant  reactance  that causes a phase shift (time delay) in the measured signal, relative to the excitation signal. Admittance technology uses this phase shift to determine the instantaneous muscle conductance and remove it from the total measured conductance. [ citation needed ]


The total Admittance (Y), of the blood filled ventricle is given by Y = G b  + G m  + iωC m  where: [ citation needed ]


The signals G m  and C m  are both properties of cardiac muscle and vary in a fixed ratio. Thus the ratio of G m  to C m  is equal to the ratio of muscle conductivity (σ) to muscle  permittivity  (ε). The ratio σ/ε is the constant of proportionality. Although both σ and ε are functions of the health of the heart tissue, they are relatively constant for short periods of time. [ citation needed ]


Using this proportionality, one can rewrite the equation for G m  as G m  = (σ/ε)C m


Note that the imaginary component of Y depends only on the amount of muscle in the field of the catheter. This makes it easy to isolate by measuring the phase shift, φ, of the measured signal: [ citation needed ]
cos(φ) = (G b  + G m )/Y
sin(φ) = ωC m /Y
Hence, C m  = Y.sin(φ)/ω
also, G m  = (σ/ε)C m


Thus, blood conductance is determined as G b  = Y.cos(φ) - G m


Wei's equations can be applied to this calculated blood conductance G b  to obtain blood volume. [ 3 ]  Unlike Baan's equation, Wei's equation takes into account the non-linear nature of the  electrical field  and the dynamic nature of the  cardiac cycle  to give a more accurate representation of the blood volume. [ 4 ]


Admittance technique involves the measurement of both phase angle and total conductance in the ventricle. Thus, it is possible to  observe how the parallel conductance (muscle conductance) varies throughout the cardiac cycle. A plot showing both the blood and muscle contribution are shown in the figure. [ citation needed ]


Advanced cardiac life support ,   advanced cardiovascular life support  ( ACLS ) refers to a set of clinical guidelines established by the American Heart Association (AHA) for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused  cardiac arrest , using advanced medical procedures, medications, and techniques. ACLS expands on  Basic Life Support  (BLS) by adding recommendations on additional medication and advanced procedure use to the CPR guidelines that are fundamental and efficacious in BLS. ACLS is practiced by advanced medical providers including physicians, some nurses and paramedics; [ 1 ]  these providers are usually required to hold certifications in ACLS care.


While "ACLS" is almost always semantically interchangeable with the term " Advanced Life Support " (ALS), when used distinctly, ACLS tends to refer to the immediate cardiac care, while ALS tends to refer to more specialized resuscitation care such as  ECMO  and  PCI . In the EMS community, "ALS" may refer to the advanced care provided by  paramedics  while "BLS" may refer to the fundamental care provided by  EMTs  and  EMRs ; without these terms referring to cardiovascular-specific care.


Advanced cardiac life support refers to a set of guidelines used by medical providers to treat life-threatening cardiovascular conditions. These life-threatening conditions range from dangerous arrhythmias to cardiac arrest. ACLS algorithms frequently address at least five different aspects of peri-cardiac arrest care: Airway management, ventilation, CPR compressions (continued from BLS), defibrillation, and medications. Due to the seriousness of the diseases treated, the paucity of data known about most ACLS patients, and the need for multiple, rapid, simultaneous treatments, ACLS is executed as a standardized, algorithmic set of treatments. Successful ACLS treatment starts with diagnosis of the correct  EKG  rhythm causing the arrest. Common cardiac arrest rhythms covered by ACLS guidelines include:  ventricular tachycardia ,  ventricular fibrillation ,  Pulseless Electrical Activity , and  asystole . Dangerous, non-arrest rhythms typically covered includes:  narrow - and wide-complex  tachycardias ,  torsades de pointe ,  atrial fibrillation / flutter  with rapid ventricular response, and  bradycardia . [ 2 ]


Successful ACLS treatment generally requires a team of trained individuals. Common team roles include: Leader, back-up leader, 2 CPR performers, an airway/respiratory specialist, an IV access and medication administration specialist, a monitor/ defibrillator attendant, a pharmacist, a lab member to send samples, and a recorder to document the treatment. [ 3 ]  For in-hospital events, these members are frequently physicians, mid-level providers, nurses and allied health providers; while for out-of-hospital events, these teams are usually composed of a small number of EMTs and paramedics.


ACLS algorithms include multiple, simultaneous treatment recommendations.  Some ACLS providers may be required to strictly adhere to these guidelines, however physicians may generally deviate to pursue different evidence-based treatment, especially if they are addressing an underlying cause of the arrest and/or unique aspects of a patient's care. ACLS algorithms are complex but the table, below, demonstrates common aspects of ACLS care. [ 2 ]


Due to the rapidity and complexity of ACLS care, as well as the recommendation that it be performed in a standardized fashion, providers must usually hold certifications in ACLS care. Certifications may be provided by a few different, generally national, organizations but their legitimacy is ultimately determined by hospital hiring and privileging boards; that is, ACLS certification is frequently a requirement for employment as a health care provider at most hospitals. [ 4 ]   ACLS certifications usually provide education on the aforementioned aspects of ACLS care  except  for specialized resuscitation techniques. Specialized resuscitation techniques are not covered by ACLS certifications and their use is restricted to further specialized providers. ACLS education is based on ILCOR recommendations which are then adapted to local practices by authoritative medical organizations such as the American Red Cross, the European Resuscitation Council, or the Resuscitation Council of Asia .


BLS proficiency is usually a prerequisite to ACLS training; however the initial portions of an ACLS class may cover CPR. [ 5 ]  Initial training usually takes around 15 hours and includes both classroom instruction and hands-on simulation experience; passing a test, with a practical component, at the end of the course is usually the final requirement to receive certification. [ 6 ]  After receiving initial certification, providers must usually recertify every two years in a class with similar content that lasts about seven hours.  Widely accepted providers of ACLS certification include, non-exclusively: American Heart Association, American Red cross,  European Resuscitation Council or the Australian Resuscitation Council.


Holding ACLS certification simply attests a provider was tested on knowledge and application of ACLS guidelines. The certification does  not  supersede a provider's  scope of practice  as determined by state law or employer protocols; and does not, itself, provide any  license  to practice.


Like a medical intervention, researchers have had to ask whether ACLS is effective. Data generally demonstrates that patients have better survival outcomes (increased ROSC, increased survival to hospital discharge and/or superior neurological outcomes) when they receive ACLS; [ 7 ]  however a large study of  ROC  patients showed that this effect may only be if ACLS is delivered in the first six minutes of arrest. [ 8 ]  This study also found that ACLS increases survival but does not produce superior neurological outcomes.


Some studies have raised concerns that ACLS education can be inconstantly or inadequately taught which can result in poor retention, leading to poor ACLS performance. [ 9 ]  One study from 1998 looked at the ACLS use of epinephrine, atropine, bicarbonate, calcium, lidocaine, and bretylium in cardiac arrests and found that these medications were not associated with higher resuscitation rates. [ 10 ]


Research on ACLS can be challenging because ACLS is a bundle of care recommendations; with each individual treatment component being profoundly consequential. There is active debate within the resuscitation research community about the value of certain interventions. Active areas of research include determining the value of vasopressors in arrests, [ 11 ]  ideal airway use [ 12 ]  and different waveforms for defibrillation. [ 13 ]


Stemming from the need for standardized, evidence based ACLS guidelines, an international network of academic resuscitation organizations was created. The International Liaison Committee on Resuscitation (ILCOR) is the central, international institution that regional resuscitation committees strive to contribute to and disseminate information from. The centralization of resuscitation research around ILCOR reduces redundant work internationally, allows for collaboration between experts from many regional organizations, and produces higher quality, higher powered research.


ILCOR  serves as a way for international resuscitation organizations to communicate and collaborate. [ 14 ]  ILCOR publishes  scientific evidence  reviews on resuscitation known as "Continuous Evidence Evaluation (CEE) and Consensus on Science with Treatment Recommendations (CoSTRs)". [ 15 ]  ILCOR uses 6 international task forces to review over 180 topics through a structured  systematic-review  process. ILCOR traditionally published updates and recommendations every five years but now conducts continuous review work. [ 16 ]  ILCOR produces international recommendations which are then adopted by regional resuscitation committees which publish guidelines. [ 17 ]  Regional guidelines can have more  medicolegal bearing  than ILCOR recommendations. [ 18 ]  ILCOR is composed of the following regional organizations:


The International Liaison Committee on Resuscitation (ILCOR) was established 1992 to serve as a way for international resuscitation organizations to communicate and collaborate. [ 14 ]


The ACLS guidelines were first published in 1974 by the  American Heart Association  and were updated in 1980, 1986, 1992, 2000, 2005, 2010, 2015. [ 22 ]  In the 2020 update the guidelines were restructured to align with ILCOR recommendations. These changes include the transition since 2015 away from the previous 5-year update cycle to an online format that can be updated as indicated by continuous evidence review. [ 23 ]


The first version of the  European Resuscitation Council  (ERC) guidelines were developed in 1992. The 2000 ERC guidelines were developed in collaboration with ILCOR. 5-year updates were published from 2000 to 2015 and annual updates have been published since 2017. [ 24 ]


An  Af-nest  or  Atrial Fibrillation Nest  (AFN) is a locus or cluster in the  atrial wall  with distinct electrical features and properties originated by  fibrillar myocardium . It plays as an "electrical multiplier" re-feeding the  atrial fibrillation .