THE SCOPE OF MODERN CARDIOLOGY

THE SCOPE OF MODERN CARDIOLOGY

THE SCOPE OF MODERN CARDIOLOGY

More than 40% of patients admitted to medical wards inthe UK have some form of heart disease. Coronary arterydisease, heart failure and cardiac arrhythmias are amongthe commonest causes of emergency hospital admission.Ischaemic heart disease is the most important cause ofdeath in the western world. It causes more than a milliondeaths per year in the USA and about 160000 deaths annuallyin the UK,where it accounts for 40-50% ofall deaths and is the main reason for men not reaching theirseventh decade.A recent concerted effort to change lifestyles withrespect to smoking, diet and exercise, as well as bettercontrol of hypertension, appears to have led to a declinein coronary artery disease deaths in the USA and the moreaffluent northern European countries, but has yet to makea major impact in the UK.Rheumatic heart disease has declined rapidly in importancein the west over the last 30-40 years.It nowaccounts for less than half the cases of heart valve diseasecoming to surgery and, with only a small number of newcases presenting, its importance will probably declinefurther. However, it is still a major cause of morbidity andmortality in the developing world.Congenital heart disease is one of the principal causesof neonatal death and is likely to remain a significant causeof morbidity and mortality in childhood. However, morecases are now treatable by cardiac surgery in childhood,and major cardiac defects can now be detected duringpregnancy, raising the possibility of neonatal, or evenantepartum, cardiac surgery.The development of sophisticated methods of investigationin cardiology now allows great precision in diagnosis,enabling full advantage to be taken of the advances incardiac surgery and catheter-based treatments. Diagnosticmethods have expanded from simple ECG and X-rayto include an ever-widening range of techniques, usingultrasound (both imaging and Doppler), isotope imaging,angiography, intracardiac electrophysiology and 24-hourECG recording, pressure measurement and magnetic resonanceimaging. Therapeutic options have also increased,to include complex cardiac surgery possible at all ages,pacemaker therapy and non-surgical interventions suchas angioplasty. The efforts of cardiac surgeons and bioengineershave produced a generation of patients withprosthetic heart valves, implanted pacemakers, modifiedcongenital heart disease and heart transplants. Thesepresent a new spectrum of pathology and altered naturalhistory.

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