The field includes medical diagnosis and treatment

of congenital heart defects, coronary artery

disease, heartfailure, valvular heart disease and

electrophysiology

Heart :

its function was first defined by William Harvey, a

British physician

In his publication in 1628,De Motu Cordis, Harvey

stated: “It has been shown by reason and experiment

that by the beat of the ventricles blood flows through the

lungs and it is pumped to the whole body. There it

passes through pores in the flesh into the veins through

which it returns from the periphery finally coming to the

vena cava and right auricle. It must then be concluded

that the blood in the animal body moves around in a

circle continuously, and that the action or function of the

heart is to accomplish this by pumping. This is the only

reason for the motion and beat of the heart”

Einthoven, a professor of physiology in the small

Dutch town of Leiden, first recorded a human

electrocardiogram and gave birth to a new specialty

Einthoven devised the first string galvanometer to

record the electrical activity of the heart

won a Nobel Prize in 1924 for his contributions to

the field of electrocardiography

Einthoven himself described various arrhythmias,

including bigeminy, atrial flutter and fibrillation, and

“P mitrale,” as well as left and right ventricular

hypertrophy.

19th-century: French physiologist Claude Bernard

catheterized and measured pressures in the various

cardiac chambers and great vessels of the animal heart

first catheterization of the living human heart was

performed by a young surgeon, Werner Forssman, (on

himself!) in 1929 in Eberswald, Germany

Forssman's goal was to find a safe way to inject drugs

and contrast material into the right atrium for cardiac

resuscitation

In 1941, Andre Cournand and Dickinson

Richards at Columbia University and Bellevue

Hospital in New York began the systematic

exploration of normal and abnormal

hemodynamics

They recorded intracardiac pressures and

cardiac output in normal subjects and in

patients with many forms of congenital and

acquired heart disease

Forssman, Cournand, and Richards were also

awarded the Nobel Prize.

Werner Forßmann

Werner Forßmann

Born 29 August 1904

Berlin

Died 1 June 1979 (aged 74)

Nationality Germany

Fields Medicine

Alma mater University of Berlin

Known for Cardiac catheterization

First performed by mason sones at the cleveland clinic

in 1958

Coronary arteriography, when combined with left

ventriculography, led to the diagnosis and then the

elucidation of the natural history of coronary artery

disease

Modern cardiovascular surgery was first applied in

1938, by Robert Gross at Harvard and Boston's

Children's Hospital successfully closed a patent

ductus arteriosus

In 1953, John Gibbon at Thomas Jefferson Hospital in

Philadelphia performed the first open-heart operation

using cardiopulmonary bypass .He successfully closed

an atrial septal defect in an 18-year-old girl

Gibbon’s design led to the construction of the heart-lung

machine by IBM engineers.

Balloon angioplasty was followed by stenting with bare

metal stents, which are now being replaced by drug-

eluting stents.

In addition to coronary stenosis, almost any abnormal

obstruction in the heart and circulation can now be

successfully opened, and many abnormal openings can

be successfully closed using catheter-based

techniques.

Before 1961:patients with acute myocardial infarction weretreated largely with benign neglect

In 1961:Desmond Julian, then a registrar in cardiology atthe Royal Infirmary in Edinburgh, Scotland, articulated theconcept of the coronary care unit

This important development rested on four pillars:

1) continuous electrocardiographic monitoring witharrhythmia alarms;

2) cardiopulmonary resuscitation with external ventriculardefibrillation;

3) the clustering of myocardial infarction patients in adiscrete unit of the hospital where skilled personnel, drugs,and equipment were available; and

4) a change in policy that permitted, indeed mandated,trained nurses to initiate resuscitation.

In the 1960s:James Black developed beta-blockers

In the 1970s: The first angiotensin-converting enzyme

inhibitor, captopril, was isolated by Cushman and

Ondetti, working at the Squibb (now Bristol Myers

Squibb) laboratories

Angiotensin-converting enzyme inhibitors have become

cornerstones in the management of heart failure and

hypertension

In 1976: The first HMG-CoA reductase inhibitor (statin) was

isolated by Akira Endo of Sankyo Pharmaceuticals, and was

built on the Nobel Prize-winning work on the low density

lipoprotein cholesterol pathway by Brown and Goldstein

In 1944, Dr. Paul Dudley White at Harvard and the

Massachusetts General Hospital, often referred to as

the father of American cardiology, pioneered the

concept of cardiovascular prevention

In 1948 the National Heart Institute (now the National

Heart, Lung, and Blood Institute) established the

Framingham Heart Study, the first prospective

population-based cohort study that focused on heart

disease

Inge Edler, a Swedish cardiologist, and Helmuth Hertz,

a Swedish physicist(1952): launched the field of

echocardiography

These investigators provided continuous recordings of

the movements of the heart walls and of the normal and

diseased mitral valve

Noninvasive imaging represents an enormous advance

both in the diagnosis of heart disease and in the care of

cardiac patients.

1842 – Johann Christian Doppler discovers the Doppler sound effects – begins the premise for sonographic imagery.

1881 – Jacques and Pierre (husband of Marie) Curie discover the principle of piezoelectricity – another stepping stone to creating the ultrasound.

1903 – Willem Einthoven records the first ECG waves, thus developing the very first electrocardiogram. This discovery heralds cardiology's status as a medical specialty.

1917 – Paul Langevin is the first to attempt to use the piezoelectric effect as sonar, to detect U-boats

1941 – Karl T. Dussikwasthe becomes the first to use an ultrasound machine, using it to examine the brain.

1950 – WD Keidel is the first to use an ultrasound to examine the heart.

1952 – JJ Wilde, JM Reid, D. Howry and W. Bliss develop the first two-dimensional ultrasound system, but didn't attempt to use it on the heart.

1953 – Physician Inge Edler and engineer C. Hellmuth Hertz borrow a shipyard sonar machine to conduct the first human echocardiogram.

1956 – S. Satumora, Yoshida, Nimura are the first to apply the Doppler principle to the use of ultrasound to detect cardiac motion (but not blood flow).

1957 – Sputnik, JJ Wild, JM Reid identify a myocardial infarction in vitro using both M mode and 2D echo in the US, and publish their images in the American Heart Journal

1960 – Echocardiography becomes more widely accepted as a method of cardiovascular research.

1963 – Dr. Harvey Feigenbaum, hailed as the "Father of Echocardiography" takes an unused echoencephalography machine and uses it to record cardiac images, rather than its original intent, to record images of the brain.

1965 – Chuck Haine, a physician at Indiana University, becomes the first cardiac sonographer.

1971 – N. Born and Paul Hugenholtz introduce the first two-dimensional scanner to produce multi-dimensional echocardiography.

1973 – Echocardiography is included as a searchableterm in Index Medicus.

1975 – Feigenbaum founds the American Society ofEchocardiography.

1978 – N Bom and J Roelandt introduce the first handheld echo machine. While not commercially producedfor another twenty years, this invention moved echo outof the laboratory to the patient's bedside and out of thehands of cardiologists to all physicians

1984 – Dr Feigenbaum's laboratory at IndianaUniversity becomes the first all-digital lab, with echosstored on floppy disks

In 1959, Elmquist and Senning at the university of

zurich reported on the first successful use of an internal

pacemaker

In 1970, Michel Mirowski, an Israeli cardiologist with

training in electrical engineering working at Sinai

Hospital in Baltimore, invented the implanted

cardioverter-defibrillator

A series of

pacemakers from the

1960s to the 1990s

(top left to bottom

right) demonstrating

the remarkable

progress in the

miniaturization of the

pacemaker. Since

1960 the weight of the

pacemaker has

decreased from 170 to

less than 20 grams.

cardiac stimulation

leads considered the

weak point in

pacemaker systems,

the Wireless Cardiac

Stimulation system

(WiCS) uses a leadless

electrode to convert

mechanical energy,

wirelessly transmitted

from an ultrasonic

pulse generator, into

electrical energy which

is used to pace the

heart as part of Cardiac

Resynchronization

Therapy (CRT).

Hybrid Long-term Temporary

Pacing

The lead was

tunnelled

subcutaneou

sly for 6cm,

and the

proximal end

was

connected to

a standard

single

chamber

pulse

generator.

The

procedure

was well

tolerated and

over a period

of four

months there

were no

complication

s or infection.

Contemporary cardiology is composed of multiple

subspecialties

Adult medical cardiology :Electro physiologists,

subspecialists in extra cardiac vascular disease,

hypertension, lipidology, care of patients with acute

coronary syndromes, and heart failure, as well as in

prevention and rehabilitation

Pediatric cardiology

cardiovascular surgery

cardiovascular radiology

Leads to greater expertise

Improves patient care, teaching, and research

Skilled subspecialists can perform complicated

procedures successfully and at relatively low risk

Disease prevention

Costs of cardiac care

costs of care are spiraling out of control

Continuing subspecialization in the pursuit oftechnical virtuosity and clinical excellence

Preventive measures based on patientcharacteristics, such as phenotypes, will expand

Heart failure is the last great battleground incardiology

The near-term future of therapy for advanced heartfailure.

• Art. Ht. = artificial heart

• BMSC = bone marrow stem cells

• ICD = implantable cardioverter-defibrillator

• LVAD = left ventricular assist device

• Cardiac xenotransplantation

gene-informed therapy: genetic identification of thefuture development of risk factors will lead to gene-informed personalized prevention

Eg:Alpha-adducin-leads to excessive sodium re-absorption by distal renal tubule cells-prophylacticallywith a salt-restricted diet or even a diuretic, leading togene-informed prevention.

The presence of specific variants of the genes forconnexin 37 (resulting in changes in endothelial gapjunctions) in men and in the genes for plasminogenactivator inhibitor-1 (altered inhibition of fibrinolysis)and stromelysin-1 (associated with altered matrixmetabolism) in women are associated with increasedrisk of myocardial infarction

Intervention versus prevention

Greater focus on prevention, using

progressively greater refinements of markers

of inflammation and of plaque instability

In1711:developmentof cardiac catheterization

Stephen Hales placed catheters into the right and left

ventricles of a living horse

in 1840s: formal study of cardiac physiology being

performed by Claude Bernard

In 1927: The technique of angiography itself was first

developed by the Portuguese physician Egas Moniz at

the University of Lisbon for cerebral angiography

In 1929: Coronary catheterization was first performed

by Werner Forssmann, created an incision in one of his

left antecubital veins and inserted a catheter into his

venous system

He then guided the catheter by fluoroscopy into his right

atrium

In 1958 Dr. Charles Dotter began working on methods

to visualize the coronary anatomy via sequential

radiographic films.

He invented a method known as occlusive aortography

in an animal model

Occlusive aortography - the transient occlusion of the

aorta and subsequent injection of a small amount of

radiographic contrast agent into the aortic root and

subsequent serial x-rays to visualize the coronary

arteries

Mason Sones, a pediatric cardiologist at the Cleveland

Clinic: while performing an aortic root aortography, ,

noted that the catheter had accidentally entered the

patient's right coronary artery.

Before the catheter could be removed 30cc of contrast

agent had been injected.

While the patient went into ventricular fibrillation, the

dangerous arrhythmia was terminated by Dr. Sones

promptly performing a precordial thump which restored

sinus rhythm

Until the 1950s: placing a catheter into either the

arterial or venous system involved a "cut down"

procedure, in which the soft tissues were dissected

out of the way until the artery or vein was directly

visualized and subsequently punctured by a

catheter; this was known as the Sones technique.

In 1953 :The percutaneous approach that is

widely used today was developed by

radiologist Sven-Ivar Seldinger . This method

was used initially for the visualization of the

peripheral arteries. Percutaneous access of the

artery or vein is still commonly known as the

Seldinger technique

By the late 1960s: Melvin Judkins had begun

work on creating catheters that were specially

shaped to reach the coronary arteries to

perform selective coronary angiography

His work was documented in 1967, and by

1968 the Judkins catheters were manufactured

in a limited number of fixed tip shapes.

Catheters in these shapes carry his name and

are still used to this day for selective coronary

angiography

The use of a balloon-tipped catheter for the

treatment of atherosclerotic vascular disease

was first described in 1964 by two interventional

radiologists, Charles Dotter and Melvin Judkins

to treat a case of atherosclerotic disease in

the superficial femoral artery of the left leg

Andreas Gruentzig performed the first

successful PTCA or percutaneous coronary

intervention (PCI)) on a human on

September 16, 1977 at University Hospital,

Zurich

By the mid 1980s, over 300,000 PTCAs

were being performed on a yearly basis,

equalling the number of bypass

surgeries being performed for coronary

artery disease.

In 1986: first intracoronary stents were

successfully deployed in coronary arteries

The first stents used were self-expanding

Wallstents

Restenosis rates were significantly lower in

individuals who received an intracoronary

stent when compared to those who

underwent just balloon angioplasty

In 1989: the Palmaz-Schatz balloon-

expandable intracoronary stent was

developed

By 1999 nearly 85% of all PCI procedures

included intracoronary stenting

Four early endovascular stents.

Ruygrok P N , and Serruys P W Circulation 1996;94:882-

890

Copyright © American Heart Association

• The upper left panels

show Dotter's early

nitinol coil wire stent

•The zig zag expanding

stainless steel stent

described by Wright et

alshown in the upper

right panels in both its

sheathed and

unsheathed forms.

• The lower left panel

shows the stents

developed by Maass et

al.

• The lower right panel

shows the balloon

expandable stainless

steel Palmaz stent.

Seven coronary stents, clockwise from bottom left: Wallstent, Palmaz-Schatz stent, Wiktor

stent, Gianturco-Roubin stent, Cordis stent, AVE stent, and multilink stent.

Ruygrok P N , and Serruys P W Circulation 1996;94:882-

890

Copyright © American Heart Association

Seven coronary stents,

clockwise from bottom

left: Wallstent

Palmaz-Schatz stent

Wiktor stent

Gianturco-Roubin stent

Cordis stent

AVE stent

multilink stent

Stent manufacturers experimented with anumber of chemical agents to prevent theneointimal hyperplasia that is the cause of in-stent restenosis.

One of the first products of the new focus onpreventing stent restenosis and late thrombosiswas the heparin coated Palmaz-Schatz stent

At approximately the same time, Cordis wasdeveloping the Cypher stent, a stent that wouldrelease sirolimus (a chemotherapeutic agent)over time

FDA approved the use of the Cypher stent as the

first drug-eluting stent for use in the general population

in the United States

Concurrent with the development of the Cypher

stent, Boston Scientific started development of

the Taxus stent

The Taxus stent was the Express2 metal stent, which

was in general use for a number of years, with

a copolymer coating of paclitaxel that inhibited cell

replication

Taxus stent was approved for use in Europe in 2003

With further study, the FDA approved the use of the

Taxus stent in the United States in March 2004.

By the end of 2004, drug eluting stents were used in

nearly 80 percent of all percutaneous coronary

interventions

Dr. B. Soma Raju and his team have performedthe first PTCA (Percutaneous TransluminalCoronory Angioplasty) in India on 1985

He has been involved in various researchprojects during the last 20 years individually

Development of India’s first Coronary Stent,which has been named the Kalam Raju Stentafter Professor A.P.J Kalam and Dr. Raju

This stent was first implanted in December1996

The development of the stent resulted in reducing the

cost of stents in the country and brought it within the

reach of the people

In October 1998 the second research product of Dr.

Raju’s endeavor, India’s first Coronary Balloon Catheter

was released

Medical College Trivandrum

ACHIEVEMENTS

First government hospital in kerala done

coronary angioplasty in 1998.

First government hospital in kerala done ICD

Inplantation

First government hospital in kerala done by

ventrical pacing for heart failure.

First government hospital in kerala to have a

round the clock angioplasty program

Medical College Trivandrum

Department of Cardiology started functioning in

1972. It started with 4 bed Intensive care unit.

The first Colour Doppler Echo in the state was

started in the department in 1992.

The cardiac catheterisation Laboratory (cath

lab) was started in 1997.

A second cathlab under the PMSSY Scheme

was started in 2010.

Electrophysiology station was established in

2009

In the 19th century: The earliest operations onthe pericardium took place and were performedby Francisco Romero, Dominique Jean Larrey, HenryDalton and Daniel Hale Williams

4 September 1895: The first surgery on the heart wasperformed by Norwegian surgeon Axel Cappelen inKristiania, now Oslo

He ligated a bleeding coronary artery in a 24 year oldman stabbed in the left axillae and was indeep shock upon arrival. Access was through aleft thoracotomy. The patient awoke and seemed finefor 24 hours, he died from mediastinitis on the thirdpostoperative day

September 7, 1896: The first successful

surgery of the heart, performed without any

complications, was by Dr. Ludwig

Rehn of Frankfurt, Germany, who repaired a

stab wound to the right ventricle

In 1925: Henry Souttar operated successfully on ayoung woman with mitral stenosis

He made an opening in the appendage of the left atriumand inserted a finger into this chamber in order topalpate and explore the damaged mitral valve.

The patient survived for several years but Souttar’sphysician colleagues at that time decided the procedurewas not justified and he could not continue.

In 1948: four surgeons carried out successful operations

for mitral stenosis resulting from rheumatic fever

In 1947 thomas holmes sellors (1902–1987) of

the middlesex hospital operated on a fallot’s

tetralogy patient with pulmonary stenosis and

successfully divided the stenosed pulmonary valve

In 1948, russell brock, used a specially designed dilator

in three cases of pulmonary stenosis

September 2, 1952: The first successful intracardiac

correction of a congenital heart

defect using hypothermia was performed by Dr. C.

Walton Lillehei and Dr. F. John Lewis at the University of

Minnesota

Dr. John Heysham Gibbon at Jefferson Medical School

in Philadelphia reported in 1953 the first successful use

of extracorporeal circulation by means of an oxygenator

In March, 1961, Zuhdi, Carey, and Greer,

performed open heart surgery on a child,

age 3½, using the total intentional

hemodilution machine

Norman shumway the father of heart transplantation

world's first adult human heart transplant wasperformed by christiaan barnard in south africa utilizingthe techniques developed and perfected by shumwayand richard lower.

Barnard performed the first transplant on louiswashkansky on december 3, 1967 at the groote schuurhospital in cape town south africa.

Adrian kantrowitz performed the first pediatric hearttransplant in the world on december 6, 1967at maimonides hospital in brooklyn, new york

Norman shumway performed the first adult hearttransplant in the united states on january 6, 1968 atthe stanford university hospital.

Since the 1990s, surgeons have begun to

perform "off-pump bypass surgery

In these operations, the heart is beating

during surgery, but is stabilized to provide an

almost still work area in which to connect the

conduit vessel that bypasses the blockage

Robot-assisted heart surgery:

Machine is used to perform surgery while being

controlled by the heart surgeon.

The main advantage to this is the size of the

incision made in the patient. Instead of an

incision being at least big enough for the

surgeon to put his hands inside, it does not

have to be bigger than 3 small holes for the

robot's much smaller hands to get through.

Russell M. Nelson performed the first

successful pediatric cardiac operation at

the Salt Lake General Hospital in March

1956, a total repair of tetralogy of Fallot in a

four-year-old girl

Dr K M Cherian: performed the first coronaryartery bypass surgery in India in 1975.

He also performed the country's second hearttransplant, first infant cardiac surgery and the firstheart and lung transplant (1999)

Cherian has performed more than 27,000operations.

the first Auto transplant;

He is the first Indian member of the AmericanAssociation for Thoracic Surgery, as well as aFellow of the Royal Society of Medicine, London,and an honorary member of the MalaysianAssociation for Thoracic and CardiovascularSurgery

Padmashri Dr. Jose Chacko Periappuramperformed the first successful human-to-human heart transplant

He was the first heart surgeon to commence abeating heart surgical program in kerala

He is also the first surgeon in kerala to performbypass surgery using arterial grafts

Awake bypass :patients who due to lungdiseases could not have their surgeries donewere helped by a very novel technique calledawake bypass surgery

Cardiac nursing is a nursing specialty that

works with patients who suffer from various

conditions of the cardiovascular system.

Cardiac nurses help treat conditions

unstable angina,cardiomyopathy, coronary

artery disease, congestive heart failure

myocardial infarction and cardiac

dysrhythmia under the direction of a

cardiologist

Cardiac nurses work in many different

environments, including coronary care

units (CCU), cardia catheterization,

inte nsive care units (ICU), operating

theatres, cardiac rehabilitation

centers,clinical research, cardiac

surgery wards, cardiovascular intensive care

units (CVICU), and cardiac medical wards

Cardiac nursing has become a specialty in

the past 50 years

Cardiac nursing continues to grow as more

understanding is gained of heart disease and

how to prolong life.

The first CCU was founded at the royal

infirmary in scotland, by dr. Desmond G.

Julian to deal with heart attack, sudden

cardiac arrest and heart arrhythmias

He recommended all staff, including nurses,

be trained in CPR in order to treat patients

with suspected heart attack as rapidly as

possible

Other cardiac care units were founded

shortly thereafter AND the need for skilled

cardiac nurses increses rapidly

Coronary care units had reduced mortality

from heart attack and sudden cardiac arrest

by up to 20 percent in the previous decade

CCU and departments continued to be added to

larger hospitals, driving the need for more

trained cardiac nurses skilled in CPR, cardiac

monitoring and the administration of cardiac

medicines.

The society for peripheral vascular nursing

(SPVN), founded in boston in 1982

Renamed the society for vascular nursing

(SVN) in 1990, helped highlight cardiac nursing

as an established nursing specialty.

American association of cardiovascular and

pulmonary rehabilitation was founded in 1985:.

Provides education and training for cardiac

nurses and other heart care professionals, as

well as certification for cardiac rehabilitation

facilities.

The Preventive Cardiovascular Nurses

Association (PCNA) was founded in the United

States in 1992 by a small group of nurses in

California

As membership expanded, the organization

began to encompass evidence-based study of a

wider array of cardiovascular disorders and

pass this information along to its members.

The American Nurses Credentialing Center (ANCC)is the world's largest nurse credentialingorganization, and a subsidiary of the AmericanNurses Association (ANA)

The first Cardiac and Vascular Nurse examinationswere administered by the PCNA in May 2001 inconjunction with the ANCC.

The PCNA continues to offer the certificationexams as well as continuing education coursesonline and live seminars and training events.

In addition to the ANCC Cardiac/Vascular NurseCertification, the PCNA supports the AccreditationCouncil for Clinical Lipidology (ACCL) certificationexamination. Cardiac nursing continues to grow asnursing becomes more specialized

Recent progress in biomedical engineering

and imaging technology is providing an ever-

increasing body of knowledge on the origins

and onset of cardiac disease, with new

options for its detection and treatment

Improved treatment of CAD has resulted inan increased survival rate

Increasing incidence of patients with severemyocardial scars caused by previousinfarction

Increase in the number of patients sufferingfrom congestive heart failure (CHF), who willform an increasingly important group

A third group of patients that is expected tobecome increasingly important is that ofpatients with cardiac arrythmias

A discernable shift from diagnosing disease at alate stage, after symptoms occur, toasymptomatic diagnosis

An important recent development is therealization that the vast majority of heart attacksare not due to progressive atherosclerosis, butto sudden rupture of non-occlusive, vulnerableplaque

Replacement of open-chest surgicalprocedures by less invasive percutaneousapproaches such as percutaneous transluminalinterventions and minimally invasive surgery(MIS) or even endoscopic surgery, will continue.

In percutaneous CAD treatment the trends

will be towards more accurate assessment of

coronary lesion dimensions, accurate

assessment of plaque morphology and

pathology, and more accurate guiding of the

intervention device

Drug-eluting stents

Non-invasive assessment of the cardiac

function in terms of perfusion, local

contraction, and myocardial apoptosis and

viability will become more and more

important

An increased use of bi-ventricular pacing for

improving cardiac function and implantation

of cardioverter defibrillators (ICD) for the

reduction of related sudden cardiac death

Increased use of local myocardial treatment,

such as local delivery of angiogenetic agents

or stem cells

Growth in the use of personal monitoring

devices such as automatic ecg recorders for

long-term disease progress monitoring

pacemaker implantation for bradycardias,

and endocardial mapping of re-entry circuits

and ectopic foci followed by ablation

Percutaneous ablation of areas around the

pulmonary veins in the left atrium is an

effective procedure for the treatment of atrial

fibrillation in the majority of patients

Bi-ventricular pacing and implanted

defibrillators -CHF and ischemic ventricular

tachycardia

X-ray imaging

X-ray imaging is still the most widely used

imaging technique

Computed Tomography (CT)

• 3D or even 4D data sets provide three

dimensional insights into the anatomy

• CT is a promising candidate for replacing

invasive diagnostic coronary angiography by a

non-invasive procedure.

Magnetic Resonance (MR) imaging

MR is the only technique capable of providing all major cardiacdiagnostic, anatomical and functional information, and istherefore an attractive option for a ‘one-stop shop’ solution

Nuclear medicine imaging

• The radioactive substance can be used to label a molecularimaging agent that will bind to a particular biological molecule,such as phosphatidyl serine which is released by dying cells.

• In cases of acute myocardial infarction, the resulting imageswill show the location and extent of cell death

• The use of a molecular imaging agent to bind to macrophagesin the fibrous cap of vulnerable plaque, which would provide avaluable early warning system

Ultrasound

Modern systems can provide real-time 3D images,

giving a valuable insight into the structure and

functioning of organs such as the heart

The image data also serves as a basis for quantitative

analysis, such as the wall-motion analysis and the

quantification of left and right ventricular volumes,

pericardial effusion, intracardiac masses, defects and

endocardial surfaces.

Examination of vessel wall motion abnormalities can

provide early indication of plaque deposition

The radial vs. femoral artery approach

80 percent reduction in complication rates and an

accompanying increase in patient satisfaction

Structural repair trends

A minimally invasive percutaneous approach to repair

structural defects and move away from open surgical

procedures.

The percutaneous aortic valve, which is on the market

for treatment of aortic stenosis and aortic insufficiency.

The mitral valve clip placement is being use for

treatment of mitral regurgitation

Vascular repair trends

› Improved stents, which have evolved from polymer-

coated, metal drug-eluting stents to drug-eluting

bioabsorbable stents, potentially reducing restenosis.

› Expansion of vascular services to improve not only

heart health but also extremity health, which greatly

benefits patients overall.

› Perhaps some of the most exciting research is being

studied in clinical trials on drug-eluting balloons,

drug-eluting stents for the periphery, and using

different forms of atherectomy in combination with

other forms of therapy.

A robotically mediated, minimally invasive bypass of the leftanterior descending coronary artery is performed using theleft internal mammary artery

This is performed without a median sternotomy and withoutcardiopulmonary bypass

Shortly thereafter, the patient undergoes stenting of eitherthe right or circumflex coronary arteries

Within the very near future, the entire procedure will beable to be carried out in one session- incorporating the fullsurgical capabilities of an operating room and the fullimaging and interventional capabilities of the cath lab

A percutaneous, rather than surgical approach to aortic

valve replacement and mitral valve repair.

These technologies are currently undergoing clinical trials

and if successful, should be available clinically in the next

3-5 years.

An expeditious approach is mandatory in quickly

incorporating aggressive pharmacologic management

with judicious implantation of heart assist devices to

address these critically ill patients and impact their high

mortality rates

Cardiovascular Nurses play a key role in the evaluation of

Cardiovascular Status, Monitoring the Hemodynamic

Functions and Disease Management.

Nursing interventions have been shown to reduce patient

stress.

Recent research findings suggest that morbidity and

mortality in cardiac patients can be improved with a

comprehensive treatment plan which has a Nurse

Managed Stress Reduction Plan

Randomised controlled trials have also demonstratedthe benefit of Nurse-run Clinics for secondaryprevention of Coronary Heart Disease (Riley, 2003)

Nurse-Provided or Nurse-Coordinated CareManagement programs using an integrated ormultifactor approach have been shown to be highlyeffective in reducing morbidity and mortality of high-riskpatients (Haskell, 2003)

Cardiovascular Nurses play a very important role atdifferent levels, ie the technical level, where the nursescarry out diagnostic examinations and riskassessments; psychological level where the nurseinforms, acts as a health counsellor and helps in thepatient self care process (Riccio et.al, 2004)

A study to observe secondary prevention practice in a

cardiovascular department in a sample of two hundred

and twenty patients discharged from the Intensive

Coronary Care Unit, Cardiac Surgery Unit and Vascular

Surgery Unit has shown that nurses play a vital role in

the implementation of guidelines, risk assessment, drug

treatment and effective patient education (Steffenino

et.al, 2003)