Cardiology is the medical field dedicated to diagnosing and treating diseases of the heart and blood vessels, collectively known as the cardiovascular system. It is a highly specialized area where physicians focus on the structure, function, and pathology of this complex organ. To manage the vast array of heart conditions, the field is organized into distinct subspecialties. This advanced focus leads to a division of labor that provides patients with highly targeted care.
Clinical Cardiology
The Clinical Cardiologist, often referred to as the General Cardiologist, serves as the primary point of contact for most patients with heart concerns. Their role centers on the long-term management of chronic conditions and the use of non-invasive diagnostic tools. These specialists manage common issues such as high blood pressure, elevated cholesterol, coronary artery disease, and heart failure through medication and lifestyle modification programs.
Diagnosis relies on interpreting data from non-invasive tests performed outside the catheterization lab. These include electrocardiograms (EKGs) to assess electrical activity, echocardiograms to visualize heart structure and function, and cardiac stress tests to determine how the heart responds to exertion. They use these results, along with patient history, to create a comprehensive treatment plan. The Clinical Cardiologist coordinates care, monitoring the patient’s condition and referring them to a procedural specialist only when intervention is necessary.
Interventional Cardiology
Interventional Cardiologists specialize in procedure-based treatments for structural heart disease and blockages within the blood vessels. This subspecialty focuses on using minimally invasive techniques, primarily involving the threading of thin, flexible tubes called catheters through blood vessels, typically starting from the wrist or groin. These procedures are performed in a specialized environment known as the cardiac catheterization lab, or “cath lab.”
The most common intervention is percutaneous coronary intervention (PCI), which includes angioplasty and stenting to restore blood flow in blocked coronary arteries. During angioplasty, a balloon is inflated to compress plaque against the artery wall, followed by the placement of a wire mesh stent to keep the vessel open. Interventionalists also treat structural issues like severe valve disease, performing transcatheter aortic valve replacement (TAVR) to implant a new valve without open-heart surgery.
Cardiac Electrophysiology
Cardiac Electrophysiologists (EPs) focus entirely on the heart’s electrical system, which dictates the rhythm and timing of heartbeats. This system can be affected by disorders known as arrhythmias, such as atrial fibrillation, ventricular tachycardia, or bradycardia. EPs are experts in mapping the precise pathways of electrical signals within the heart to diagnose and correct these rhythm disturbances.
A core diagnostic tool is the Electrophysiology (EP) Study, an invasive procedure that uses specialized catheters to record electrical activity directly from inside the heart chambers. Treatment often involves catheter ablation, where radiofrequency energy or cryotherapy is used to destroy or isolate small areas of tissue causing abnormal electrical signals. EPs are also responsible for implanting and managing electronic devices, including pacemakers to treat slow heart rates and implantable cardioverter-defibrillators (ICDs) to correct dangerously fast heart rhythms.
Training and Certification
The path to becoming a cardiologist begins with four years of medical school followed by a three-year residency in Internal Medicine. Upon completion of residency, a physician must complete a three-year fellowship focused on general cardiovascular disease, which encompasses the training required for the Clinical Cardiology role. Successful completion of this training allows a physician to seek board certification in Cardiovascular Disease from the American Board of Internal Medicine (ABIM).
To specialize further in a procedural field, additional training is required after the initial three-year cardiology fellowship. Physicians pursuing Interventional Cardiology or Cardiac Electrophysiology must complete a further one to two-year advanced fellowship specific to their chosen subspecialty. These specialized fellowships provide the hands-on experience needed to master complex interventions or advanced rhythm management techniques, leading to subsequent subspecialty board certification.