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Heart & Cardiology/Heart attacks, muscle, artery, vein, and nerve questions.


QUESTION: Hello! Can you explain the differences in the training and levels of knowledge between a cardiologist, interventional cardiologist, cardiac surgeon, cardiothoracic surgeon, and cardiopulmonary surgeon?

I know to be a cardiologist first you have to be board certified in internal medicine, then cardiology fellowship, then interventional cardiology fellowship. And to be a surgeon, you have to complete a general surgery residency and then fellowships in either cardiovascular/cardiothoracic/cardiopulmonary surgery.

I know interventional cardiologists can do minor heart surgeries such as balloon angioplasty, stent replacement, etc. through feeding a balloon catheter through the femoral vein and possibly inserted a stent to prop open the arteries.

What are some things heart surgeons are much more experienced about than cardiologists in the field of cardiology?

What are some things cardiologists are much more experienced about than heart surgeons in the field of cardiology?

And another question...

Heart attacks are generally clogged arteries in the heart/atherosclerosis. But can clogged veins also cause heart attacks?

What about heart nerve issues, do they also have attacks? Or is that just SA/AV/pacemaker node failures?

What about if something like the Purkinje fibers fail, or the bicuspid/tricuspid valve fails? Does stuff like that happen, and what is it called? Is this under general MI, or is it called something else?

Thanks!!! Sorry if I sound ignorant.


ANSWER: Hello Stacy,

Surgeons are more experienced in cutting open chests and hearts and bypassing coronary arteries.

Cardiologists are more experienced about EKGs, echocardiograms, cardiac catheterization and coronary angiography, and of course balloon angioplasty and stents.

If a coronary vein got blocked, it would cause a heart attack, but I never heard of one getting blocked except by a cardiologist damaging one with a catheter or balloon.

I don't understand about nerves having attacks.  SA or AV node failure is fairly common and does not require a heart attack, tho heart attack can cause AV block.

Purkinje fiber failure would cause bundle branch block if the Purkinje fibers were in a bundle.

Valve failure is called incompetence if the valve leaks and stenosis if the valve gets too narrowed.  Either leak or stenosis is fairly common.  MI can cause the mitral valve to leak, but other causes of leak are much more common.

Please write back if this note doesn’t answer all your questions.

David Richardson

---------- FOLLOW-UP ----------

QUESTION: Thank you very much.

Out of all the things listed above, which ones do you see most commonly, and which ones are the most scary, and cause death the quickest/soonest/most common? What about being debilitated for life?

I have heard that SA and AV node failure is fairly common, does not require a heart attack, and is very deadly. Very scary.

Can you explain a little bit about how the SA/AV node could suddenly shut down with no prior warning?

Kindest regards dear sir.

Thank you,
~ Stacy ~

ANSWER: Heart attack and heart failure are common.  Valve and heart block less so.  Heart attack and Complete AV node bock can lead to sudden death.  Congestive heart failure, often caused by a heart attack or hypertension or a leaky valve, can be debilitating for life.

SA node failure is not deadly.  The AV node can take over pacemaking okay.  Complete (third degree) AV node failure can lead to sudden death.   Neither is common.  Spontaneous death of cells due to aging can cause SA and AV node failure.  The common cause of AV node failure is heart attack.

---------- FOLLOW-UP ----------

QUESTION: Thank you. So if both SA and AV node fail, you will die.

So if the SA node fails and the AV node still works, will you be ok?

If the AV node fails and the SA node still works, will you be ok?

Is there any way that a doctor can predict spontaneous death of cells due to aging which cause SA/AV node failure? Is there any way to prevent it?

Yes, if Both fail, you will die.

Yes, heart can work okay without SA node.

No, if AV node doesn't work, you will die.

No way that I know of except the standard ways to avoid heart attack.

Why don't you get a library to get you a copy of a cardiology textbook like Hurst or Topol so you can learn more about the heart

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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