Cardiology (from ancient Greek καρδία kardía , German 'heart' and logic ) is the study of the heart , which deals with its structures and functions in the organism as well as with its diseases and their treatment. As a branch of internal medicine , cardiology includes cardiovascular diseases . The pediatric in Germany and Switzerland, an independent branch of Pediatrics .
In the German-speaking countries, cardiologist is a legally protected name for a heart specialist that may only be used by doctors who have acquired and proven special knowledge in the field of cardiology as part of a special training course .
History and Development
People have felt the heart as a particularly vulnerable organ for a long time, as indicated by stone age wall paintings in Spain. In ancient times and in antiquity, the Chinese, Greeks and Romans, who were knowledgeable about medicine, paid special attention to the heart and, initially, much more to the pulse as an expression of mechanical heart activity. Around 500 BC An extensive pulse theory developed in China, which differentiated 30 different types of pulse and concluded from them diagnoses of diseases. Herophilos of Chalcedon constructed around 300 BC A pocket water watch for measuring the pulse of fever patients. He differentiated between different types of pulse characteristics and assumed that the pulse wave comes about through an active expansion ( diastole ) and a passive collapse ( systole ) of the heart and arteries. This theory was also represented by Galen of Pergamon and founded a pulse theory that was valid throughout the Middle Ages. About 2000 years ago the Roman writer Seneca the Younger described his angina pectoris as follows: “The attack is very short and similar to a storm. With other ailments one has to struggle with the disease, but here with dying. ”In cardiological terms, the Middle Ages and the early modern period were determined by the anatomical and physiological views of Galen, who derived his ideas from animal anatomy. However, the anatomist Vesal was unable to prove the pores in the heart septum, which are fundamental to Galen's theories, in human corpses. The beginning of modern cardiology can best be dated to 1628, when the English doctor William Harvey published his discovery of the blood circulation . Harvey recognized systole as the active contraction that drives the blood, and diastole as the blood-sucking passive relaxation of the heart.
In 1733 the English priest and scientist Stephen Hales was able to “bloody” for the first time. H. invasive, measuring blood pressure by inserting a cannula into a horse's carotid artery and connecting it to a glass cylinder. The oldest cardiac drug is digitalis , whose use in the treatment of " dropsy " was described in 1785 by William Withering . In 1816 the Frenchman René Laënnec invented the stethoscope , initially in the form of quite simple wooden cylinders, which made auscultation possible. Stethoscopes with flexible tubes for both ears were already in use at the end of the 19th century. An early device of the indirect "bloodless", i.e. H. non-invasive blood pressure measurement was e.g. B. the sphygmograph of the German physiologist Karl von Vierordt (1818-1884). The first sphygmomanometer was invented by the Austrian pathologist Samuel Siegfried Karl Ritter von Basch (1837–1905). In 1896 the Italian doctor Scipione Riva-Rocci described a simple device for measuring blood pressure with an arm cuff, which was improved by Harvey Williams Cushing , and whose measurement method was modified in 1905 by the Russian military doctor Nikolai Sergejewitsch Korotkow . Nowadays the Riva-Rocci method is rarely used anymore. Then the blood pressure measured in this way is named ( RR ). Nowadays the Korotkow blood pressure is wrongly called “RR” in practice.
The 20th century
In the course of the 20th century, cardiovascular diseases gained significantly in importance. At the beginning they were responsible for less than 10% of the deaths worldwide, towards the end for almost 50% in the industrialized countries and 25% in the developing countries. This shift is explained by the rarer occurrence of infectious diseases and malnutrition as the previously most common causes of death and increasing life expectancy. Since cardiovascular diseases occur more frequently in old age, the increase in average life expectancy - in the USA from 49.2 years in 1900 to 76.9 years in 2000 - explains a large part of the increase.
At the beginning of the 20th century, cardiology emerged as an independent research area within internal medicine . In 1907 the first edition of the specialist journal “Archives de Maladies du Coeur et des Vaisseaux” was published in Paris , and in 1909 the Central Journal for Heart Disease and Vascular Disease in Vienna . Heart magazine followed in England in 1910 and the American Heart Journal in the USA in 1925 . Also in 1925, the American Heart Association was founded as the first specialist cardiology society . It was followed in 1927 by the German Society for Circulatory Research as the first specialist society in Europe, whose membership increased from 180 to 300 in the first ten years of its existence.
In 1903 the Dutchman Willem Einthoven developed the electrocardiograph (EKG). At that time, the hands and feet of the patients were dipped in saline solution to divert the cardiac currents; it was not until the 1940s that registration was carried out with the help of metal disks on the wrists and ankles, which were connected to the recording device by wires. Today's treatment of cardiac arrhythmias is based u. a. on the work of the Japanese Sunao Tawara , in 1906 while working at the Marburger pathologist Ludwig Aschoff the basics of the conduction system published of the heart.
The first cardiac catheter examination in the broader sense took place in 1929 when the then surgical assistant doctor and later urologist Werner Forßmann in Eberswalde pushed a rubber tube through his arm vein into the right atrium . In 1941 André Frédéric Cournand published his experiences with cardiac catheterization as a diagnostic method. In 1956 Forßmann and Cournand u. a. for these services together with Dickinson Woodruff Richards the Nobel Prize.
The first heart operation was performed on September 9, 1896 by the Frankfurt surgeon Ludwig Rehn . He sewed the heart of a Frankfurt gardener journeyman who had been stabbed in a knife. This was preceded by animal experiments which had shown that the heart muscle was capable of regeneration. In the USA, the first heart operation for an open Botalli duct followed in 1938 by the American surgeon Robert E. Gross, the first open heart operation in 1952 by F. John Lewis.
The first echocardiographies were performed in 1950 by Wolf-Dieter Keidel and in 1954 by Inge Edler and Carl H. Hertz. The armchair treatment propagated by Bernard Lown and Samuel A. Levine in 1952 for heart attack treatment did not find acceptance in Germany until the 1960s. While in the first half of the 20th century, all physical exertion was forbidden and strict bed rest was prescribed for six to eight weeks, one week after the heart attack, they could now sit in armchairs for up to two hours a day to stimulate their circulation and break down muscles and to prevent thrombosis. Today, patients get up on the first or second day after an uncomplicated heart attack and are discharged from the hospital after seven to ten days, in the USA after less than five days.
Only after the introduction of the heart-lung machine by John Gibbon in 1953 was it possible to operate on a stationary heart; the first operation with this device in Germany was carried out in 1957 by the Berlin surgeon Emil Sebastian Bücherl . In 1958, the first of Ake Senning and Siemens development chief was at the Karolinska Hospital in Stockholm Rune Elmqvist built pacemaker implanted. In 1959, the German Behring-Werke brought streptokinase onto the market, which can dissolve the blood clot in the coronary artery in the event of an acute heart attack and thus restore the blood supply to the affected area.
The first artificial heart valve was implanted in 1961 by the two Americans Albert Starr and Lowell Edwards. In 1963, the German company provided Knoll with Verapamil the first calcium antagonists before. The first beta blocker was developed in 1964 by the Scot James W. Black , who received the Nobel Prize in 1980. The first coronary artery bypass was created in 1967 by René G. Favaloro . Also in 1967 the first heart transplant was carried out by Christiaan Barnard .
In 1980, Johns Hopkins University first used an internal defibrillator to end life-threatening tachycardias and ventricular fibrillation . In 1981, the pharmaceutical company Squibb introduced captopril as the first ACE inhibitor in therapy. The first stent was developed by Ulrich Sigwart in Lausanne and used for the first time in 1986. In 1987, the American-living Greek Roy Vagelos developed the first statin . The Doppler-based echocardiography was indeed used in 1959 by the Japanese S. Satomura, however, came only in the early 1980s, with the availability of powerful computers by K. Namekawa, William J. Bommer and Larry Miller to market. In the late 1980s, transesophageal echocardiography ( TEE for short ; "swallowing echo ") and stress echocardiography, two major expansions of ultrasound examinations of the heart , became widespread . The TEE is used in particular for the fine assessment of heart valve changes and the search for embolism sources, while stress echocardiography is used to assess circulatory disorders of the heart muscle.
The first bypass operation using minimally invasive technology was performed in the USA in 1994, and for the first time in Germany in 1995 by Joachim Laas in the cardiovascular clinic in Bad Bevensen . While computed tomography (CT) and magnetic resonance tomography (MRT) were initially only rarely used in cardiology due to the rapid natural movement of the heart, these examination methods have also become established in this field with the introduction of increasingly powerful computers in the 1990s.
In North America and Western Europe, at the beginning of the 21st century, cardiology is represented almost everywhere in practices or clinics, while in the 1960s it was almost exclusively present in university hospitals and in a few specialized centers. In the United States, approximately 14,000 cardiologists were certified in 1999 . Due to increasingly powerful computers, CT and MRI can already provide comparable or better results than echocardiography or cardiac catheterization for a number of questions , but are not in use in many countries for various reasons (including availability, costs, radiation exposure and the inability to intervene) the routine care involved.
|Left heart catheter
At the end of 2003, 3059 cardiologists were working in Germany, of which 2126 were active as statutory health insurance physicians. In 2002 only at the expense of the statutory health insurance u. a. 3,721,705 echocardiographs performed.
In the area of invasive cardiology ( cardiac catheter examinations ) and interventional cardiology ( balloon dilatations and other catheter-supported therapy methods), there has been a significant expansion in performance. From the beginning of the systematic data collection in 1984 to 2005, there was a clear increase in the number of examinations and treatments in German catheter laboratories.
|Left heart catheter
In 2001, 356 left heart catheter facilities with 503 measuring stations were registered in Germany . This corresponded to a density of 4.3 facilities and 6.2 measuring stations per 1 million inhabitants.
In 2004, 8695 diagnostic left heart catheters and 3022 balloon dilatations were performed per 1 million population in Germany. These figures are quite high in comparison with other countries (see table), which is also of importance in terms of health economics in view of the estimated costs of 573 million euros for the left heart catheter and 871 million euros for the balloon dilatation .
In 2001, 35 left heart catheter facilities with 39 measuring stations were registered in Austria, four of them for children. This corresponds to 4.3 facilities and 4.8 measuring stations per 1 million inhabitants.
The 28 left heart catheter facilities registered for Switzerland in 2000 (five of them also and two only for children) with 36 measuring stations resulted in a density of 3.9 facilities and 5.0 measuring stations per 1 million inhabitants.
In 2004 a total of 323 cardiologists were registered.
Cardiology not only focuses on congenital and acquired diseases of the heart ( cardiopathies ), it also deals with the blood circulation and the blood vessels near the heart . The term derived from the cardiovascular diseases, including cardiovascular disease (in English-speaking cardiovascular diseases referred to), also includes high blood pressure (hypertension) , stroke , vascular disease and many other diseases, but is not defined binding (see. Cardiovascular disease ). In the diagnosis and treatment of diseases that are not directly localized to the heart, there is an overlap with other fields such as angiology , neurology and pulmonology .
Special tasks and examination procedures of cardiology are
- the detection and treatment of congenital and acquired diseases of the heart, the circulatory system, the vessels near the heart and the pericardium ,
- advising and guiding cardiovascular patients in rehabilitation and the socio-medical assessment of their professional resilience,
- the intensive care basic care,
- the ultrasound examination of the heart (e.g. echocardiography , stress echocardiography, Doppler and duplex echocardiography, transesophageal echocardiography ),
- the diagnostic left and right heart catheter examinations and the like a. with coronary angiography ,
- therapeutic coronary interventions (e.g. PTCA , stent implantation , atherectomy , rotablation , brachytherapy ),
- Electrocardiograms (EKG)
- drug, apparatus and interventional antiarrhythmic therapy including defibrillation and ablation ,
- the pacemaker therapy and aftercare,
- the indication and aftercare of implantable cardioverter defibrillators (ICD) and
- together with other specialist disciplines, the interdisciplinary identification and assessment of nuclear medicine examinations and surgical treatment procedures.
Coronary heart disease
In North America, Western Europe, Japan, Australia and New Zealand, the vast majority of the managed by cardiologists patient suffers today at the coronary heart disease (CHD), so that there the detection, treatment and aftercare of angina pectoris , myocardial infarction and infarct-related heart failure in the main activity of most cardiologists has become.
In addition to drug therapy, invasive therapies have become more and more important over the past two decades . These are the bypass surgery performed by cardiac surgeons and the balloon dilatation performed by interventional cardiologists , which today is usually combined with the implantation of a stent . Precondition for both procedures is the exact knowledge of the coronary anatomy, which is gained during the coronary angiography as part of a left- heart catheter examination .
In addition to CHD and heart failure , cardiac arrhythmias play a major role in today's cardiology ( rhythmology ), with atrial fibrillation predominating in terms of numbers and ventricular arrhythmias ( ventricular tachycardia and ventricular fibrillation ) being particularly significant in terms of importance for the patient . In contrast, diseases of the heart valves (especially heart valve defects ), primary diseases of the heart muscle ( cardiomyopathies ) and inflammatory heart diseases ( endocarditis , myocarditis and pericarditis ) have receded into the background today. In particular, the rheumatic valve defects after infections with β-hemolytic streptococci , which used to be more significant in Europe , have become much rarer. While only around 1.5% of deaths from cardiovascular diseases are due to rheumatic heart disease, the proportion in developing countries is 10–15%.
Children and adolescents with (usually congenital) cardiovascular diseases are cared for in pediatric cardiology , a focus of pediatrics . The cardiological care of patients with congenital complex heart defects who have reached adulthood represents a particular problem . Their number is constantly increasing. After operations in newborns and children, they need further care - usually for life. The transition from pediatric cardiology to adult cardiology was not conclusively regulated until recently, as these clinical pictures are new and are developing through new surgical procedures. As a result of this necessity, certification regulations for an additional qualification for adults with congenital heart defects were drawn up and adopted in 2006 by a medical task force . As a result, three supraregional competence centers for adults with congenital heart defects (GUCH) in Germany were certified in July 2011. Close interdisciplinary cooperation with other necessary specialist clinics ensures high-quality treatment for patients at the Berlin, Hamburg (German heart centers) and Münster (university clinic) locations. In addition to this close interlinking of the specialist clinics, appropriate personnel and technical equipment in the competence centers is a basic requirement for certification, compliance with which by three major medical societies (German Society for Cardiology, the German Society for Pediatric Cardiology and the German Society for Thoracic, Cardiac and Cardiac Research) Vascular surgery) is checked.
High blood pressure is also researched and treated by nephrologists, pulmonary hypertension also by pulmonologists, arterial occlusive disease by angiologists, inflammatory vascular diseases by rheumatologists and stroke by neurologists and neuroradiologists.
Relationships between mental illnesses and heart diseases are the subject of psychocardiology .
The specialist society of German cardiologists is the German Society for Cardiology , which was founded in 1927 as the first cardiological society in Europe. In 2006 it had more than 6,000 members, around 15% of whom were women. In Austria , more than 1000 doctors are organized in the Austrian Cardiological Society , which was founded in 1968 . The Swiss Society for Cardiology is the specialist society for Swiss cardiologists .
In Germany the cardiologists working in the practice are organized in the Federal Association of Resident Cardiologists (BNK). The tasks of the BNK include, among other things, representing the interests of cardiologists working under contract doctors and organizing scientific and professional training for members.
The increase in knowledge and special techniques has led to an increasing specialization of cardiologists as a whole and also within cardiology. The former branch of internal medicine is establishing itself more and more clearly as an independent focus and within cardiology, a sub-specialization in non-invasive and invasive cardiology and electrophysiology is developing.
The cardiological training of doctors and subsequent certification as cardiologists is regulated by country. In the United States, for example, the American Board of Internal Medicine issues certificates for 16 sub-disciplines, one of which is cardiology. The first three years of training in general internal medicine are completed with a certificate. This is followed by a three-year sub-specialization in cardiology , which also ends with a certificate. In cardiology, in a third tier (third tier), a further one-year specialization in clinical electrophysiology of the heart or interventional cardiology can be added and also certified.
In Germany, around 300 to 350 doctors each year successfully complete their advanced training as cardiologists with an examination at the state medical associations. Cardiology emerged from a specialization within internal medicine and is organized as one of its main areas (such as gastroenterology or nephrology ). The exact name is specialist in internal medicine with a focus on cardiology . Most of the cardiologists working today are also specialists in general internal medicine because, according to an older training regulation, they first completed the six-year training and examination to become an internist and then went on to specialize in cardiology.
Initiatives of the last few years to regard cardiology as an independent specialist discipline alongside “general” internal medicine and its other sub-areas and to establish it accordingly are judged controversial. In Germany, the model further training regulations passed in 2003 provide for a specialist in internal medicine with a focus on cardiology with at least six years of further training (including three years in internal medicine) alongside a specialist in internal and general medicine .
In Austria , cardiology training - like all medical training - is regulated by the decreed by the Health Minister . According to current law, the cardiology specialty comprises nine months of basic training, followed by a 27-month basic specialty training course and a 36-month specialty specialty training course, which is shortened to 27 months upon completion of the scientific module . At the end of the training, the specialist examination must be taken ( (1) Z 3 ÄrzteG 1998). The explicitly prescribed training content is set out in the AEO as an annex.
In Switzerland , a cardiologist with at least six years of further training (the first two years in internal medicine) has been planned since 2001 .
Cardiology in veterinary medicine
Cardiology is also becoming increasingly important in veterinary medicine , especially for dogs and cats. Heart diseases occasionally occur in farm animals, especially in connection with some animal diseases , but these are not treated, if at all, by cardiologically specialized veterinarians.
In Germany, cardiology is not a separate specialist veterinary field , but an additional designation to a related specialist veterinary field (small animals, internal medicine). In 1981 the European Society of Veterinary Cardiology was founded in Venice . She has published the Journal of Veterinary Cardiology ( ) since 1998 . In 1994 the European Society of Veterinary Internal Medicine established a European advanced training course in the field of small animal internal medicine , which has been recognized by the European Board of Veterinary Specialization since 2003 . Within this European College of Veterinary Internal Medicine - Companion Animals ( ECVIM-CA ) there is a specialization cardiology. This postgraduate training course has significantly higher technical demands than the German training system and requires, among other things, a three-year training at an approved training facility. Graduates of this additional training may hold the title Diplomate of the European College of Veterinary Internal Medicine - Companion Animals (Cardiology) - Dipl. ECVIM-CA (Cardiology). At the moment (as of May 2006) 30 veterinarians have completed this additional training, including three Germans and two Swiss. This European training system was created on the model of the American ACVIM-CA (Cardiology). This long-standing degree is also recognized in Europe and its holders are also eligible for further training at the European College. The cardiology degree from the American College was earned by 129 veterinarians (as of 2005).
Key areas of veterinary cardiology
In the small animal area, around 11 percent of all presented patients have a heart disease. The focus here is on acquired heart diseases, which occur in small breeds of dogs mainly in the form of degenerative valve diseases ( valve endocardiosis ), in large breeds of dogs mainly in the form of heart muscle diseases ( dilated cardiomyopathy ). Cats also tend to develop cardiomyopathies , but here the hypertrophic form occurs much more frequently, also as a result of the overactive thyroid gland that has been increasingly diagnosed in recent years . Feeding-related heart muscle diseases (mostly dilated cardiomyopathies in certain dog breeds and cats) that occurred earlier are now rare due to the wide use of industrial ready-made feed. Heartworm disease (dirofilariasis) also plays a greater role in the southern states of the USA and in the Mediterranean region .
The examination of hereditary heart diseases has developed into a further focus of small animal cardiology in recent years. With research programs, many dog and cat breeding associations attempt to breed heart diseases that occur more frequently in individual breeds (e.g. boxers : aortic stenosis; Newfoundland , Irish wolfhound : dilated cardiomyopathy; Maine Coon cat : hypertrophic cardiomyopathy). In contrast to humans, coronary heart disease hardly ever occurs in animals.
In horses, myocarditis in connection with infectious diseases, feeding and metabolism-related myocardosis, heart valve defects (especially aortic valve insufficiency) and cardiac arrhythmias play a role.
- German Society for Cardiology
- Swiss Society for Cardiology
- Austrian Cardiological Society
- European Society of Cardiology
- American College of Cardiology
- American Heart Association
- European Society of Veterinary Cardiology
Literature on the history of cardiology
- Susanne Hahn: Cardiology. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 718-722.
- Axel W. Bauer : Cardiovascular diseases. In: Werner E. Gerabeku. a. (Ed.): Encyclopedia of medical history. Walter de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 722–728.
- James S. Forrester: The Heart Healers. The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives. New York 2015. ISBN 978-1-250-10540-0 .
- Wilhelm Pape , Max Sengebusch (arrangement): Concise dictionary of the Greek language . 3rd edition, 6th impression. Vieweg & Sohn, Braunschweig 1914 ( zeno.org [accessed September 30, 2019]).
- Susanne Hahn: Cardiology. In: Werner E. Gerabek, Bernhard D. Haage, Gundolf Keil, Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte . De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , pp. 718–722, here: p. 718.
- Susanne Hahn (2005), p. 718.
- Axel W. Bauer (2005), p. 723.
- Compare also Roger Rullière: The cardiology up to the end of the 18th century. In: Illustrated History of Medicine. German adaptation by Richard Toellner et al., Special edition in six volumes, 1986, Volume II, pp. 1054–1103.
- J.M. Gaziano: Global Burden of Cardiovascular Disease. In: DP Zipes u. a. (Ed.): Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 7th edition. WB Saunders Company, Philadelphia 2004, ISBN 1-4160-0014-3 .
- G. Arnold: The German Cardiac Society from its foundation as the German Society for Circulation Research to the present: its history, structure and targets. In: Zeitschrift für Kardiologie (2002) 91 Suppl 4, pp. IV / 1 – IV / 8.
- Hermann Mannebach: Hundred Years of Heart History. Development of cardiology 1887–1987. Springer-Verlag, 1988, p. 108.
- LO Langdon: Subspecialty internal medicine in the United States: in and outside the hospital . In: Switzerland Med Wochenschr. (1999) 129, pp. 1870-1876.
- E. Bruckenberger: German heart report 2004 with transplant surgery. 17th report. Self-published, 2005.
- A. Viola: Puzzling Mortality Differences . In: CardioNews. 2006, Vol. 9, No. 10, p. 6, .
- E. Bruckenberger: Heart report 2003 with transplant surgery. 16th report. Self-published, 2004.
- E. Bruckenberger: Heart report 2001 with transplant surgery. 14. Report of the working group on hospitals of the working group of the highest state health authorities of the states (AOLG). Hanover 2002.
- M. Bertschi: Investigation of medical care. Final report . Federal Office of Public Health, 2005. (online) ( Memento of the original dated August 22, 2016 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved July 23, 2006.
- (sample) training regulations. As of June 25, 2010 . ( Memento from January 21, 2012 in the Internet Archive ) (PDF) German Medical Association, accessed on September 18, 2012.
- , BGBl II 2015/147.