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Cardiology
FromWikipedia,thefreeencyclopedia

Cardiology(fromGreekkardi,"heart"and
logia,"study")isabranchofmedicinedealing
withdisordersoftheheartbeithumanoranimal.The
fieldincludesmedicaldiagnosisandtreatmentof
congenitalheartdefects,coronaryarterydisease,heart
failure,valvularheartdiseaseandelectrophysiology.
Physicianswhospecializeinthisfieldofmedicineare
calledcardiologists.Physicianswhospecializein
cardiacsurgeryarecalledcardiacsurgeons.

Cardiology

Contents
1Specialization
2Theheart
3Disorders
3.1Disordersofthecoronarycirculation
3.2Cardiacarrest
3.3Disordersofthemyocardium(muscle
oftheheart)
3.4Disordersofthepericardium(outer

Bloodflowdiagramofthehumanheart.Blue
componentsindicatedeoxygenatedbloodpathways
andredcomponentsindicateoxygenatedpathways.
System

Subdivisions Interventional,Nuclear
Significant
diseases

Heartdisease,Cardiovascular
disease,Atherosclerosis,
Cardiomyopathy,Hypertension
(HighBloodPressure)

Significant
tests

Bloodtests,Electrophysiology
study,Cardiacimaging,ECG,
Echocardiograms,Stresstest

Specialist

Cardiologist

liningoftheheart)
3.5Disordersoftheheartvalves
3.6Congenitalheartdefect
3.7Diseasesofbloodvessels(vascular
diseases)

Cardiovascular

3.8Procedurestocountercoronaryartery
disease
3.9Devicesusedincardiology
3.10Diagnostictestsandprocedures
4Cardiologists
5Journals
6Associations
7Seealso
8References
9Externallinks
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Specialization
Cardiologyisaspecialtyofinternalmedicine.TobeacardiologistintheUnitedStates,athreeyear
residencyininternalmedicineisfollowedbyathreeyearfellowshipincardiology.Itispossibleto
specializefurtherinasubspecialty.RecognizedsubspecialtiesintheUnitedStatesbytheACGMEare:
Cardiacelectrophysiology:Studyoftheelectricalpropertiesandconductiondiseasesoftheheart.
Echocardiography:Theuseofultrasoundtostudythemechanicalfunction/physicsoftheheart.
Interventionalcardiology:Theuseofcathetersforthetreatmentofstructuralandischemicdiseases
oftheheart.
Nuclearcardiology:Theuseofnuclearmedicinetovisualizetheuptakeofanisotopebytheheart
usingradioactivesources.
RecognizedsubspecialtiesintheUnitedStatesbytheAmericanOsteopathicAssociationBureauof
OsteopathicSpecialists(AOABOS)include:[1]
Clinicalcardiacelectrophysiology
Interventionalcardiology

Theheart
Asthecenterfocusofcardiology,thehearthasnumerousanatomicalfeatures(e.g.,atria,ventricles,heart
valves)andnumerousphysiologicalfeatures(e.g.,systole,heartsounds,afterload)thathavebeen
encyclopedicallydocumentedformanycenturies.
Disordersoftheheartleadtoheartdiseaseandcardiovasculardiseaseandcanleadtoasignificantnumber
ofdeaths:cardiovasculardiseaseistheleadingcauseofdeathandcaused29.34%ofalldeathsin2002.
Theprimaryresponsibilityoftheheartistopumpbloodthroughoutthebody.Itpumpsbloodfromthebody
calledthesystemiccirculationthroughthelungscalledthepulmonarycirculationandthen
backouttothebody.Thismeansthattheheartisconnectedtoandaffectstheentiretyofthebody.
Simplified,theheartisacircuitoftheCirculation.Whileplentyisknownaboutthehealthyheart,thebulk
ofstudyincardiologyisindisordersoftheheartandrestoration,andwherepossible,offunction.
Theheartisamusclethatsqueezesbloodandfunctionslikeapump.Eachpartoftheheartissusceptibleto
failureordysfunctionandtheheartcanbedividedintothemechanicalandtheelectricalparts.
Theelectricalpartoftheheartiscenteredontheperiodiccontraction(squeezing)ofthemusclecellsthatis
causedbythecardiacpacemakerlocatedinthesinoatrialnode.Thestudyoftheelectricalaspectsisasub
fieldofelectrophysiologycalledcardiacelectrophysiologyandisepitomizedwiththeelectrocardiogram
(ECG/EKG).Theactionpotentialsgeneratedinthepacemakerpropagatethroughouttheheartinaspecific
pattern.Thesystemthatcarriesthispotentialiscalledtheelectricalconductionsystem.Dysfunctionofthe
electricalsystemmanifestsinmanywaysandmayincludeWolffParkinsonWhitesyndrome,ventricular
fibrillation,andheartblock.
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Themechanicalpartoftheheartiscenteredonthefluidicmovementofbloodandthefunctionalityofthe
heartasapump.Themechanicalpartisultimatelythepurposeoftheheartandmanyofthedisordersofthe
heartdisrupttheabilitytomoveblood.Failuretomovesufficientbloodcanresultinfailureinotherorgans
andmayresultindeathifsevere.Heartfailureisoneconditioninwhichthemechanicalpropertiesofthe
hearthavefailedorarefailing,whichmeansinsufficientbloodisbeingcirculated.

Disorders
Cardiologyisconcernedwiththenormalfunctionalityoftheheartandthedeviationfromahealthyheart.
Manydisordersinvolvetheheartitselfbutsomeareoutsideoftheheart.

Disordersofthecoronarycirculation
Contrarytoabasicunderstandingofthe
cardiovascularsystem,theheartcannotitself
receiveenoughoxygenandnutrientsfromthe
blooditpumpsanditmustbesuppliedwith
bloodasifitwereanyotherorganinthebody.
Unlikethesystemicorganstheheartreceives
perfusioninthephaseofdiastoleratherthan
systole.Thiscirculationofbloodiscalledthe
coronarycirculation.Thecoronarycirculation
consistsofcoronaryarteriesandcoronaryveins.
Disordersofthecoronarycirculationcanhave
devastatingeffectstotheheartsincedamageto
theheartcanreducecoronarycirculationwhich
causesfurtherdamage.Afewexamplesare
presented,asfollows:

Coronaryarterieslabeledinredtextandotherlandmarksin
bluetext.

Acutecoronarysyndrome(ACS)
Acutecoronarysyndromeisabroadtermencompassingmanyacutemyocardialinfarction
symptoms.
Anginapectoris
Anginapectorisliterallymeans"chestpain"thatreferstopaincausedbyischemiaoftheheart.
Atherosclerosis
Atherosclerosisistheconditioninwhichanarterywallthickensastheresultofabuildupoffatty
materials(e.g.,cholesterol).Atherosclerosisofacoronaryarteryleadstocoronaryheartdisease.
Coronaryheartdisease
Coronaryheartdiseaseisageneraltermforanyreductionincoronarycirculation.Onesuch
conditionisatherosclerosis.
Myocardialinfarction(akaheartattack)
Amyocardialinfarctionisthedeathofapartoftheheartwhichistypicallycausedbyablockageof
thecoronarycirculationorcoronaryheartdisease.
Restenosis
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Recurrenceofstenosiswhichwouldrefertoanarrowingofacoronaryarteryinthecontextofthe
coronarycirculation.

Cardiacarrest
Cardiacarrestreferstothecessation(tocease)of
normalsystemiccirculationduetofailurein
propercontractionoftheheart.Thereare
severalconditionsthatcancausecardiacarrest.
Asystole("flatline")
Asystolereferstotheabsenceof
electricalactivityoftheheartandis
sometimesreferredtoasa"flatline"

Arhythmstripshowingacouplebeatsofnormalsinus
rhythmfollowedbyanatrialbeatandasystole("flatline").

becausetheelectrocardiogramshowsa
solidlineduetotheabsenceofelectricalactivity.
Pulselesselectricalactivity(PEA)
Pulselesselectricalactivityiswhentheelectrocardiogramshowsarhythmthatshouldproducea
pulsebutitdoesnot.PEAiscommonlycausedbythe6H'sand6T's(seePEAarticle).
Pulselessventriculartachycardia
Pulselessventriculartachycardia(VT)IsoneclassificationofVTsuchthatnopulseisfeltbecauseof
anineffectivecardiacoutputwhichcausescardiacarrest.
Suddencardiacdeath
Suddencardiacdeathisaconceptofnaturaldeathratherthanaspecificmedicalcondition.Thereare
severalcausesofsuddencardiacdeathanditisdistinctfromcardiacarrest.
Ventricularfibrillation
Ventricularfibrillationisfibrillationoftheventriclesoftheheart.Rhythmiccontractionisnecessary
forefficientmovementofbloodandfibrillationdisruptsthisrhythmsufficientlytocausecardiac
arrest
Treatmentofcardiacarrestincludescardiopulmonaryresuscitation(CPR)anddefibrillationdependingon
theexactcauseofcardiacarrest.

Disordersofthemyocardium(muscleoftheheart)
Cardiomyopathy
Cardiomyopathyisadeteriorationofthemyocardium.
Ischemiccardiomyopathy
Cardiomyopathycausingischemiaoftheheartduetocoronaryarterydisease.
Nonischemiccardiomyopathy
Cardiomyopathynotcausedbyischemiaoftheheart.
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Amyloidcardiomyopathy
Cardiomyopathycausedbyamyloidosis.
Hypertrophiccardiomyopathy(HCM)
Cardiomyopathycausedbyhypertrophyoftheheart.
Hypertrophicobstructivecardiomyopathy(HOCM)(Idiopathichypertrophic
subaorticstenosis(IHSS))
Dilatedcardiomyopathy
Cardiomyopathycausedby
dilationoftheheart.
Alcoholiccardiomyopathy
Atypeofdilated
cardiomyopathy
causedbychronic
abuseofalcohol.
Tachycardiainduced
cardiomyopathy
Atypeofdilated

Thediagramshowsahealthyheart(left)andonesuffering
fromrightventricularhypertrophy(right).

cardiomyopathy
causedbychronictachycardia.
Takotsubocardiomyopathy(Transientapicalballooning,stressinduced
cardiomyopathy)
Atypeofdilatedcardiomyopathycausedbyasuddentemporaryweakeningofthe
myocardium.
Arrhythmogenicrightventriculardysplasia(Arrhythmogenicrightventricular
cardiomyopathy)
Cardiomyopathycausedbyageneticmutationofthedesmosomesthatconnect
myocytes.
Restrictivecardiomyopathy
Cardiomyopathycausedbyexcessiverigidityoftheheart.
Heartfailure
Failureofthehearttoproducesufficientbloodflowtomeetmetabolicdemandsofthebody.
Corpulmonale
Untreatedcorpulmonalecancauserightheartfailurefromchronicpulmonaryhypertrophy.
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Ventricularhypertrophy
Hypertrophyoftheventricle.
Leftventricularhypertrophy
Hypertrophyoftheleftventricle.
Rightventricularhypertrophy
Hypertrophyoftherightventricle.
Primarytumorsoftheheart
Tumorsthatariseinitiallyintheheartandnot
fromelsewhereinthebody.
Myxoma
Mostcommontumoroftheheart.
Myocardialrupture
Agrossstructuralfailureoftheheart.Commonly
aresultofmyocardialinfarction.

Disordersofthepericardium(outerliningof
theheart)

Amanwithcongestiveheartfailureandmarked
jugularvenousdistension.Externaljugularvein
markedbyanarrow.

Thepericardiumisadoublewalledsacfibrous
pericardiumandserouspericardiumthatcontainstheheart.
Constrictivepericarditis
Pericarditisthatconstrictstheexpansionoftheheartand
inhibitsheartfunction.
Pericardialeffusion
Anabnormalaccumulationoffluidinthepericardiumthat
canleadtotamponade.
Pericardialtamponade
Accumulationoffluidinthepericardiumthatinhibitsheart
function.
Pericarditis
Inflammationofthepericardium.

Posteriorwallofthepericardialsac.

Disordersoftheheartvalves
Theheartcontainsfourvalvesthatdirecttheflowofbloodinasingledirection.Failuretopreventreverse
flowiscalledregurgitation,orinsufficiency.Narrowingofthevalvesobstructsflowandiscalledstenosis.
Aorticvalve
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Disordersandtreatmentsoftheaorticvalvethatseparatestheleftventricleandaorta.
Aorticregurgitation/aorticinsufficiency
Deficiencyoftheaorticvalvethatpermits
regurgitationfromtheaortaintotheleft
ventricle.
Aorticstenosis
Narrowingoftheaorticvalveopeningthat
reducesbloodflowthroughthevalve.
Aorticvalvereplacement
Replacementoftheaorticvalvedueto
aorticregurgitation,aorticstenosis,orother
reasons.
Aorticvalverepair
Repair,insteadofreplacement,ofthe
aorticvalve.
Aorticvalvuloplasty

3Dreconstructionoftheheartasviewedfromthe
apextowardsthevalves,imageflipped180
relativetoillustrationabove.Pulmonaryvalvenot
visible,leafletsofthetricuspidandaorticvalves
onlypartlyvisible.Tothelefttwoimagesin2D
fromthesamedataset,showingtricuspidandmitral
valves(above)andaortalandmitralvalve(below).

Repairofthevalvebyusinga
ballooncathetertoforceitopen.
Mitralvalve
Disordersandtreatmentsofthemitralvalvethatseparatestheleftatriumandleftventricle.
Mitralvalveprolapse
Prolapseofthemitralvalveintotheleftatriumduringventricularsystole.
Mitralregurgitation/mitralinsufficiency
Deficiencyofthemitralvalvethatpermitsregurgitationfromtheleftventricleintotheleft
atrium.
Mitralstenosis
Narrowingofthemitralvalveopeningthatreducesbloodflowthroughthevalve.
Mitralvalvereplacement
Replacementofthemitralvalveduetomitralregurgitation,mitralstenosis,orotherreasons.
Mitralvalverepair
Repair,insteadofreplacement,ofthemitralvalve.
Mitralvalvuloplasty
Repairofthevalvebyusingaballooncathetertoforceitopen.
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Pulmonaryvalve
Disordersofthepulmonaryvalvethatseparatestherightventricleandpulmonaryartery.
Pulmonaryregurgitation/pulmonaryinsufficiency
Deficiencyofthepulmonaryvalvethatpermitsregurgitationfromthepulmonaryarteryinto
therightventricle.
Pulmonicstenosis
Narrowingofthepulmonaryvalveopeningthatreducesbloodflowthroughthevalve.
Tricuspidvalve
Disordersofthetricuspidvalvethatseparatestherightatriumandrightventricle.
Tricuspidregurgitation/tricuspidinsufficiency
Deficiencyofthetricuspidvalvethatpermitsregurgitationfromtherightventricleintothe
rightatrium.

Congenitalheartdefect
Congenitalheartdefectsaredefectsinthe
structureoftheheartwhicharepresentatbirth.
Atrialseptaldefect
Defectintheinteratrialseptumthat
permitsbloodflowbetweenatria,
includingapatentforamenovale(PFO).
Bicuspidaorticvalve
Formationoftwovalveleafletsinthe
aorticvalveinsteadofthreeleaflets.
Hypoplasticleftheartsyndrome
Defectinthedevelopmentoftheleft
heartsuchthatitishypoplastic(under
Atrialseptaldefectwithlefttorightshunt.
developed).
Patentductusarteriosus(PDA)
Failureoftheductusarteriosustocloseonbirth.
Patentforamenovale(PFO)
Anatrialseptaldefectinthattheforamenovalefailstocloseatbirth.
Persistenttruncusarteriosus
Defectinthatthetruncusarteriosusfailstodivide.
TetralogyofFallot
Setoffouranatomicalabnormalities:pulmonarystenosis,overridingaorta,ventricularseptaldefect,

andrightventricularhypertrophy.
Transpositionofthegreatvessels(TGV)
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Abnormalspatialarrangementofthegreatvessels(superiorvenacava,inferiorvenacava,pulmonary
arteries,pulmonaryveins,andaorta).
Ventricularseptaldefect
Defectintheventricularseptumthatpermitsbloodflowbetweenventricles.

Diseasesofbloodvessels(vasculardiseases)
Atherosclerosis
Thickeningofanarterialwalldueto
increasedcholesterolandmacrophages.
Aneurysm
Balloonlikebulgingoftheartery.
Aorta
Diseasesoftheaorta:
Coarctationoftheaorta
Narrowingoftheaortaatthe
ductusarteriosus/ligamentum
arteriosum.
Aorticdissection
Dissectionalongthelengthofthe
aortabetweenthelayersofthe
aorticwallandfilledwithblood.
Aorticaneurysm
Aneurysmoftheaorta.

Theprogressionofatherosclerosis(sizeexaggerated).

Carotidartery
Diseasesofthecarotidarteries:
Carotidarterystenosis/carotidarterydiseaseNarrowingofthecarotidartery,typicallydue
toatherosclerosis.
Carotidarterydissection
Dissectionalongthelengthofthecarotidarterybetweenthelayersofthecarotidwalland
filledwithblood.
Deepveinthrombosis(DVT)
Formationofathrombusinadeepvein,commonlyinthelegs.
Traveller'sthrombosis/economyclasssyndrome
ADVTduetobeingsedentaryduringairtravel.
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Varicoseveins
Veinsthathavebecomeenlargedandtortuouswithfailedvalves,commonlyinthelegs.
Vasculitis
Inflammationofbloodvessels.

Procedurestocountercoronaryarterydisease
Coronaryarterybypasssurgery(CABG)
Graftinganarteryorveinfromelsewhere(typicallythe
leg)tobypassastenoticcoronaryartery.
Enhancedexternalcounterpulsation(EECP)
Pneumaticallyassistingthehearttomovebloodusing
inflatablecuffsonthelegs.
Percutaneouscoronaryintervention(PCI)
Procedurestotreatstenoticcoronaryarteriesby
accessingthroughabloodvessel.
PercutaneousTransluminalCoronaryAngioplasty(PTCA)
Enlargingthelumenofacoronaryarterybyforcibly
expandingitwithaballoon.
Atherectomy
Enlargingthelumenofacoronaryarterybyremovalof

Anexampleofadrugelutingstent.Thisis
theTAXUSExpress2PaclitaxelEluting
CoronaryStentSystem,whichreleases
paclitaxel.

atheroscleroticplaque.
Stenting
Enlargingthelumenofacoronaryarterybyforciblyexpandingitwithametalwiretube.

Devicesusedincardiology
Stethoscope
Acousticdeviceforhearinginternalsoundsincludingheart
sounds.
Devicesusedtomaintainnormalelectricalrhythm
Pacemaker
Animplantedelectricaldevicethatreplacestheheart's
naturalpacemaker.
Defibrillator
Electricaldevicestoaltertheheart'srhythmwith

Astethoscope.

electricalenergy.
Automatedexternaldefibrillator(AED)
Anexternaldefibrillatorthatiscommonlyfoundoutsideofhealthcaresettings.Often
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designedforanyonetouse.
Implantablecardioverterdefibrillator(ICD)
Animplanteddevicetopreventlifethreateningconditions(e.g.,ventriculartachycardia,
ventricularfibrillation).
Devicesusedtomaintainbloodpressure
Artificialheart
Aninternalpumpthatwhollyreplacesthepumpingactionoftheheart.
Cardiopulmonarybypass(CPB)/heartlungmachine
Externalpumptotakeoverthefunctionofboththeheartandlungs.
Intraaorticballoonpump(IABP)
Aballoonplacedinthethoracicaortatosupplementcardiacoutputfromtheheart.
Ventricularassistdevice
Internalpumptosupplementorreplacethepumpingactionofaventricle.

Diagnostictestsandprocedures
Variouscardiologydiagnostictestsandprocedures.
Bloodtests
Echocardiography("echo")
Ultrasonographyofthehearttoinspectchambers,valves,and
bloodflow.
Transthoracicechocardiogram(TTE)
Echocardiogramoftheheartthroughthethoraxexternal
tothebody.
Transesophagealechocardiogram(TEE)
Echocardiogramoftheheartthroughacatheterplaced
intheesophagus.
Cardiovascularmagneticresonanceimaging(CMR)
Magneticresonanceimaging(MRI)oftheheartthatutilizes

Cardiologistsusediagramslikethis:a
heartwithanECGindicator

theECGforgatingandtolookatspecificmechanicalfunctionsoftheheart.
Cardiacstresstest
Testingofthecardiovascularsystemthroughcontrolledexerciseordrugs.
Auscultation
Listeningtosounds(e.g.,heartsounds)withastethoscope.
Electrocardiography(ECGorEKG)
Measurementoftheelectricalactivityoftheheart,typicallywith4or10electrodesontheskin.
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Holtermonitor
PortableECGdeviceforcontinuousmonitoring.
Electrophysiologystudy
Studyingtheelectricalactivityoftheheartthroughtheuseofcathetersplacedintheheartviaveins
orarteries.
Sphygmomanometer
Bloodpressurecuffusedtomeasurearterialbloodpressure.
Cardiacmarker
Testingforbiomarkersinthebloodthatmayindicatevariousconditions.
Coronarycatheterization
Catheterizationofthecoronaryarteries.
Fractionalflowreserve(FFRmyo)
Testingthebloodflowthroughastenosisofacoronaryarterytodeterminetheperfusionofthe
heart.
Intravascularultrasound(IVUS)
Ultrasonographyofacoronaryartery.
Opticalcoherencetomography(OCT)
Testingthroughtheuseofopticalscatteringforcoronaryarterydisease.

Cardiologists
RobertAtkins(19302003),knownfortheAtkins

Cardiologist

diet
EugeneBraunwald(born1929),editorof
Braunwald'sHeartDiseaseand1000+
publications
WillemEinthoven(18601927),aphysiologist
whobuiltthefirstpracticalECGandwonthe1924

Occupation
Names

Doctor,MedicalSpecialist

Occupation
type

Specialty

Activity
sectors

Medicine
Description

Nobelprizeinmedicine
AndreasGruentzig(19391985),firstdeveloped
balloonangioplasty

Education
required

MaxHolzmann(18991994),cofounderofthe

DoctorofMedicine(M.D.)
DoctorofOsteopathic
Medicine(D.O.)

SwissSocietyofCardiology,presidentfrom1952
1955
SamuelA.Levine(18911966),recognizedthesignknownasLevine'ssignaswellasthecurrent
gradingoftheintensityofheartmurmurs,knownastheLevinescale
HenryMarriott(19172007),ECGinterpretationandMarriott'sPracticalElectrocardiography
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JohnParkinson(18851976),knownforWolffParkinsonWhitesyndrome
HelenB.Taussig(18981986),founderofpediatriccardiologyandextensivelyworkedonbluebaby
syndrome
PaulDudleyWhite(18861973),knownforWolffParkinsonWhitesyndrome
LouisWolff(18981972),knownforWolffParkinsonWhitesyndrome
BernardLown(born1921)knownforbeingtheoriginaldeveloperoftheDefibrillator

Journals
ActaCardiologica
AmericanJournalofCardiology
AnnalsofCardiacAnaesthesia
Cardiology
CardiologyinReview
Circulation
CirculationResearch
ClinicalandExperimentalHypertension
ClinicalCardiology
EPEuropace
EuropeanHeartJournal
Heart
HeartRhythm
InternationalJournalofCardiology
JournaloftheAmericanCollegeofCardiology
PacingandClinicalElectrophysiology

Associations
AmericanCollegeofCardiology
AmericanHeartAssociation
HeartRhythmSociety
NationalHeartFoundationofAustralia

Seealso
Interventionalcardiology
Clinicalcardiacelectrophysiology
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Listofcardiacpharmaceuticalagents

References
1. ^"Specialties&Subspecialties"(http://www.osteopathic.org/insideaoa/development/aoaboard
certification/Pages/specialtysubspecialtycertification.aspx).AmericanOsteopathicAssociation.Retrieved
23September2012.

Externallinks
U.S.NationalInstituteofHealth(NIH):HeartandCirculation(http://health.nih.gov/search.asp/10)
AmericanCollegeofCardiology(http://www.acc.org)
TheBeginnersGuidetoUnderstandingCardiology
(http://www.publicsafetydegrees.com/articles/ems/cardiologyguide.php)
Cardiologynewswebsite(http://www.theheart.org/)
CardiologyTrialssummaries(http://cardiologytrials.org)
Retrievedfrom"http://en.wikipedia.org/w/index.php?title=Cardiology&oldid=639292298"
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