Unraveling Cardiology

Break­ing down sub-spe­cial­ties with­in Cardiology

The human heart is respon­si­ble for pump­ing blood and oxy­gen through­out your body, mak­ing it one of the most vital organs. It is com­prised of arter­ies, mus­cles and elec­tri­cal impuls­es that keep us healthy and mov­ing on a dai­ly basis. Due to its com­plex­i­ty and rela­tion­ship with oth­er organs in your body, there are a vari­ety of car­di­ol­o­gists who spe­cial­ize in dif­fer­ent func­tions of your car­diac system.

Under­stand­ing what a spe­cial­ist does and does not do can help you deter­mine the most appro­pri­ate route to take, spe­cif­ic to your heart con­di­tion. Our Car­di­ol­o­gy physi­cians dis­cuss their areas of exper­tise in treat­ing heart conditions.

Car­diac Elec­tro­phys­i­ol­o­gy — Dr. Eugene Green­stein, MD

Car­diac Elec­tro­phys­i­ol­o­gy is a branch of car­di­ol­o­gy that focus­es on diag­nos­ing and treat­ing heart con­di­tions that affect the elec­tri­cal activ­i­ty of your heart. The heart is a com­plex elec­tri­cal sys­tem. When your heart is healthy, the elec­tri­cal impuls­es are respon­si­ble for steady, pre­dictable heart con­trac­tions and nor­mal blood flow. If you have a car­diac rhythm dis­or­der, or arrhyth­mia, the impuls­es don’t spread even­ly through­out your heart, result­ing in an abnor­mal heart beat. Symp­toms of arrhyth­mia may include chron­ic chest pain, a flut­ter­ing sen­sa­tion in your chest, short­ness of breath and/​or a slow (brady­car­dia) or rac­ing (tachy­car­dia) heartbeat.

A car­diac elec­tro­phys­i­ol­o­gist will test the elec­tri­cal activ­i­ty of your heart to under­stand where your abnor­mal heart rhythm is com­ing from. To do this, they will order an elec­tro­phys­i­ol­o­gy (EPS) test that threads small catheters to your heart, through a vein, in order to record your car­diac elec­tri­cal activ­i­ty. Your car­di­ol­o­gist will then sig­nal elec­tric puls­es through the catheters to make your heart beat at dif­fer­ent rhythms. The EPS test is out­pa­tient and usu­al­ly takes one to four hours for imag­ing, and two to three hours for recovery.

Dur­ing your recov­ery, your car­diac elec­tro­phys­i­ol­o­gist will ana­lyze your EPS test results and pro­duce an informed diag­no­sis and rec­om­mend­ed treat­ment plan. Some com­mon treat­ment options for arrhyth­mia, depend­ing on your sever­i­ty, include car­diac abla­tion or a biven­tric­u­lar pace­mak­er or defibrillator.

  • Car­diac abla­tion is a min­i­mal­ly inva­sive pro­ce­dure that cre­ates scar tis­sue on your heart in order to stop unwant­ed elec­tri­cal impulses.
  • There are many dif­fer­ent types of pace­mak­ers and defib­ril­la­tors but they all work to mon­i­tor changes in your heart­beat and send elec­tri­cal impuls­es to cor­rect it when need­ed. In most cas­es, these devices are implant­ed direct­ly in your heart through a min­i­mal­ly inva­sive procedure.

Inter­ven­tion­al Car­di­ol­o­gy - Dr. Vinay Aro­ra, MD

Inter­ven­tion­al car­di­ol­o­gy is a sub-spe­cial­ty that works with inva­sive treat­ments for heart dis­ease. Inter­ven­tion­al car­di­ol­o­gists receive addi­tion­al train­ing in diag­nos­ing and treat­ing car­dio­vas­cu­lar dis­ease through catheter-based pro­ce­dures such as angio­plas­ty and coro­nary stent­ing. The most com­mon heart con­di­tions treat­ed by inter­ven­tion­al car­di­ol­o­gists include coro­nary artery dis­ease (CAD) and block­ages in oth­er ves­sels of the body.

Coro­nary Artery Disease

CAD is the most com­mon type of heart dis­ease in the Unit­ed States and the lead­ing cause of death in both men and women. CAD is due to a buildup of cho­les­terol on the inner walls of your heart, restrict­ing blood flow through your arter­ies. If left untreat­ed, CAD can cause severe chest pain, irreg­u­lar heart­beats or lead to heart fail­ure or heart attack. If you are sus­pect­ed to have CAD, you will be referred to an inter­ven­tion­al car­di­ol­o­gist who will order diag­nos­tic test­ing. Your test­ing may vary depend­ing on your con­di­tion, but you will most like­ly be rec­om­mend­ed for an echocar­dio­gram, car­diac catheter­i­za­tion and angiogram or a coro­nary com­put­er­ized tomog­ra­phy angiogram (CCTA).

If your CAD is less severe, your inter­ven­tion­al car­di­ol­o­gist may rec­om­mend med­ica­tion such as beta block­ers to decrease blood pres­sure, cho­les­terol mod­i­fy­ing med­ica­tions, cal­ci­um chan­nel block­ers to improve chest pain, nitro­glyc­erin tablets to con­trol chest pain and your heart’s demand for blood or oth­er forms of med­ica­tions to help improve your con­di­tion. If your CAD is more aggres­sive, an angio­plas­ty and stent place­ment or coro­nary bypass surgery may be recommended.


In addi­tion to CAD, inter­ven­tion­al car­di­ol­o­gists also work to treat oth­er con­di­tions that cause accu­mu­lat­ed block­ages in your heart. Clogged arter­ies are usu­al­ly due to a diet high in fat and cho­les­terol, high blood pres­sure, insulin resis­tance, lack of phys­i­cal activ­i­ty, obe­si­ty and smok­ing. Com­mon symp­toms of block­age include chest pain, dizzi­ness, fatigue, heart pal­pi­ta­tions, nau­sea, short­ness of breath and sweat­ing. If left untreat­ed, CAD can lead to heart attack (myocar­dial infarc­tion), con­ges­tive heart fail­ure and even death.

To test for buildup in your arter­ies, your inter­ven­tion­al car­di­ol­o­gist may order one or more of the fol­low­ing diag­nos­tic tests includ­ing an angiogram, com­put­er­ized tomog­ra­phy (CT) scan, cho­les­terol screen­ing, echocar­dio­gram, or mag­net­ic res­o­nance imag­ing (MRI). Once your test results are ana­lyzed by your inter­ven­tion­al car­di­ol­o­gist, they may rec­om­mend sev­er­al dif­fer­ent treat­ment options includ­ing lifestyle mod­i­fi­ca­tions for diet and exer­cise, med­ica­tions to mon­i­tor cho­les­terol and blood pres­sure and/​or sur­gi­cal and inter­ven­tion­al procedures.

An inter­ven­tion­al car­di­ol­o­gist may per­form an angio­plas­ty and stent place­ment to open clogged arter­ies, or in the case of severe or mul­ti­ple block­ages, bypass surgery may be recommended.

Struc­tur­al Car­di­ol­o­gy — Dr. Ethan Koso­va, MD

Struc­tur­al car­di­ol­o­gists diag­nose and treat struc­tur­al heart dis­ease, which is when the tis­sues or valves in your heart have an abnor­mal anato­my and func­tion. Many struc­tur­al heart dis­eases are con­gen­i­tal, or present at birth, but some devel­op lat­er in life. Some risk fac­tors for devel­op­ing a struc­tur­al heart con­di­tion include high blood pres­sure (hyper­ten­sion), high cho­les­terol, kid­ney dis­ease, cer­tain can­cer treat­ments, a his­to­ry of heart attacks or heart fail­ure, and a his­to­ry of heart valve problems. 

The symp­toms of struc­tur­al heart dis­ease vary depend­ing on your type, but the most com­mon indi­ca­tors are short­ness of breath, chest pain, wors­en­ing fatigue, heart pal­pi­ta­tions, swollen feet and ankles, faint­ing and stroke. 

The diag­no­sis of a struc­tur­al heart con­di­tion means that there is a prob­lem with the tis­sues or valves of the heart. The fol­low­ing are some of the most com­mon heart con­di­tions treat­ed by a struc­tur­al cardiologist.

Aor­tic valve steno­sis (AS)

AS occurs when your aor­tic valve open­ing is nar­rowed, result­ing in restrict­ed blood flow from the left ven­tri­cle to the aor­ta. Your struc­tur­al heart doc­tor will order an echocar­dio­gram to help deter­mine the sever­i­ty of your AS con­di­tion. Depend­ing on your diag­no­sis, your car­di­ol­o­gist may rec­om­mend sur­gi­cal valve replace­ment (open-heart surgery) or catheter-based valve replace­ment through a min­i­mal­ly inva­sive pro­ce­dure called tran­scatheter aor­tic valve replace­ment (TAVR)).

Atri­al sep­tal defect (ASD) and patent fora­men ovale (PFO)

ASD and PFO are two types of holes, or defects, which can occur between the upper two cham­bers of your heart. A car­di­ol­o­gist who spe­cial­izes in struc­tur­al heart dis­or­ders will assess your ASD or PFO through car­diac imag­ing and rec­om­mend a treat­ment course. If the hole is small, treat­ments may not be need­ed. How­ev­er, if your ASD is large or asso­ci­at­ed with symp­toms, or if you have had an unex­plained stroke and have a PFO, your car­di­ol­o­gist may rec­om­mend treat­ment with a min­i­mal­ly inva­sive pro­ce­dure that uses a catheter and a clo­sure device to close the hole.

Mitral valve regurgitation

Mitral valve regur­gi­ta­tion occurs when there is abnor­mal clos­ing of your mitral valve caus­ing blood to leak back­wards in the heart. In some cas­es, no symp­toms are present, but oth­er times symp­toms may include heart pal­pi­ta­tions, short­ness of breath, swollen legs or heart fail­ure. Your struc­tur­al car­di­ol­o­gist will order car­diac imag­ing to assess the degree of your leak­age to help deter­mine a rec­om­mend­ed treat­ment plan. If your regur­gi­ta­tion is severe, your car­di­ol­o­gist may rec­om­mend sur­gi­cal mitral valve repair (open-heart surgery) or mitral valve repair with a min­i­mal­ly inva­sive catheter-based procedure. 

Whether you have chron­ic heart fail­ure or would just like to dis­cuss symp­toms you’re expe­ri­enc­ing, our physi­cians have the exper­tise to treat your spe­cif­ic car­diac con­di­tion. To learn more about our Car­di­ol­o­gy depart­ment or to sched­ule an appoint­ment online, vis­it our Car­di­ol­o­gy page.

Health Topics:

  • To provide a thoughtful and thorough approach to patient care focusing on an open dialogue with each patient, answering questions and informing patients of their options.

  • I believe health care begins with prevention. Life style and risk factor modification can greatly reduce a patient's need for medical and invasive treatments. When these therapies are needed, however, I encourage my patients to take an active role in their health care and make informed decisions that we both believe to be in their best interest.

  • I am committed to providing the best cardiovascular care possible to each of my patients and their families. I strive to deliver individualized medical care that reflects the needs, values and choices of each person. My goal for my patients is to prevent cardiovascular disease whenever possible, and to treat cardiovascular disease aggressively and appropriately when it occurs based on the best standards of care that are available.