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Cardiology deals with a variety of medical conditions ranging from angina, arrhythmias to congenital heart disease and coronary artery disease. Consulting a cardiologist is vital for successfully treating heart diseases, which often have to be managed extensively over several years with the aid of medications and surgery. Cardiovascular diseases are importantly diagnosed with the aid of tests and procedures, which are performed by cardiologists.

The prevalence of heart disease in India and the world

Worldwide and in India Cardiovascular diseases (CVDs) continue to be the top cause of mortality and as a result demand for cardiologists keeps increasing. Statistics collected by the WHO in 2016 show that worldwide 17.9 million people lost their lives due to CVDs. Additionally, CVDs are increasingly common in India where associated death rates were around 209.1 per 100,000 in 2016. In India the correlation between population aging and the death rate attributable to CVDs is high, and studies have shown that at the state level there is a large variation when it comes to age-adjusted Ischemic Heart Disease (IHD) and stroke.

 

Image 1: State-level variation in age-adjusted ischemic heart disease (A) and stroke (B) mortality rate per 100,000 in India (2016) (Source: sciencedirect.com)

What you need to know to understand cardiovascular disease

The types of Cardiovascular Disease that a cardiologist has to deal with are many and range from myocardial infarction (heart attack) to narrowed arteries and veins, arrhythmias and diseases of heart valves. Congenital diseases of the heart, pericardial and heart muscle diseases are some of the other conditions that are grouped under CVDs.  In India, especially as the population ages the instances of CVDs have steadily climbed. Worldwide WHO statistics indicate that 31% of all deaths were due to CVDs in 2016. Another statistic from the WHO shows that around three-quarters of all CVD related deaths occur in countries where the average income is either low or classified in the middle income category. In such a global scenario when cardiovascular diseases are the highest cause of mortality, cardiologists continue to play an important role and demand for their services will grow in future.

The role of a cardiologist in treating cardiovascular disease

Globally and in India a cardiologist helps in the diagnosis and treatment of those with CVDs. People with a variety of symptoms ranging from chest pain, to changes detected in routine ECGs are referred by general physicians to Cardiologists. Upon referral Cardiologists counsel patients on how to change their lifestyle so as to reduce their symptoms. In other cases cardiologists put patients through a variety of tests and then based on the results recommend or provide medications and treatment to patients. Trained to perform a variety of procedures when they study cardiology, cardiologists can perform several interventional procedures and also assist a heart surgeon when required.

Symptoms and Causes of Cardiovascular Diseases

Sedentary lifestyles, improper diet along with metabolic risk factors such as high blood pressure have contributed to the increased occurrence of CVDs. With symptoms of Cardiovascular Diseases often ranging from shortness to breath, fainting spells, to chest pain and abnormal rhythms, cardiologists have to deal with people who have one or more of them. Cardiologists also deal with heart attacks, ischemic strokes and other medical emergencies. Also in the case when patients need interventional surgery or non-invasive surgery cardiologists who have the right training and experience step in to handle procedures.

Figure 2. CVD DALYs Attributable to Metabolic Risk Factors, Globally, in India, and in the United States From 1990 to 2016 (Source: sciencedirect.com)

Image 3: Cardiovascular Disease Disability-Adjusted Life-Years Attributable to Behavioral Risk Factors (Dietary Risks, Tobacco Use, and Low Physical Activity), Globally, in India and the United States From 1990 to 2016 (Source: sciencedirect.com)

What differentiates a cardiologist from a cardiac surgeon?

A cardiothoracic surgeon is trained over several years to operate on the heart, lungs and adjacent organs in the upper chest. Other cardiac surgeons often only specialize in surgeries of the heart and its valves. Cardiologists meanwhile are involved in the diagnosis and treatment of a wide range of cardiovascular diseases, ranging from mild cases of hypertension to problems such as angina and even heart rhythms issues. Some of the work that cardiologists do such as implantation of pacemakers can also be done by a cardiac surgeon. However, minimally-invasive cardiology and interventional procedures such as angioplasty, heart catheterizations, and stenting are performed by cardiologists.  Cardiologists also play an important role in evaluating patients before heart surgery and work with cardiac surgeons to manage patients after surgery.

Understanding Cardiology

Invasive – Cardiology surgeries that require tissues and membranes to be incised and the chest to be opened.

Non-invasive – Under non-invasive cardiology the focus is on the use of tests and procedures carried out externally which aid in the diagnosis and treatment of CVDs.

Interventional – Based on the use of catheters, interventional cardiology minimizes scaring and pain after surgery, and includes procedures such angioplasty, Valvuloplasty and percutaneous coronary intervention.

Current shortage of cardiologists in India

As India continues to be battered with a rising tide of heart diseases, the amount of cardiologists available to handle them are not sufficient. This shortage means that India in 2018 had about 4,000 cardiologists when actually a far higher amount of 88,000 was required. The shortage of cardiologists in India is expected to continue in the future as fewer medical students opt to be trained in cardiology.

Training and courses for cardiologists in India

Students with a completed MBBS and who are interested to study cardiology have to enroll in further courses that last over 6-7 years to qualify as cardiologists. Many however opt for a shorter Fellowship path at this stage. The next step for those wanting to become fully qualified cardiologists is the completion of a three year PG Doctor of Medicine (MD) course. Those who want to become fully certified cardiologists, have to finally complete a DM in Cardiology which lasts for three years. 

Difficulties of getting a cardiology seat in India

Fewer people choose to study cardiology in India and hence only a limited number of 395 seats are available in the whole country as per MCI 2019. Many factors, such as an intensive and long training period which sometimes can last for a decade are major hurdles, and cause students to choose other super specialties over cardiology. There are also high costs involved, with average fees for a DM in Cardiology ranging anywhere from 5-10 lakhs per year, and this is another factor which results in students choosing a Fellowship instead.

Benefits and importance of Non-Invasive Cardiology

Non-invasive cardiology tests and procedures are routinely used to manage cardiovascular diseases more effectively, monitor rhythm issues in the heart and diagnose them. The benefits of these tests and procedures include better monitoring of patients who have cardiac disease.  Early detection of a range of CVDs using nuclear cardiology, echocardiography, heart monitors and CT scans before they become serious issues and result in a major cardiac related problem is also another benefit.

A Fellowship in Non-Invasive Cardiology at Texila American University is the right choice for many, as it not only helps meet the increased demand for cardiologists, but also provides a specifically-designed Academic Curriculum that focuses on both theoretical and clinical components. This allows one to gain global exposure, and is a solid pathway to becoming a cardiac specialist.  The program pathway allows for a Master of Medical Science (MMSc) Degree upon completion of a thesis, and includes opportunities to earn a stipend when training in hospitals.

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