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The field includes medical diagnosis and treatment
of congenital heart defects, coronary artery
disease, heartfailure, val...
Heart :
its function was first defined by William Harvey, a
British physician
In his publication in 1628,De Motu Cordis, H...
Einthoven, a professor of physiology in the small
Dutch town of Leiden, first recorded a human
electrocardiogram and gave ...
19th-century: French physiologist Claude Bernard
catheterized and measured pressures in the various
cardiac chambers and g...
In 1941, Andre Cournand and Dickinson
Richards at Columbia University and Bellevue
Hospital in New York began the systemat...
Werner Forßmann
Werner Forßmann
Born 29 August 1904
Berlin
Died 1 June 1979 (aged 74)
Nationality Germany
Fields Medicine
...
First performed by mason sones at the cleveland clinic
in 1958
Coronary arteriography, when combined with left
ventriculog...
Modern cardiovascular surgery was first applied in
1938, by Robert Gross at Harvard and Boston's
Children's Hospital succe...
Balloon angioplasty was followed by stenting with bare
metal stents, which are now being replaced by drug-
eluting stents....
Before 1961:patients with acute myocardial infarction were
treated largely with benign neglect
In 1961:Desmond Julian, the...
In the 1960s:James Black developed beta-blockers
In the 1970s: The first angiotensin-converting enzyme
inhibitor, captopri...
In 1976: The first HMG-CoA reductase inhibitor (statin) was
isolated by Akira Endo of Sankyo Pharmaceuticals, and was
buil...
In 1944, Dr. Paul Dudley White at Harvard and the
Massachusetts General Hospital, often referred to as
the father of Ameri...
Inge Edler, a Swedish cardiologist, and Helmuth Hertz,
a Swedish physicist(1952): launched the field of
echocardiography
T...
1842 – Johann Christian Doppler discovers the Doppler sound effects – begins
the premise for sonographic imagery.
1881 – J...
1956 – S. Satumora, Yoshida, Nimura are the first to apply
the Doppler principle to the use of ultrasound to detect
cardia...
1973 – Echocardiography is included as a searchable
term in Index Medicus.
1975 – Feigenbaum founds the American Society o...
In 1959, Elmquist and Senning at the university of
zurich reported on the first successful use of an internal
pacemaker
In...
A series of
pacemakers from the
1960s to the 1990s
(top left to bottom
right) demonstrating
the remarkable
progress in the...
cardiac stimulation
leads considered the
weak point in
pacemaker systems,
the Wireless Cardiac
Stimulation system
(WiCS) u...
Hybrid Long-term Temporary
Pacing
The lead was
tunnelled
subcutaneou
sly for 6cm,
and the
proximal end
was
connected to
a ...
Contemporary cardiology is composed of multiple
subspecialties
Adult medical cardiology :Electro physiologists,
subspecial...
Leads to greater expertise
Improves patient care, teaching, and research
Skilled subspecialists can perform complicated
pr...
 Disease prevention
 Costs of cardiac care
costs of care are spiraling out of control
Continuing subspecialization in the pursuit of
technical virtuosity and clinical excellence
Preventive measures based on p...
gene-informed therapy: genetic identification of the
future development of risk factors will lead to gene-
informed person...
Intervention versus prevention
Greater focus on prevention, using
progressively greater refinements of markers
of inflamma...
In1711:developmentof cardiac catheterization
Stephen Hales placed catheters into the right and left
ventricles of a living...
In 1927: The technique of angiography itself was first
developed by the Portuguese physician Egas Moniz at
the University ...
In 1958 Dr. Charles Dotter began working on methods
to visualize the coronary anatomy via sequential
radiographic films.
H...
Mason Sones, a pediatric cardiologist at the Cleveland
Clinic: while performing an aortic root aortography, ,
noted that t...
Until the 1950s: placing a catheter into either the
arterial or venous system involved a "cut down"
procedure, in which th...
In 1953 :The percutaneous approach that is
widely used today was developed by
radiologist Sven-Ivar Seldinger . This metho...
By the late 1960s: Melvin Judkins had begun
work on creating catheters that were specially
shaped to reach the coronary ar...
The use of a balloon-tipped catheter for the
treatment of atherosclerotic vascular disease
was first described in 1964 by ...
Andreas Gruentzig performed the first
successful PTCA or percutaneous coronary
intervention (PCI)) on a human on
September...
In 1986: first intracoronary stents were
successfully deployed in coronary arteries
The first stents used were self-expand...
In 1989: the Palmaz-Schatz balloon-
expandable intracoronary stent was
developed
By 1999 nearly 85% of all PCI procedures
...
Four early endovascular stents.
Ruygrok P N , and Serruys P W Circulation 1996;94:882-
890
Copyright © American Heart Asso...
Seven coronary stents, clockwise from bottom left: Wallstent, Palmaz-Schatz stent, Wiktor
stent, Gianturco-Roubin stent, C...
Stent manufacturers experimented with a
number of chemical agents to prevent the
neointimal hyperplasia that is the cause ...
FDA approved the use of the Cypher stent as the
first drug-eluting stent for use in the general population
in the United S...
Taxus stent was approved for use in Europe in 2003
With further study, the FDA approved the use of the
Taxus stent in the ...
Dr. B. Soma Raju and his team have performed
the first PTCA (Percutaneous Transluminal
Coronory Angioplasty) in India on 1...
The development of the stent resulted in reducing the
cost of stents in the country and brought it within the
reach of the...
Medical College Trivandrum
ACHIEVEMENTS
First government hospital in kerala done
coronary angioplasty in 1998.
First gover...
Medical College Trivandrum
Department of Cardiology started functioning in
1972. It started with 4 bed Intensive care unit...
In the 19th century: The earliest operations on
the pericardium took place and were performed
by Francisco Romero, Dominiq...
September 7, 1896: The first successful
surgery of the heart, performed without any
complications, was by Dr. Ludwig
Rehn ...
In 1925: Henry Souttar operated successfully on a
young woman with mitral stenosis
He made an opening in the appendage of ...
In 1948: four surgeons carried out successful operations
for mitral stenosis resulting from rheumatic fever
In 1947 thomas...
September 2, 1952: The first successful intracardiac
correction of a congenital heart
defect using hypothermia was perform...
In March, 1961, Zuhdi, Carey, and Greer,
performed open heart surgery on a child,
age 3½, using the total intentional
hemo...
Norman shumway the father of heart transplantation
world's first adult human heart transplant was
performed by christiaan ...
Since the 1990s, surgeons have begun to
perform "off-pump bypass surgery
In these operations, the heart is beating
during ...
Robot-assisted heart surgery:
Machine is used to perform surgery while being
controlled by the heart surgeon.
The main adv...
Russell M. Nelson performed the first
successful pediatric cardiac operation at
the Salt Lake General Hospital in March
19...
Dr K M Cherian: performed the first coronary
artery bypass surgery in India in 1975.
He also performed the country's secon...
Padmashri Dr. Jose Chacko Periappuram
performed the first successful human-to-
human heart transplant
He was the first hea...
Cardiac nursing is a nursing specialty that
works with patients who suffer from various
conditions of the cardiovascular s...
Cardiac nurses work in many different
environments, including coronary care
units (CCU), cardia catheterization,
inte nsiv...
Cardiac nursing has become a specialty in
the past 50 years
Cardiac nursing continues to grow as more
understanding is gai...
The first CCU was founded at the royal
infirmary in scotland, by dr. Desmond G.
Julian to deal with heart attack, sudden
c...
Coronary care units had reduced mortality
from heart attack and sudden cardiac arrest
by up to 20 percent in the previous ...
The society for peripheral vascular nursing
(SPVN), founded in boston in 1982
Renamed the society for vascular nursing
(SV...
The Preventive Cardiovascular Nurses
Association (PCNA) was founded in the United
States in 1992 by a small group of nurse...
The American Nurses Credentialing Center (ANCC)
is the world's largest nurse credentialing
organization, and a subsidiary ...
Recent progress in biomedical engineering
and imaging technology is providing an ever-
increasing body of knowledge on the...
Improved treatment of CAD has resulted in
an increased survival rate
Increasing incidence of patients with severe
myocardi...
A discernable shift from diagnosing disease at a
late stage, after symptoms occur, to
asymptomatic diagnosis
An important ...
In percutaneous CAD treatment the trends
will be towards more accurate assessment of
coronary lesion dimensions, accurate
...
Non-invasive assessment of the cardiac
function in terms of perfusion, local
contraction, and myocardial apoptosis and
via...
Increased use of local myocardial treatment,
such as local delivery of angiogenetic agents
or stem cells
Growth in the use...
pacemaker implantation for bradycardias,
and endocardial mapping of re-entry circuits
and ectopic foci followed by ablatio...
X-ray imaging
X-ray imaging is still the most widely used
imaging technique
Computed Tomography (CT)
• 3D or even 4D data ...
Magnetic Resonance (MR) imaging
MR is the only technique capable of providing all major cardiac
diagnostic, anatomical and...
Ultrasound
Modern systems can provide real-time 3D images,
giving a valuable insight into the structure and
functioning of...
The radial vs. femoral artery approach
80 percent reduction in complication rates and an
accompanying increase in patient ...
Vascular repair trends
› Improved stents, which have evolved from polymer-
coated, metal drug-eluting stents to drug-eluti...
A robotically mediated, minimally invasive bypass of the left
anterior descending coronary artery is performed using the
l...
A percutaneous, rather than surgical approach to aortic
valve replacement and mitral valve repair.
These technologies are ...
An expeditious approach is mandatory in quickly
incorporating aggressive pharmacologic management
with judicious implantat...
Cardiovascular Nurses play a key role in the evaluation of
Cardiovascular Status, Monitoring the Hemodynamic
Functions and...
Randomised controlled trials have also demonstrated
the benefit of Nurse-run Clinics for secondary
prevention of Coronary ...
A study to observe secondary prevention practice in a
cardiovascular department in a sample of two hundred
and twenty pati...
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
History of cardiology
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History of cardiology

history of cardiology

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History of cardiology

  1. 1. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heartfailure, valvular heart disease and electrophysiology
  2. 2. Heart : its function was first defined by William Harvey, a British physician In his publication in 1628,De Motu Cordis, Harvey stated: “It has been shown by reason and experiment that by the beat of the ventricles blood flows through the lungs and it is pumped to the whole body. There it passes through pores in the flesh into the veins through which it returns from the periphery finally coming to the vena cava and right auricle. It must then be concluded that the blood in the animal body moves around in a circle continuously, and that the action or function of the heart is to accomplish this by pumping. This is the only reason for the motion and beat of the heart”
  3. 3. Einthoven, a professor of physiology in the small Dutch town of Leiden, first recorded a human electrocardiogram and gave birth to a new specialty Einthoven devised the first string galvanometer to record the electrical activity of the heart won a Nobel Prize in 1924 for his contributions to the field of electrocardiography Einthoven himself described various arrhythmias, including bigeminy, atrial flutter and fibrillation, and “P mitrale,” as well as left and right ventricular hypertrophy.
  4. 4. 19th-century: French physiologist Claude Bernard catheterized and measured pressures in the various cardiac chambers and great vessels of the animal heart first catheterization of the living human heart was performed by a young surgeon, Werner Forssman, (on himself!) in 1929 in Eberswald, Germany Forssman's goal was to find a safe way to inject drugs and contrast material into the right atrium for cardiac resuscitation
  5. 5. In 1941, Andre Cournand and Dickinson Richards at Columbia University and Bellevue Hospital in New York began the systematic exploration of normal and abnormal hemodynamics They recorded intracardiac pressures and cardiac output in normal subjects and in patients with many forms of congenital and acquired heart disease Forssman, Cournand, and Richards were also awarded the Nobel Prize.
  6. 6. Werner Forßmann Werner Forßmann Born 29 August 1904 Berlin Died 1 June 1979 (aged 74) Nationality Germany Fields Medicine Alma mater University of Berlin Known for Cardiac catheterization
  7. 7. First performed by mason sones at the cleveland clinic in 1958 Coronary arteriography, when combined with left ventriculography, led to the diagnosis and then the elucidation of the natural history of coronary artery disease
  8. 8. Modern cardiovascular surgery was first applied in 1938, by Robert Gross at Harvard and Boston's Children's Hospital successfully closed a patent ductus arteriosus In 1953, John Gibbon at Thomas Jefferson Hospital in Philadelphia performed the first open-heart operation using cardiopulmonary bypass .He successfully closed an atrial septal defect in an 18-year-old girl Gibbon’s design led to the construction of the heart-lung machine by IBM engineers.
  9. 9. Balloon angioplasty was followed by stenting with bare metal stents, which are now being replaced by drug- eluting stents. In addition to coronary stenosis, almost any abnormal obstruction in the heart and circulation can now be successfully opened, and many abnormal openings can be successfully closed using catheter-based techniques.
  10. 10. Before 1961:patients with acute myocardial infarction were treated largely with benign neglect In 1961:Desmond Julian, then a registrar in cardiology at the Royal Infirmary in Edinburgh, Scotland, articulated the concept of the coronary care unit This important development rested on four pillars: 1) continuous electrocardiographic monitoring with arrhythmia alarms; 2) cardiopulmonary resuscitation with external ventricular defibrillation; 3) the clustering of myocardial infarction patients in a discrete unit of the hospital where skilled personnel, drugs, and equipment were available; and 4) a change in policy that permitted, indeed mandated, trained nurses to initiate resuscitation.
  11. 11. In the 1960s:James Black developed beta-blockers In the 1970s: The first angiotensin-converting enzyme inhibitor, captopril, was isolated by Cushman and Ondetti, working at the Squibb (now Bristol Myers Squibb) laboratories Angiotensin-converting enzyme inhibitors have become cornerstones in the management of heart failure and hypertension
  12. 12. In 1976: The first HMG-CoA reductase inhibitor (statin) was isolated by Akira Endo of Sankyo Pharmaceuticals, and was built on the Nobel Prize-winning work on the low density lipoprotein cholesterol pathway by Brown and Goldstein
  13. 13. In 1944, Dr. Paul Dudley White at Harvard and the Massachusetts General Hospital, often referred to as the father of American cardiology, pioneered the concept of cardiovascular prevention In 1948 the National Heart Institute (now the National Heart, Lung, and Blood Institute) established the Framingham Heart Study, the first prospective population-based cohort study that focused on heart disease
  14. 14. Inge Edler, a Swedish cardiologist, and Helmuth Hertz, a Swedish physicist(1952): launched the field of echocardiography These investigators provided continuous recordings of the movements of the heart walls and of the normal and diseased mitral valve Noninvasive imaging represents an enormous advance both in the diagnosis of heart disease and in the care of cardiac patients.
  15. 15. 1842 – Johann Christian Doppler discovers the Doppler sound effects – begins the premise for sonographic imagery. 1881 – Jacques and Pierre (husband of Marie) Curie discover the principle of piezoelectricity – another stepping stone to creating the ultrasound. 1903 – Willem Einthoven records the first ECG waves, thus developing the very first electrocardiogram. This discovery heralds cardiology's status as a medical specialty. 1917 – Paul Langevin is the first to attempt to use the piezoelectric effect as sonar, to detect U-boats 1941 – Karl T. Dussikwasthe becomes the first to use an ultrasound machine, using it to examine the brain. 1950 – WD Keidel is the first to use an ultrasound to examine the heart. 1952 – JJ Wilde, JM Reid, D. Howry and W. Bliss develop the first two- dimensional ultrasound system, but didn't attempt to use it on the heart. 1953 – Physician Inge Edler and engineer C. Hellmuth Hertz borrow a shipyard sonar machine to conduct the first human echocardiogram.
  16. 16. 1956 – S. Satumora, Yoshida, Nimura are the first to apply the Doppler principle to the use of ultrasound to detect cardiac motion (but not blood flow). 1957 – Sputnik, JJ Wild, JM Reid identify a myocardial infarction in vitro using both M mode and 2D echo in the US, and publish their images in the American Heart Journal 1960 – Echocardiography becomes more widely accepted as a method of cardiovascular research. 1963 – Dr. Harvey Feigenbaum, hailed as the "Father of Echocardiography" takes an unused echoencephalography machine and uses it to record cardiac images, rather than its original intent, to record images of the brain. 1965 – Chuck Haine, a physician at Indiana University, becomes the first cardiac sonographer. 1971 – N. Born and Paul Hugenholtz introduce the first two-dimensional scanner to produce multi-dimensional echocardiography.
  17. 17. 1973 – Echocardiography is included as a searchable term in Index Medicus. 1975 – Feigenbaum founds the American Society of Echocardiography. 1978 – N Bom and J Roelandt introduce the first hand held echo machine. While not commercially produced for another twenty years, this invention moved echo out of the laboratory to the patient's bedside and out of the hands of cardiologists to all physicians 1984 – Dr Feigenbaum's laboratory at Indiana University becomes the first all-digital lab, with echos stored on floppy disks
  18. 18. In 1959, Elmquist and Senning at the university of zurich reported on the first successful use of an internal pacemaker In 1970, Michel Mirowski, an Israeli cardiologist with training in electrical engineering working at Sinai Hospital in Baltimore, invented the implanted cardioverter-defibrillator
  19. 19. A series of pacemakers from the 1960s to the 1990s (top left to bottom right) demonstrating the remarkable progress in the miniaturization of the pacemaker. Since 1960 the weight of the pacemaker has decreased from 170 to less than 20 grams.
  20. 20. cardiac stimulation leads considered the weak point in pacemaker systems, the Wireless Cardiac Stimulation system (WiCS) uses a leadless electrode to convert mechanical energy, wirelessly transmitted from an ultrasonic pulse generator, into electrical energy which is used to pace the heart as part of Cardiac Resynchronization Therapy (CRT).
  21. 21. Hybrid Long-term Temporary Pacing The lead was tunnelled subcutaneou sly for 6cm, and the proximal end was connected to a standard single chamber pulse generator. The procedure was well tolerated and over a period of four months there were no complication s or infection.
  22. 22. Contemporary cardiology is composed of multiple subspecialties Adult medical cardiology :Electro physiologists, subspecialists in extra cardiac vascular disease, hypertension, lipidology, care of patients with acute coronary syndromes, and heart failure, as well as in prevention and rehabilitation Pediatric cardiology cardiovascular surgery cardiovascular radiology
  23. 23. Leads to greater expertise Improves patient care, teaching, and research Skilled subspecialists can perform complicated procedures successfully and at relatively low risk
  24. 24.  Disease prevention  Costs of cardiac care costs of care are spiraling out of control
  25. 25. Continuing subspecialization in the pursuit of technical virtuosity and clinical excellence Preventive measures based on patient characteristics, such as phenotypes, will expand Heart failure is the last great battleground in cardiology  The near-term future of therapy for advanced heart failure. • Art. Ht. = artificial heart • BMSC = bone marrow stem cells • ICD = implantable cardioverter-defibrillator • LVAD = left ventricular assist device • Cardiac xenotransplantation
  26. 26. gene-informed therapy: genetic identification of the future development of risk factors will lead to gene- informed personalized prevention Eg:Alpha-adducin-leads to excessive sodium re- absorption by distal renal tubule cells-prophylactically with a salt-restricted diet or even a diuretic, leading to gene-informed prevention. The presence of specific variants of the genes for connexin 37 (resulting in changes in endothelial gap junctions) in men and in the genes for plasminogen activator inhibitor-1 (altered inhibition of fibrinolysis) and stromelysin-1 (associated with altered matrix metabolism) in women are associated with increased risk of myocardial infarction
  27. 27. Intervention versus prevention Greater focus on prevention, using progressively greater refinements of markers of inflammation and of plaque instability
  28. 28. In1711:developmentof cardiac catheterization Stephen Hales placed catheters into the right and left ventricles of a living horse in 1840s: formal study of cardiac physiology being performed by Claude Bernard
  29. 29. In 1927: The technique of angiography itself was first developed by the Portuguese physician Egas Moniz at the University of Lisbon for cerebral angiography In 1929: Coronary catheterization was first performed by Werner Forssmann, created an incision in one of his left antecubital veins and inserted a catheter into his venous system He then guided the catheter by fluoroscopy into his right atrium
  30. 30. In 1958 Dr. Charles Dotter began working on methods to visualize the coronary anatomy via sequential radiographic films. He invented a method known as occlusive aortography in an animal model Occlusive aortography - the transient occlusion of the aorta and subsequent injection of a small amount of radiographic contrast agent into the aortic root and subsequent serial x-rays to visualize the coronary arteries
  31. 31. Mason Sones, a pediatric cardiologist at the Cleveland Clinic: while performing an aortic root aortography, , noted that the catheter had accidentally entered the patient's right coronary artery. Before the catheter could be removed 30cc of contrast agent had been injected. While the patient went into ventricular fibrillation, the dangerous arrhythmia was terminated by Dr. Sones promptly performing a precordial thump which restored sinus rhythm
  32. 32. Until the 1950s: placing a catheter into either the arterial or venous system involved a "cut down" procedure, in which the soft tissues were dissected out of the way until the artery or vein was directly visualized and subsequently punctured by a catheter; this was known as the Sones technique.
  33. 33. In 1953 :The percutaneous approach that is widely used today was developed by radiologist Sven-Ivar Seldinger . This method was used initially for the visualization of the peripheral arteries. Percutaneous access of the artery or vein is still commonly known as the Seldinger technique
  34. 34. By the late 1960s: Melvin Judkins had begun work on creating catheters that were specially shaped to reach the coronary arteries to perform selective coronary angiography His work was documented in 1967, and by 1968 the Judkins catheters were manufactured in a limited number of fixed tip shapes. Catheters in these shapes carry his name and are still used to this day for selective coronary angiography
  35. 35. The use of a balloon-tipped catheter for the treatment of atherosclerotic vascular disease was first described in 1964 by two interventional radiologists, Charles Dotter and Melvin Judkins to treat a case of atherosclerotic disease in the superficial femoral artery of the left leg
  36. 36. Andreas Gruentzig performed the first successful PTCA or percutaneous coronary intervention (PCI)) on a human on September 16, 1977 at University Hospital, Zurich By the mid 1980s, over 300,000 PTCAs were being performed on a yearly basis, equalling the number of bypass surgeries being performed for coronary artery disease.
  37. 37. In 1986: first intracoronary stents were successfully deployed in coronary arteries The first stents used were self-expanding Wallstents Restenosis rates were significantly lower in individuals who received an intracoronary stent when compared to those who underwent just balloon angioplasty
  38. 38. In 1989: the Palmaz-Schatz balloon- expandable intracoronary stent was developed By 1999 nearly 85% of all PCI procedures included intracoronary stenting
  39. 39. Four early endovascular stents. Ruygrok P N , and Serruys P W Circulation 1996;94:882- 890 Copyright © American Heart Association • The upper left panels show Dotter's early nitinol coil wire stent •The zig zag expanding stainless steel stent described by Wright et alshown in the upper right panels in both its sheathed and unsheathed forms. • The lower left panel shows the stents developed by Maass et al. • The lower right panel shows the balloon expandable stainless steel Palmaz stent.
  40. 40. Seven coronary stents, clockwise from bottom left: Wallstent, Palmaz-Schatz stent, Wiktor stent, Gianturco-Roubin stent, Cordis stent, AVE stent, and multilink stent. Ruygrok P N , and Serruys P W Circulation 1996;94:882- 890 Copyright © American Heart Association Seven coronary stents, clockwise from bottom left: Wallstent Palmaz-Schatz stent Wiktor stent Gianturco-Roubin stent Cordis stent AVE stent multilink stent
  41. 41. Stent manufacturers experimented with a number of chemical agents to prevent the neointimal hyperplasia that is the cause of in- stent restenosis. One of the first products of the new focus on preventing stent restenosis and late thrombosis was the heparin coated Palmaz-Schatz stent At approximately the same time, Cordis was developing the Cypher stent, a stent that would release sirolimus (a chemotherapeutic agent) over time
  42. 42. FDA approved the use of the Cypher stent as the first drug-eluting stent for use in the general population in the United States Concurrent with the development of the Cypher stent, Boston Scientific started development of the Taxus stent The Taxus stent was the Express2 metal stent, which was in general use for a number of years, with a copolymer coating of paclitaxel that inhibited cell replication
  43. 43. Taxus stent was approved for use in Europe in 2003 With further study, the FDA approved the use of the Taxus stent in the United States in March 2004. By the end of 2004, drug eluting stents were used in nearly 80 percent of all percutaneous coronary interventions
  44. 44. Dr. B. Soma Raju and his team have performed the first PTCA (Percutaneous Transluminal Coronory Angioplasty) in India on 1985 He has been involved in various research projects during the last 20 years individually Development of India’s first Coronary Stent, which has been named the Kalam Raju Stent after Professor A.P.J Kalam and Dr. Raju This stent was first implanted in December 1996
  45. 45. The development of the stent resulted in reducing the cost of stents in the country and brought it within the reach of the people In October 1998 the second research product of Dr. Raju’s endeavor, India’s first Coronary Balloon Catheter was released
  46. 46. Medical College Trivandrum ACHIEVEMENTS First government hospital in kerala done coronary angioplasty in 1998. First government hospital in kerala done ICD Inplantation First government hospital in kerala done by ventrical pacing for heart failure. First government hospital in kerala to have a round the clock angioplasty program
  47. 47. Medical College Trivandrum Department of Cardiology started functioning in 1972. It started with 4 bed Intensive care unit. The first Colour Doppler Echo in the state was started in the department in 1992. The cardiac catheterisation Laboratory (cath lab) was started in 1997. A second cathlab under the PMSSY Scheme was started in 2010. Electrophysiology station was established in 2009
  48. 48. In the 19th century: The earliest operations on the pericardium took place and were performed by Francisco Romero, Dominique Jean Larrey, Henry Dalton and Daniel Hale Williams 4 September 1895: The first surgery on the heart was performed by Norwegian surgeon Axel Cappelen in Kristiania, now Oslo He ligated a bleeding coronary artery in a 24 year old man stabbed in the left axillae and was in deep shock upon arrival. Access was through a left thoracotomy. The patient awoke and seemed fine for 24 hours, he died from mediastinitis on the third postoperative day
  49. 49. September 7, 1896: The first successful surgery of the heart, performed without any complications, was by Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle
  50. 50. In 1925: Henry Souttar operated successfully on a young woman with mitral stenosis He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar’s physician colleagues at that time decided the procedure was not justified and he could not continue.
  51. 51. In 1948: four surgeons carried out successful operations for mitral stenosis resulting from rheumatic fever In 1947 thomas holmes sellors (1902–1987) of the middlesex hospital operated on a fallot’s tetralogy patient with pulmonary stenosis and successfully divided the stenosed pulmonary valve In 1948, russell brock, used a specially designed dilator in three cases of pulmonary stenosis
  52. 52. September 2, 1952: The first successful intracardiac correction of a congenital heart defect using hypothermia was performed by Dr. C. Walton Lillehei and Dr. F. John Lewis at the University of Minnesota Dr. John Heysham Gibbon at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an oxygenator
  53. 53. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age 3½, using the total intentional hemodilution machine
  54. 54. Norman shumway the father of heart transplantation world's first adult human heart transplant was performed by christiaan barnard in south africa utilizing the techniques developed and perfected by shumway and richard lower. Barnard performed the first transplant on louis washkansky on december 3, 1967 at the groote schuur hospital in cape town south africa. Adrian kantrowitz performed the first pediatric heart transplant in the world on december 6, 1967 at maimonides hospital in brooklyn, new york Norman shumway performed the first adult heart transplant in the united states on january 6, 1968 at the stanford university hospital.
  55. 55. Since the 1990s, surgeons have begun to perform "off-pump bypass surgery In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area in which to connect the conduit vessel that bypasses the blockage
  56. 56. Robot-assisted heart surgery: Machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the surgeon to put his hands inside, it does not have to be bigger than 3 small holes for the robot's much smaller hands to get through.
  57. 57. Russell M. Nelson performed the first successful pediatric cardiac operation at the Salt Lake General Hospital in March 1956, a total repair of tetralogy of Fallot in a four-year-old girl
  58. 58. Dr K M Cherian: performed the first coronary artery bypass surgery in India in 1975. He also performed the country's second heart transplant, first infant cardiac surgery and the first heart and lung transplant (1999) Cherian has performed more than 27,000 operations. the first Auto transplant; He is the first Indian member of the American Association for Thoracic Surgery, as well as a Fellow of the Royal Society of Medicine, London, and an honorary member of the Malaysian Association for Thoracic and Cardiovascular Surgery
  59. 59. Padmashri Dr. Jose Chacko Periappuram performed the first successful human-to- human heart transplant He was the first heart surgeon to commence a beating heart surgical program in kerala He is also the first surgeon in kerala to perform bypass surgery using arterial grafts Awake bypass :patients who due to lung diseases could not have their surgeries done were helped by a very novel technique called awake bypass surgery
  60. 60. Cardiac nursing is a nursing specialty that works with patients who suffer from various conditions of the cardiovascular system. Cardiac nurses help treat conditions unstable angina,cardiomyopathy, coronary artery disease, congestive heart failure myocardial infarction and cardiac dysrhythmia under the direction of a cardiologist
  61. 61. Cardiac nurses work in many different environments, including coronary care units (CCU), cardia catheterization, inte nsive care units (ICU), operating theatres, cardiac rehabilitation centers,clinical research, cardiac surgery wards, cardiovascular intensive care units (CVICU), and cardiac medical wards
  62. 62. Cardiac nursing has become a specialty in the past 50 years Cardiac nursing continues to grow as more understanding is gained of heart disease and how to prolong life.
  63. 63. The first CCU was founded at the royal infirmary in scotland, by dr. Desmond G. Julian to deal with heart attack, sudden cardiac arrest and heart arrhythmias He recommended all staff, including nurses, be trained in CPR in order to treat patients with suspected heart attack as rapidly as possible Other cardiac care units were founded shortly thereafter AND the need for skilled cardiac nurses increses rapidly
  64. 64. Coronary care units had reduced mortality from heart attack and sudden cardiac arrest by up to 20 percent in the previous decade CCU and departments continued to be added to larger hospitals, driving the need for more trained cardiac nurses skilled in CPR, cardiac monitoring and the administration of cardiac medicines.
  65. 65. The society for peripheral vascular nursing (SPVN), founded in boston in 1982 Renamed the society for vascular nursing (SVN) in 1990, helped highlight cardiac nursing as an established nursing specialty. American association of cardiovascular and pulmonary rehabilitation was founded in 1985:. Provides education and training for cardiac nurses and other heart care professionals, as well as certification for cardiac rehabilitation facilities.
  66. 66. The Preventive Cardiovascular Nurses Association (PCNA) was founded in the United States in 1992 by a small group of nurses in California As membership expanded, the organization began to encompass evidence-based study of a wider array of cardiovascular disorders and pass this information along to its members.
  67. 67. The American Nurses Credentialing Center (ANCC) is the world's largest nurse credentialing organization, and a subsidiary of the American Nurses Association (ANA) The first Cardiac and Vascular Nurse examinations were administered by the PCNA in May 2001 in conjunction with the ANCC. The PCNA continues to offer the certification exams as well as continuing education courses online and live seminars and training events. In addition to the ANCC Cardiac/Vascular Nurse Certification, the PCNA supports the Accreditation Council for Clinical Lipidology (ACCL) certification examination. Cardiac nursing continues to grow as nursing becomes more specialized
  68. 68. Recent progress in biomedical engineering and imaging technology is providing an ever- increasing body of knowledge on the origins and onset of cardiac disease, with new options for its detection and treatment
  69. 69. Improved treatment of CAD has resulted in an increased survival rate Increasing incidence of patients with severe myocardial scars caused by previous infarction Increase in the number of patients suffering from congestive heart failure (CHF), who will form an increasingly important group A third group of patients that is expected to become increasingly important is that of patients with cardiac arrythmias
  70. 70. A discernable shift from diagnosing disease at a late stage, after symptoms occur, to asymptomatic diagnosis An important recent development is the realization that the vast majority of heart attacks are not due to progressive atherosclerosis, but to sudden rupture of non-occlusive, vulnerable plaque Replacement of open-chest surgical procedures by less invasive percutaneous approaches such as percutaneous transluminal interventions and minimally invasive surgery (MIS) or even endoscopic surgery, will continue.
  71. 71. In percutaneous CAD treatment the trends will be towards more accurate assessment of coronary lesion dimensions, accurate assessment of plaque morphology and pathology, and more accurate guiding of the intervention device Drug-eluting stents
  72. 72. Non-invasive assessment of the cardiac function in terms of perfusion, local contraction, and myocardial apoptosis and viability will become more and more important An increased use of bi-ventricular pacing for improving cardiac function and implantation of cardioverter defibrillators (ICD) for the reduction of related sudden cardiac death
  73. 73. Increased use of local myocardial treatment, such as local delivery of angiogenetic agents or stem cells Growth in the use of personal monitoring devices such as automatic ecg recorders for long-term disease progress monitoring
  74. 74. pacemaker implantation for bradycardias, and endocardial mapping of re-entry circuits and ectopic foci followed by ablation Percutaneous ablation of areas around the pulmonary veins in the left atrium is an effective procedure for the treatment of atrial fibrillation in the majority of patients Bi-ventricular pacing and implanted defibrillators -CHF and ischemic ventricular tachycardia
  75. 75. X-ray imaging X-ray imaging is still the most widely used imaging technique Computed Tomography (CT) • 3D or even 4D data sets provide three dimensional insights into the anatomy • CT is a promising candidate for replacing invasive diagnostic coronary angiography by a non-invasive procedure.
  76. 76. Magnetic Resonance (MR) imaging MR is the only technique capable of providing all major cardiac diagnostic, anatomical and functional information, and is therefore an attractive option for a ‘one-stop shop’ solution Nuclear medicine imaging • The radioactive substance can be used to label a molecular imaging agent that will bind to a particular biological molecule, such as phosphatidyl serine which is released by dying cells. • In cases of acute myocardial infarction, the resulting images will show the location and extent of cell death • The use of a molecular imaging agent to bind to macrophages in the fibrous cap of vulnerable plaque, which would provide a valuable early warning system
  77. 77. Ultrasound Modern systems can provide real-time 3D images, giving a valuable insight into the structure and functioning of organs such as the heart The image data also serves as a basis for quantitative analysis, such as the wall-motion analysis and the quantification of left and right ventricular volumes, pericardial effusion, intracardiac masses, defects and endocardial surfaces. Examination of vessel wall motion abnormalities can provide early indication of plaque deposition
  78. 78. The radial vs. femoral artery approach 80 percent reduction in complication rates and an accompanying increase in patient satisfaction Structural repair trends  A minimally invasive percutaneous approach to repair structural defects and move away from open surgical procedures.  The percutaneous aortic valve, which is on the market for treatment of aortic stenosis and aortic insufficiency.  The mitral valve clip placement is being use for treatment of mitral regurgitation
  79. 79. Vascular repair trends › Improved stents, which have evolved from polymer- coated, metal drug-eluting stents to drug-eluting bioabsorbable stents, potentially reducing restenosis. › Expansion of vascular services to improve not only heart health but also extremity health, which greatly benefits patients overall. › Perhaps some of the most exciting research is being studied in clinical trials on drug-eluting balloons, drug-eluting stents for the periphery, and using different forms of atherectomy in combination with other forms of therapy.
  80. 80. A robotically mediated, minimally invasive bypass of the left anterior descending coronary artery is performed using the left internal mammary artery This is performed without a median sternotomy and without cardiopulmonary bypass Shortly thereafter, the patient undergoes stenting of either the right or circumflex coronary arteries Within the very near future, the entire procedure will be able to be carried out in one session- incorporating the full surgical capabilities of an operating room and the full imaging and interventional capabilities of the cath lab
  81. 81. A percutaneous, rather than surgical approach to aortic valve replacement and mitral valve repair. These technologies are currently undergoing clinical trials and if successful, should be available clinically in the next 3-5 years.
  82. 82. An expeditious approach is mandatory in quickly incorporating aggressive pharmacologic management with judicious implantation of heart assist devices to address these critically ill patients and impact their high mortality rates
  83. 83. Cardiovascular Nurses play a key role in the evaluation of Cardiovascular Status, Monitoring the Hemodynamic Functions and Disease Management. Nursing interventions have been shown to reduce patient stress. Recent research findings suggest that morbidity and mortality in cardiac patients can be improved with a comprehensive treatment plan which has a Nurse Managed Stress Reduction Plan
  84. 84. Randomised controlled trials have also demonstrated the benefit of Nurse-run Clinics for secondary prevention of Coronary Heart Disease (Riley, 2003) Nurse-Provided or Nurse-Coordinated Care Management programs using an integrated or multifactor approach have been shown to be highly effective in reducing morbidity and mortality of high-risk patients (Haskell, 2003) Cardiovascular Nurses play a very important role at different levels, ie the technical level, where the nurses carry out diagnostic examinations and risk assessments; psychological level where the nurse informs, acts as a health counsellor and helps in the patient self care process (Riccio et.al, 2004)
  85. 85. A study to observe secondary prevention practice in a cardiovascular department in a sample of two hundred and twenty patients discharged from the Intensive Coronary Care Unit, Cardiac Surgery Unit and Vascular Surgery Unit has shown that nurses play a vital role in the implementation of guidelines, risk assessment, drug treatment and effective patient education (Steffenino et.al, 2003)

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history of cardiology

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