peripheral arterial disease. it is the most important risk factor for cardiovascular morbidity and mortality, in industrialized countries. congenital heart defects main article: congenital heart defect a congenital heart defect, also known as a "congenital heart anomaly" or "congenital heart disease", is a problem in the structure of the heart that is present at birth. signs and symptoms depend on the specific type of problem. symptoms can vary from none to life-threatening. when present they may include rapid breathing, bluish skin, poor weight gain, and feeling tired. it does not cause chest pain. most congenital heart problems do not occur with other diseases. complications that can result from heart defects include heart failure. the cause of a congenital heart defect is often unknown. certain cases may be due to infections during pregnancy such as rubella, use of certain medications or drugs such as alcohol or tobacco, parents being closely related, or poor nutritional status or obesity in the mother. having a parent with a congenital heart defect is also a risk factor. a number of genetic conditions are associated with heart defects including down syndrome, turner syndrome, and marfan syndrome. congenital heart defects are divided into two main groups: cyanotic heart defects and non-cyanotic heart defects, depending on whether the child has the potential to turn bluish in color. the problems may involve the interior walls of the heart, the heart valves, or the large blood vessels that lead to and from the heart. congenital heart defects are partly preventable through rubella vaccination, the adding of iodine to salt, and the adding of folic acid to certain food products. some defects do not need treatment. other may be effectively treated with catheter based procedures or heart surgery. occasionally a number of operations may be needed. occasionally heart transplantation is required. with appropriate treatment outcomes, even with complex problems, are generally good. heart defects are the most common birth defect. in 2013 they were present in 34.3 million people globally. they affect between 4 and 75 per 1,000 live births depending upon how they are diagnosed. about 6 to 19 per 1,000 cause a moderate to severe degree of problems. congenital heart defects are the leading cause of birth defect-related deaths. in 2013 they resulted in 323,000 deaths down from 366,000 deaths in 1990. tetralogy of fallot tetralogy of fallot is the most common congenital heart disease arising in 1–3 cases per 1,000 births. the cause of this defect is a ventricular septal defect (vsd) and an overriding aorta. these two defects combined causes deoxygenated blood to bypass the lungs and going right back into the circulatory system. the modified blalock-taussig shunt is usually used to fix the circulation. this procedure is done by placing a graft between the subclavian artery and the ipsilateral pulmonary artery to restore the correct blood flow. pulmonary atresia pulmonary atresia happens in 7–8 per 100,000 births and is characterized by the aorta branching out of the right ventricle. this causes the deoxygenated blood to bypass the lungs and enter the circulatory system. surgeries can fix this by redirecting the aorta and fixing the right ventricle and pulmonary artery connection. there are two types of pulmonary atresia, classified by whether or not the baby also has a ventricular septal defect. pulmonary atresia with an intact ventricular septum: this type of pulmonary atresia is associated with complete and intact septum between the ventricles. pulmonary atresia with a ventricular septal defect: this type of pulmonary atresia happens when a ventricular septal defect allows blood to flow into and out of the right ventricle. double outlet right ventricle double outlet right ventricle (dorv) is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. there is usually a vsd in different particular places depending on the variations of dorv, typically 50% are subaortic and 30%. the surgeries that can be done to fix this defect can vary due to the different physiology and blood flow in the defected heart. one way it can be cured is by a vsd closure and placing conduits to restart the blood flow between the left ventricle and the aorta and between the right ventricle and the pulmonary artery. another way is systemic-to-pulmonary artery shunt in cases associated with pulmonary stenosis. also, a balloon atrial septostomy can be done to relieve hypoxemia caused by dorv with the taussig-bing anomaly while surgical correction is awaited. transposition of great arteries dextro-transposition of the great arteries there are two different types of transposition of the great arteries, dextro-transposition of the great arteries and levo-transposition of the great arteries, depending on where the chambers and vessels connect. dextro-transposition happens in about 1 in 4,000 newborns and is when the right ventricle pumps blood into the aorta and deoxygenated blood enters the bloodstream. the temporary procedure is to create an atrial septal defect. a permanent fix is more complicated and involves redirecting the pulmonary return to the right atrium and the systemic return to the left atrium, which is known as the senning procedure. the rastelli procedure can also be done by rerouting the left ventricular outflow, dividing the pulmonary trunk, and placing a conduit in between the right ventricle and pulmonary trunk. levo-transposition happens in about 1 in 13,000 newborns and is characterized by the left ventricle pumping blood into the lungs and the right ventricle pumping the blood into the aorta. this may not produce problems at the beginning, but will eventually due to the different pressures each ventricle uses to pump blood. switching the left ventricle to be the systemic ventricle and the right ventricle to pump blood into the pulmonary artery can repair levo-transposition. persistent truncus arteriosus persistent truncus arteriosus is when the truncus arteriosus fails to split into the aorta and pulmonary trunk. this occurs in about 1 in 11,000 live births and allows both oxygenated and deoxygenated blood into the body. the repair consists of a vsd closure and the rastelli procedure. ebstein anomaly ebstein's anomaly is characterized by a right atrium that is significantly enlarged and a heart that is shaped like a box. this is very rare and happens in less than 1% of congenital heart disease cases. the surgical repair varies depending on the severity of the disease. pediatric cardiology is a sub-specialty of pediatrics. to become a pediatric cardiologist in the u.s., one must complete a three-year residency in pediatrics, followed by a three-year fellowship in pediatric cardiology. per doximity, pediatric cardiologists make an average of $303,917 in the u.s. diagnostic tests in cardiology main article: diagnostic tests in cardiology diagnostic tests in cardiology are the methods of identifying heart conditions associated with healthy vs. unhealthy, pathologic heart function. the starting point is obtaining a medical history, followed by auscultation. then blood tests, electrophysiological procedures, and cardiac imaging can be ordered for further analysis. electrophysiological procedures include electrocardiogram, cardiac monitoring, cardiac stress testing, and the electrophysiology study. trials cardiology is known for randomized controlled trials that guide clinical treatment of cardiac diseases. while dozens are published every year, there are landmark trials that shift treatment significantly. trials often have an acronym of the trial name, and this acronym is used to reference the trial and its results. some of these landmark trials include: v-heft (1986) — use of vasodilators (hydralazine & isosorbide dinitrate) in heart failure isis-2 (1988) — use of aspirin in myocardial infarction case i (1991) — use of antiarrhythmic agents after a heart attack increases mortality solvd (1991) — use of ace inhibitors in heart failure 4s (1994) — statins reduce risk of heart disease cure (1991) — use of dual antiplatelet therapy in nstemi miracle (2002) — use of cardiac resynchronization therapy in heart failure scd-heft (2005) — the use of implantable cardioverter-defibrillator in heart failure rely (2009), rocket-af (2011), aristotle (2011) — use of doacs in atrial fibrillation instead of warfarin ischemia (2020) — medical therapy is as good as coronary stents in stable heart disease cardiology community associations american college of cardiology american heart association european society of cardiology heart rhythm society canadian cardiovascular society indian heart association national heart foundation of australia cardiology society of india journals acta cardiologica american journal of cardiology annals of cardiac anaesthesia current research: cardiology cardiology in review circulation circulation research clinical and experimental hypertension clinical cardiology ep – europace european heart journal heart heart rhythm international journal of cardiology journal of the american college of cardiology pacing and clinical electrophysiology indian heart journal cardiologists cardiologistoccupationnamesdoctor, medical specialistoccupation typespecialtyactivity sectorsmedicinedescriptioneducation required doctor of medicine (m.d.) doctor of osteopathic medicine (d.o.) bachelor of medicine, bachelor of surgery (m.b.b.s.) fields ofemploymenthospitals, clinics robert atkins (1930–2003), known for the atkins diet eugene braunwald (born 1929), editor of braunwald's heart disease and 1000+ publications wallace brigden (1916–2008), identified cardiomyopathy manoj durairaj (1971– ), cardiologist from pune, india who received pro ecclesia et pontifice willem einthoven (1860–1927), a physiologist who built the first practical ecg and won the 1924 nobel prize in physiology or medicine ("for the discovery of the mechanism of the electrocardiogram") werner forssmann (1904–1979), who infamously performed the first human catheterization on himself that led to him being let go from berliner charité hospital, quitting cardiology as a speciality, and then winning the 1956 nobel prize in physiology or medicine ("for their discoveries concerning heart catheterization and pathological changes in the circulatory system") andreas gruentzig (1939–1985), first developed balloon angioplasty william harvey (1578–1657), wrote exercitatio anatomica de motu cordis et sanguinis in animalibus that first described the closed circulatory system and whom forssmann described as founding cardiology in his nobel lecture murray s. hoffman (born 1924) as president of the colorado heart association, he initiated one of the first jogging programs promoting cardiac health max holzmann (1899–1994), co-founder of the swiss society of cardiology, president from 1952 to 1955 samuel a. levine (1891–1966), recognized the sign known as levine's sign as well as the current grading of the intensity of heart murmurs, known as the levine scale henry joseph llewellyn "barney" marriott (1917–2007), ecg interpretation and practical electrocardiography bernard lown (born 1921), original developer of the defibrillator woldemar mobitz (1889–1951), described and classified the two types of second-degree atrioventricular block often called "mobitz type i" and "mobitz type ii" jacqueline noonan (born 1928), discoverer of noonan syndrome that is the top syndromic cause of congenital heart disease john parkinson (1885–1976), known for wolff–parkinson–white syndrome helen b. taussig (1898–1986), founder of pediatric cardiology and extensively worked on blue baby syndrome paul dudley white (1886–1973), known for wolff–parkinson–white syndrome fredrick arthur willius (1888-1872), founder of the cardiology department at the mayo clinic and an early pioneer of electrocardiography louis wolff (1898–1972), known for wolff–parkinson–white syndrome karel frederik wenckebach (1864–1940), first described what is now called type i second-degree atrioventricular block in 1898