What does an interventional cardiologist do?

An interventional cardiologist is a cardiologist who specialises in doing invasive procedures of the heart, Dr Chiam says. “That means that for most of us the bread and butter therapies would be coronary angioplasty, which is ballooning and stenting of the heart arteries, simply because ischemic heart disease, which is the narrowing of the heart arteries, is the commonest thing that a cardiologist would see.”

More than that, at least for some interventional cardiologists, there are other things we’ve been trained to do, Dr Chiam says. One, for example is in heart valve disease, this kind of specialised therapy is only performed by some interventional cardiologists, like ballooning of the mitral valve and replacement of the aortic valve via the groin or what we call a transcatheter aortic valve replacement.

Apart from that, we see patients with vascular disease everywhere, which means that their artery blockages are not just confined to the heart but are also seen in the lower limbs or perhaps even arteries in the neck. Some of us are trained to perform balloons and stents in these locations.

For example, some patients come in complaining of severe calf pain when they walk, so what happens is that the arteries in the leg are blocked and they do not get enough blood supply when they walk so those muscles start to hurt. We can help them by opening up the arteries in the leg and putting stents in.

The other group of patients that we see is patients with gangrene or non-healing wounds to the foot. Again this is due to a problem with poor blood supply, especially in diabetics. What we can do is perform a balloon angioplasty, or ballooning of these arteries, to improve blood supply and help healing of the foot.

The other group that we sometimes see, although much less common, is patients with very refractory high blood pressure or who suddenly develop heart failure. Some of these patients have a condition called renal artery stenosis, meaning they have very severe narrowing in the arteries supplying the kidneys. In a small proportion of these patients, we can perform an angioplasty and stenting of these kidney arteries to enlarge them and reduce, or at least partially resolve, the problem of refractory high blood pressure and sudden heart failure.

The other therapy we perform is what we call carotid stenting. The carotid artery is a big artery in the neck that supplies the brain, and sometimes when this artery becomes narrowed and diseased, it may cause a stroke because the cholesterol debris goes directly up into the brain. For some of these patients, angioplasty and stenting of this artery may be required, or the other alternative is surgery to remove the plug. If the patient is not suitable for surgery, or if they refuse surgery, then this is something that an interventionist cardiologist can do to stent the artery to try to reduce the incidence of further stroke in the future.

Dr Paul T.L. Chiam is a consultant cardiologist with a subspecialty interest in interventional cardiology. He is in private practice at The Heart and Vascular Centre at Mount Elizabeth Medical Centre in Singapore and can be reached at +65 6735 3022.