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IM Subspecialities:

    Allergy and Immunology

    Cardiology

    Endocrinology

    Gastroenterology

    Geriatrics

    Hematology

    Oncology

    Infectious Diseases

    Nephrology

    Respirology

    Rheumatology

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Cardiology

Introduction

Cardiology is an internal medicine specialty primarily focused on the investigation, diagnosis, treatment and long-term management of patients with diseases impacting the heart including congenital defects (although these are primarily dealt with earlier in life by pediatric cardiologists), coronary artery disease, valvular diseases and heart failure. Cardiology training through internal medicine is synonymous with adult cardiology and training for pediatric cardiology requires a route of training through pediatrics as first entry.

Cardiologists are trained to act as effective consultants and experts in the clinical, scientific and socio-behavioural factors relevant to the field of cardiology. They must be able to perform complete history and physical assessments of cardiac patients integrating all available information and investigations in the thorough analysis and management of patients. Cardiologists implement strategies aimed at preventing cardiovascular disease in the patients they manage in order to minimize the need for therapeutic interventions. They must also act as effective collaborators with other health professionals in the long term care and follow-up of patients and their families. Common proficiencies expected of cardiologists are the use of clinical electrophysiology (ECGs, exercise testing and ambulatory monitors), cardiac catheterization, cardioversion and defibrillation, periocardiocentesis and echocardiography. Cardiologists also have important roles in the interpretation and application of implanted devices, nuclear cardiology imaging, angiography, chest X-rays, MRI, CT and other imaging modalities relevant in cardiac patient assessment.

In order to properly management the diseases listed below, cardiologists must have appropriate knowledge of coronary anatomy and physiology. They must understand normal valve structure and function in order to tease out signs of pathology and indications for interventions such as surgery and prosthesis. Expertise in the hemodynamic functions of the heart including normal and pathological systolic and diastolic function is also necessary.

Common Disease and Disorders

Coronary Artery Disease
Umbrella term for a number of diseases that include stable or unstable angina, myocardial infarction and sudden coronary death. CAD is the most common cardiovascular disease encountered in internal medicine. Cardiologists play an important role in identifying early signs of coronary artery disease and implementing strategies for prevention such as life style changes and routine follow-up monitoring. Myocardial infarctions, also known as a heart attack, occurs with ischemic damage to heart muscle and can lead to heart failure or cardiac arrest. Cardiologists have an important role in the diagnosis and treatment of MIs.

Valvular Heart Disease
Disease processes impacting the valves of the heart. These include problems of stenotic or regurgatant/insufficient valves. Cardiologists know the particular features of each valve disease and how to identify them inside and out. They also integrate available investigations, historical and physical data in their evaluation of best treatment plans and outcomes such as repairs or replacements which may also involve cardiac surgery professionals.

Congestive Heart Failure and Cardiomyopathy
The heart can no longer sufficiently maintain blood flow to meet the demands of the body. Heart failure may be caused by CAD, valvular diseases, previous myocardial infarctions, high blood pressure and cardiomyopathies. Cardiologists recognize the signs and symptoms of patients with CHF, implement investigations and management strategies and slowing its progression and prolonging quality and quantity of life.

Hypertension
Blood pressure elevations beyond the normal range, also known as high blood pressure. It presents as a chronic condition impacting systolic, diastolic function or both. While often asymptomatic, it can lead to heart disease, coronary artery disease, strokes, aneurisms, peripheral artery disease and kidney disease. It is therefore imperative that hypertensive patients are carefully monitored and managed with an emphasis on dietary and lifestyle changes as well as certain medications. Cardiologists often manage a large cohort of patients with hypertension, finding solutions on a case by case basis and integrating available resources in a multi-disciplinary team to find the most benefit for their patients.

Pericardial Diseases
These include pericarditis (inflammation of the pericardium – the membrane around the heart), pericardial effusion (an abnormal accumulation of fluid around the heart) and cardiac tamponade (compression of the heart by fluid in the pericardial sac). Pericardial diseases can be serious and life threatening and may often be a manifestation of an underlying disease requiring thorough investigation.

Further Advanced Training Opportunities

Once the core internal medicine and subsequent general cardiology residency/fellowship is completed, practicing physicians may choose to pursue advanced training opportunities throughout the country and abroad. These include fellowships in preventative cardiology, heart function and transplant, adult congenital heart disease, advanced echocardiography, electrophysiology, and interventional cardiology. Further training may afford the opportunity to practice in more specialized settings in academic and tertiary centers requiring advanced expertise in particular areas of cardiology.

Gender Breakdown
91 responses (2014 National Survey Results)

Age Breakdown
91 responses (2014 National Survey Results)
Hours Breakdown
87 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 24.11
Direct patient care with a teaching component 10.42
Teaching/ educating without direct patient care 2.91
Indirect patient care 7.45
Health facility committees 1.40
Administration 3.38
Research 3.84
Managing your practice 1.54
CME/ CPD (Continuing Professional Development) 2.90
Other actvities .73
Total Hours 58.69


Cardiology Residency Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

Queen’s University
Kingston, Ontario

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

University of Saskatchewan
Saskatoon, Saskatchewan

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Université Laval
Laval, Québec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Page Author(s): John Haddad (2017)
© 2017 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry