What types of heart specialist are there, and what should you know?

Cardiologist or cardiac surgeon? The training paths are different, the roles are different, and knowing which is which changes the conversation you have with each.

Do you find it difficult to understand the difference between a cardiologist and a cardiac or cardiovascular surgeon? Do they seem like synonyms, adding to your confusion?

Don't worry. It took me nearly two decades to train as a cardiac surgeon and even so, my own mother still calls me a cardiologist sometimes.

These two professionals usually work as a team, but you will very probably meet both, and their role in your treatment is completely different.

Why the difference matters

If you or a relative are going through a complex situation involving the heart, these two specialists will become close and trusted people for you and your family. Knowing the different specialists will help you understand the kind of conversation you will have with each.

You will also understand why only a small percentage of doctors perform certain procedures — as is the case with the cardiac surgeon who carries out minimally invasive procedures. Only 7–8% of cardiac surgeons perform minimally invasive surgery.

The cardiologist

A cardiologist studies medicine to become a general doctor — usually 6 to 7 years at university — and then sits an examination to undertake a specialty, beginning with internal medicine. That specialty, which can last up to 4 years (completing all 4 is not obligatory), serves as a "common trunk" before undertaking a subspecialty in cardiology, which lasts between 3 and 4 years depending on where they study.

Once qualified as a cardiologist, they can practise as such — a clinical cardiologist — or opt for still more focused specialisation. This last step is known as a fellowship. Some of the options are:

• Echocardiography (ultrasound of the heart)
• Interventional cardiology (catheterisation)
• Electrophysiology (study and treatment of rhythm and conduction disorders)
• Cardiac rehabilitation (after an infarction, surgery or heart failure)
• Heart failure
• Cardiovascular intensive care
• Several others

Although it is not strictly necessary for a cardiologist to take one of these options, which can last up to two years, modern medicine does tend towards hyper-specialisation.

The cardiac surgeon

The cardiac surgeon's path begins very similarly, with 6 years of general medicine at university. On finishing, they must sit an examination to enter the specialty of general surgery, which lasts 4 years and, as with internal medicine for cardiologists, serves as a "common trunk".

At the end of that period, if they wish and are selected for a programme, they can begin a subspecialty in cardiac surgery which in Mexico lasts obligatorily 4 years. At the end of that, the cardiac surgeon has the training and capacity to perform a wide range of open-heart procedures, and is certified by their institution, their university and the Medical Council of Specialties to practise freely.

At this point the surgeon can practise in the public and private sectors, or can seek further training and specialisation through a fellowship.

A fellow is a doctor who already holds a completed specialty diploma in their own country — already a specialist in their own right — but who decides to go to another country, or sometimes elsewhere within the same country, in search of superior or highly specialised training in a particular area.

It generally lasts up to two years, though it can be as long as four, is paid, and carries university endorsement. In practical terms it is a job within the hospital performing procedures in a very specific area of the specialty.

Some of the options:

• Advanced minimally invasive or robotic surgery — usually 2 further years
• Paediatric cardiac surgery — usually two years
• Transcatheter procedures, known as structural cardiology, replacing valves through catheters — usually 1 year
• Several others

It is important to remember that currently only 7–8% of cardiac surgeons worldwide perform minimally invasive procedures — those with formal training in these interventions.

The percentage of cardiac surgeons trained in transcatheter techniques is lower still. So it is worth paying particular attention to which surgeons are qualified to offer open-heart surgery, minimally invasive surgery and transcatheter surgery alike.

Both look after your heart. They are a team

The cardiac surgeon and the cardiologist differ in one fundamental principle: the cardiologist is clinical — they do not operate. They focus on diagnosis through multiple studies such as ultrasound, CT, MRI and stress testing, as well as assessment, follow-up and medical treatment of heart disease.

The exceptions to the rule are interventional cardiologists, who perform catheter procedures in the coronary arteries — sometimes placing stents — and some of whom are trained in transcatheter procedures for valve problems; and electrophysiologists, the cardiologists who analyse heart rhythm problems and who ultimately place pacemakers and perform procedures to end arrhythmias. These can be considered cardiac interventions or surgery.

The surgeon, as described, does operate and repairs cardiac problems, whether by open-heart surgery, minimally invasive surgery or transcatheter techniques. That last is the most modern area, where the cardiac surgeon and the cardiologist perform similar procedures.

In fact, by law, these procedures must be carried out jointly, with a surgeon and an interventional cardiologist working together in the same procedure.

The cardiac surgeon and the cardiologist work together and complement each other. This is where teamwork and the multidisciplinary groups known as the Heart Team are so relevant in decisions about the individualised management and treatment of each patient and each condition.

And remember: a group of experts issues its recommendations with your best interest and the best will to help. The final decision about the path to follow, however, is always yours and your loved ones'.

Talk to a specialist

Request a free video consultation to clear up your questions and make a better-informed decision.

Schedule a free video consultation