Patients come to a cardiologist one of two ways—through a referral from a primary care provider or on their own. Either way, an appointment with a cardiologist is indicated should any of the tests or problems listed below present themselves.
EXERCISE STRESS TESTING
An exercise stress test involves rapid walking on a treadmill while connected to an electrocardiogram (EKG) machine. Stress tests are used for coronary artery disease screening, evaluation of chest pain and palpitations, exercise screening, for the detection of abnormal heart rhythms (arrhythmias), and to evaluate various cardiac medications.
NUCLEAR STRESS TESTING
The nuclear stress test uses a radioactive tracer to follow the flow of blood through the coronary arteries. By comparing the flow at rest to the flow after exertion, blockages in the arteries can be detected, and lifesaving cardiac procedures initiated. During the test, a treadmill or medication is used to create physical “stress.” A special camera takes computer images of the heart as it is put through its paces. The tests are used for coronary artery disease screening, for evaluation of chest pain, and for screening or evaluation of abnormal symptoms such as chest pain or shortness of breath.
An echocardiogram is an ultrasound (also known as a “sonogram”) of the heart. The entirely noninvasive procedure produces high-quality images of the heart muscle that can be used to evaluate its strength and the efficacy of its valves. Echocardiography is used to diagnose the cause of heart murmurs, to evaluate abnormal heart valves, chest pains and shortness of breath. Evidence of old heart attacks can be detected and evaluations made for the treatment of high blood pressure and for people with a family history of sudden cardiac death.
TREATMENT OF VENOUS DISEASE/VARICOSE VEINS
Veins rely on leg muscle contraction and one-way valves inside the veins to carry blood back toward the heart. If those valves fail, gravity keeps blood from returning to the heart efficiently. Blood pools, backups ensue and as pressure builds up, diseased veins become enlarged, eventually bulging to the skin’s surface. The same disease process can affect veins of any size. But when larger veins fail, they are called varicose veins. Smaller affected veins are typically called spider veins. Varicose veins signal their presence through leg pain and appearance though sometimes compromised veins are not visible. As a result, diagnostics ultrasound is often used to determine the cause and severity of the problem.
EVALUATION OF HEART VALVE DISORDERS
Heart valves connect the various chambers of the heart and control the blood that flows through them. When heart valves become dysfunctional, blood can leak backward through an incompetent valve (regurgitation), or fail to pass forward through a very narrowed valve (stenosis). These disorders may not produce symptoms and may only be detected by the presence of a heart murmur on physical examination, or through other symptoms like fatigue, shortness of breath, swollen ankles, palpitations, and occasionally chest pain. Echocardiography is used to diagnose the specific valve problem so that appropriate treatments (antibiotics, cardiac medications, or valve repair or replacement) can be initiated.
EVALUATION OF CORONARY ARTERY DISEASE
The coronary arteries supply blood to the heart muscle. When coronary arteries become diseased or blocked, chest pain, shortness of breath, and a variety of other symptoms may result. If left uncorrected, a heart attack (myocardial infarction) could occur. Screening and treatment for coronary artery disease is the domain of the cardiologist who will use medications and cardiac procedures (cardiac catheterization, coronary artery angioplasty, and/or stenting) to maintain coronary artery health. Heart disease is the number one cause of death in men and women. It is imperative that all patients with coronary artery disease see a cardiologist regularly.
EVALUATION OF HYPERTENSION (HIGH BLOOD PRESSURE)
High blood pressure is one the most common medical disorders. Caused by a combination of genetics, age, and lifestyle, it is often called the “silent killer” because it often goes undetected until it results in a stroke, heart attack, blindness, or kidney failure. Primary care providers commonly treat high blood pressure. But treatment in some cases can be complicated and physicians will often enlist the help of a cardiologist to assist in the management of the condition.
EVALUATION OF CHEST PAIN AND SHORTNESS OF BREATH
Chest pain and shortness of breath are among the most common reasons patients see a cardiologist. Although many non-cardiac disorders can cause these symptoms, all patients who experience them should be screened for the presence of cardiac disease. Failure to do so could have dire consequences.
EVALUATION OF CARDIAC ARRHYTHMIAS
Cardiac arrhythmias are abnormalities in the beating of the heart. They can produce palpitations, fatigue, shortness of breath, fainting, strokes, and even death. It is important to diagnose the type of arrhythmia present—cardiologists have a number of monitoring devices at their disposal—so that appropriate treatment can be initiated. While many arrhythmias require no treatment, failure to recognize a dangerous condition can be catastrophic.
EVALUATION OF FAINTING (SYNCOPE)
Fainting, also known by its medical term as syncope, is a common problem. While fainting and near fainting episodes are often caused by non-serious conditions, patients are frequently referred to a cardiologist for evaluation to rule out the presence of any serious cardiac abnormalities.
EVALUATION OF FATIGUE
Fatigue is one of the most frequent patient complaints. Though its cause is often due to non-cardiac issues, certain cardiac conditions such as arrhythmias, coronary artery disease, heart valve disease, and a weak heart muscle (cardiomyopathy) can be the culprit. A cardiologic evaluation can help rule out those conditions.
CHOLESTEROL DISORDERS (DYSLIPIDEMIA)
High cholesterol is one of the most prevalent medical problems in our society today. Each year, our store of information about the importance of cholesterol screening and treatment grows. While we know that disorders of cholesterol are associated with heart attacks and stroke, we also know that each patient is different. Individual goals for maintaining cholesterol levels need to be determined. Lifestyle changes can help, but when they are not sufficient, medication needs to be prescribed to reduce cholesterol to acceptable levels.
Frequently a cardiologist will be asked to assess a patient’s risk of cardiac complications prior to surgery. Undetected heart abnormalities can cause problems under the stress of anesthesia and surgery, and may even result in a heart attack. A cardiologist will often order a number of tests—stress tests and echocardiograms are the most common—before concluding that a patient may safely undergo surgery. While these tests are not perfect and do not prevent cardiac complications in all cases, they can significantly reduce the chances of a bad outcome.
WEIGHT LOSS AND NUTRITIONAL CONSULTING
Obesity is at near epidemic levels in the United States, along with its medical consequences—sleep apnea, pulmonary hypertension, high blood pressure, high cholesterol, diabetes, and more. Patients can often benefit from a referral to a nutritionist.