When to See a Cardiologist
Written by Todd Neff on behalf of National Jewish Health
There are many reasons to see a heart specialist. But first, it’s important to know when to dial 911 to report a possible heart attack and get help fast.
Signs that you may be having a heart attack and need emergency care include:
- Chest pain
- Pressure in your chest that lasts for more than a few minutes or that goes away and comes back
- Pain going down the left arm or that spreads to the neck, jaw or back
- Shortness of breath
- Nausea
- Sweating or fainting
Women may feel different symptoms. For example, women are less likely to experience typical chest pain symptoms.
“The left arm is sometimes all it is for women,” said National Jewish Health cardiologist Christopher Dyke, MD, FACC. “Women presenting with a heart attack are more likely than men to lack classical chest pain symptoms, but rather experience some of the other common associated symptoms, particularly shortness of breath, nausea or vomiting, and back or jaw pain.”
Ideally, though, you’ll see a cardiologist before it’s an emergency. Cardiologists help prevent and treat problems of the heart and major blood vessels. Among those problems include:
- Abnormal heartbeats (arrhythmias)
- Congenital heart problems (heart problems you’re born with)
- Family-related heart problems (genetic in origin)
- Heart attacks
- Heart failure
- Heart muscle disease (cardiomyopathy)
- Heart valve disease
- And more
Given all that, it’s no surprise that the field of cardiology, itself a specialty, has many subspecialties.
Reasons to See a Cardiologist
There are two main reasons to see a cardiologist. The first has to do with things that increase your risk of heart problems:
- Chronic kidney disease
- Diabetes
- Family history of heart issues
- Gum disease (there is a connection between gum disease and heart disease)
- High blood pressure
- High cholesterol
- History of chemotherapy with toxins that are known to effect the heart
- History of heavy alcohol use or other substance abuse
- History of preeclampsia (high blood pressure during pregnancy or soon afterward)
- History of smoking
- Peripheral artery disease
- Starting a new exercise routine after being inactive for a while
The second set of reasons to see a cardiologist involve how you’re feeling. Symptoms of heart problems include:
- Chest pain, pressure, or discomfort
- Heart flutter/palpitations
- Shortness of breath with movement
- Shortness of breath when lying flat
- Swelling of the legs or abdomen
- Ulcers or skin color changes in the feet and legs
- Leg pain when walking that resolves with rest (claudication)
- Dizziness or fainting
What to Expect When You See a Cardiologist
Most people are referred to a cardiologist by their primary care physician.
“We do get some self-referrals, but most patients are referred to cardiology by a primary care physician,” Dyke said. “With a referral, we know that somebody is looking after other health issues that may be more easily addressed in primary care.”
When you see a cardiologist, they’ll review your health history and perform a physical examination. At that point, specialized tools for diagnosis come into play. That may involve doing a blood draw to understand factors such as cholesterol levels and the presence of abnormal proteins. There are also many ways to look at the heart and important blood vessels to determine how they’re working.
Common Heart Tests
Electrocardiograms, or EKGs, detect the heart’s electrical activity as it beats. Cardiologists can learn a lot from the squiggly line patterns an EKG creates. In addition to heart rhythm problems, EKGs can clue cardiologists in to possible structural problems. These can include thick heart muscles, enlarged heart chambers, blocked arteries or an inflamed pericardium (the membrane surrounding the heart).
Echocardiograms use sound waves (ultrasound) to let cardiologists observe the heart as it beats. They can see the size, shape and movement of your heart and its valves. Echocardiograms help determine how well the heart is pumping, the most important assessment in cardiology.
“It’s the number-one tool in looking at heart function,” said Dr. Dyke. “It’s simple, noninvasive, portable, and relatively inexpensive.”
Nuclear cardiology is used mostly for stress testing – that is, observing the heart and key blood vessels while the heart is being pushed to work hard through exercise on a treadmill, stationary bicycle, or through medications. Nuclear cardiology involves using a small amount of radioactive tracer in the blood. A scanning device called a gamma camera uses the tracer to detect blood flow to a region of heart muscle.
Advanced Cardiac Imaging
MRIs image the heart to give cardiologists a comprehensive picture of the heart’s structure and function. An MRI also can look at the makeup of the heart muscle itself. That helps a cardiologist see whether damage to the heart muscle is being caused by:
- Abnormal muscle cells (hypertrophic cardiomyopathy)
- Deposits from abnormal proteins (amyloidosis) or granulomas (sarcoidosis)
- Inflammation from viruses like COVID-19
- Scarring from heart attacks
CT scans focus on the state of the blood vessels feeding the heart. The image helps the cardiologist determine locations and makeup of arterial plaque that can narrow or clog blood vessels. Narrow or clogged blood vessels often lead to heart attacks, strokes and other problems. Cardiac CT scanning recently improved greatly with the introduction of photon-counting CT scanners. These scanners can observe the heart at 0.2-millimeter resolution (a typical mechanical pencil lead is 0.5 mm in diameter). That is three time sharper than previous versions and with less exposure to X-rays.
Dr. Dyke is optimistic that future photon-counting CT scanners may be able to see not only if there’s plaque, but also what it’s made of and how likely it is to break loose and cause a heart attack or stroke.
“CT technology is getting to the place where we’re able to look at those high-risk characteristics that make plaque vulnerable,” explained Dr. Dyke. “And that is the future of cardiology.”
Diagnosing the nature of heart problems takes a specialist – and often, several of them. Based on your risk of heart problems and how you’re feeling, cardiologists have many tools to diagnose what’s happening with your heart. Once that’s done, they will work with you determine the right type of cardiologist for your care.