Signs It's Time to See a Cardiologist

Given that heart disease remains the nation's No. 1 killer of adults, it hardly needs noting that keeping the organ in the pink of condition should be a top priority.

Doctors habitually promote exercise and a healthy diet, advice most everyone can follow to reduce their risk of heart disease. But people nonetheless develop heart issues, one reason someone in the U.S. dies from cardiovascular disease every 36 seconds.

It's also a reason more people should be seeing a cardiologist. Specialists in diseases of the heart and blood vessels, cardiologists administer and evaluate tests, manage patients' risk factors, determine the best treatments and prevent complications.

Dr. Bindu Chebrolu, a cardiologist at Houston Methodist, lays out the symptoms that warrant an immediate visit to a cardiologist, the risk factors that signal you already should have a cardiologist and what to expect at your first appointment, including specific tests. Her bottom-line message: It's almost never too soon to see a cardiologist.

"I would say the earlier, the better," says Dr. Chebrolu. "You never want to wait too long."

Who should schedule an appointment?

Definitely see a cardiologist if you're experiencing:

• Chest pain
• Shortness of breath
• Abnormally fast or slow heart rate
• Swelling in your legs
• Dizziness or fainting
  

"Sometimes people don't have these classic symptoms, but they would still benefit from seeing a cardiologist because they know they're not doing well," says Dr. Chebrolu. "It is also good to know where you stand in the spectrum of your cardiovascular health, from knowledge to practice."

Ideally, it doesn't come to an acute issue. The best time to seek out a cardiologist is based on risk factors, before symptoms hit.

What risk factors make you a candidate?

It's time to schedule an appointment if you have any of the following key risk factors:

1. A family history of heart disease

Your heart disease risk increases if your ancestors had the disease. A cardiologist can monitor the risk factors, conduct the needed screenings and recommend early interventions when needed.

2. A history of smoking

A history of smoking increases the risk of arterial blockages and damages the arteries, a cause of heart disease.

3. Diabetes

High blood glucose levels may lead to coronary artery disease.

4. High cholesterol

Elevated levels of cholesterol can cause atherosclerosis, a form of heart disease in which narrowed arteries slow or block blood flow to the heart. The result can be a heart attack.

5. High blood pressure

Blood pressure, the force at which blood pushes against the arterial walls, can reduce the amount of blood and oxygen that reaches the heart when the levels are high, resulting in a heart attack.

One thing that Dr. Chebrolu recommends people do is plug their personal information and test numbers into an atherosclerotic cardiovascular disease (ASCVD) risk calculator. The tool — you can go on the American Conference of Cardiologist's here — estimates people's 10-year ASCVD risk.

What should you expect at your appointment with a cardiologist?

Dr. Chebrolu says your first cardiology appointment will include a complete assessment of your symptoms, analysis of your risk factors and an estimate or where you stand in terms of tests needed.

Presumably, your primary care doctor already has conducted tests to determine your cholesterol, glucose and blood pressure. Depending on your condition, your cardiologist could order any of a number of additional tests, including:

• An exercise cardiac stress test: determines how your heart responds when it's working its hardest
• An electrocardiogram: records your heart's electrical activity to check for different conditions
• An echocardiogram: checks how your heart's chambers and valves are pumping blood
• A coronary artery calcium scoring test: uses computerized tomography (CT) to detect calcified plaque on artery
• A CT or invasive coronary angiogram: both use a powerful X-ray machine to produce images of your heart and its blood vessels
• A cardiac MRI: produces still or moving pictures of the blood flowing through the heart

Dr. Chebrolu says everyone, especially those with risk factors, should get the calcium scoring test. The more evidence of calcium and thickening seen in the inside lining of the arteries, the higher the score. The higher your CAC score, the more likely you are to develop heart disease or have an event such as a heart attack or stroke.

Dr. Chebrolu says the test is a very accurate, widely available, noninvasive, reproducible and inexpensive means for assessing ASCVD risk and cardiovascular outcomes, and can provide more information to aid in informed decision-making about the need for medications or other interventions.

It has been found that an estimated 15% of people assumed to be at low risk actually have a relatively high amount of calcified plaque and are thus at higher risk of a cardiac event than anticipated. Conversely, it has been found that about 30%-50% of patients in traditional high-risk categories have no calcified plaque and therefore are actually at lower risk.

"The test really takes the guesswork out of the condition of your arteries, the amount of plaque in them," says Dr. Chebrolu. "It's changing the whole field of preventive cardiology."

In any event, Dr. Chebrolu says you really can't go wrong scheduling an appointment with a cardiologist.

"A cardiologist just provides an additional perspective, a focus on your cardiovascular health as opposed to your general heart," says Dr. Chebrolu. "We help you do what you need to do to prevent cardiovascular disease, which is the important question to avoid a premature death. So one visit a year, or once every couple of years, is definitely worth it."

March 24, 2022