Cochin Cardiac Club

Health Blog by Dr.Uday Nair

WHAT HAPPENS WHEN YOU MEET A CARDIOLOGIST?



When you meet your physician or family doctor and he says please do see a cardiologist what does run in your mind?

It is understandable that people who have never seen a cardiologist before may be scared about the problem that they are having as well as what the cardiologist will think about it.


Just remember that the doctor is part of your  team. Our only goal is to make your health better. In order to do this, the cardiologist must know what your health  worries are.

You can help by organizing your thoughts and records, and by being prepared for the questions that you will be asked.

Prepared patients are more able to get all of their concerns answered on the first visit, while unprepared patients often leave with many more questions than they came in with.

Most often little information would have been communicated by the referring physician before the consultation visit (often in a hospital hallway, or rushed telephone conversation or in your hospital card).

Often a patient will perceive the reason for the consultation as for a different purpose than the original reason of the referring physician.

A critical question will relate to the reason for which you made the appointment. Focus on this problem will permit the cardiologist to answer the questions properly. Often, patients blurt out a partial history, but don’t tell me that their underlying concerns relate to worry about a stroke or cancer rather than the left shoulder pain for which the patient originally made the appointment.

If I am unaware of the patient's concern, I may focus on the shoulder and not understand that the concerns are elsewhere and the patient misses out at a chance to have the concern answered.



Here's what goes inside a Cardiologists Office-


1.Medical History



A detailed Medical History is taken by the Cardiologist.

With respect to the chief reason for the visit you will be asked to describe the problem.

If it is a rapid heart beat (as an example), how fast does it go (how many beats per minute), is it regular (like a metronome) or irregular, is it associated with anything else that happens at the same time (dizziness, sweatiness, feeling like you are going to pass out, passing out, chest pain, shortness of breath, headache, nausea, vomiting, etc)?

How long does the event last?

How often does this occur?

How long have these episodes been occurring?What triggers the episodes or relieves them (examples: always when I drink coffee or smoke, when I run or vacuum, when I take cold medications, etc)?

Have any  investigations or tests (blood tests,ECG,TMT etc) previously been done to look into this problem?


Has it ever happened before in your life?

Do you have any problems that would make a heart problem more likely to occur (history of heart murmur, rheumatic fever, family history of heart disease, diabetes, hypertension, high cholesterol, smoking history, thyroid disease)?

No one has all the answers at the beginning, so it is useful to involve your spouse, family or friends to help you remember things like your previous surgeries, and illnesses that may influence your health.
Certainly a list of  medications and their doses (including over the counter remedies that you use) will be helpful to your doctors, as will be a list of medications that you haven’t tolerated for one reason or another.


2.Auscultation



Auscultation is an essential part of even a cursory cardiac exam using a stethoscope.  Listening to the heart you can gather information about the  1) rate and rhythm, 2) value functioning (e.g. stenosis, regurgitation/insufficiency), and 3) anatomical defects (e.g. atrial septal defects, ventricular septal defect (VSD), hypertrophy).

3.Blood Tests 



The doctor will order blood tests(Blood Routine,Urea,Creatinine,Blood Sugar,Thyroid) to see if your parameters fall within normal range.

4.ECG(Electrocardiogram)




The information obtained from an electrocardiogram can be used to discover different types of heart disease. It may be useful for seeing how well the patient is responding to treatment.
  • It is a good idea to have an ECG in the case of symptoms such as dyspnoea (difficulty in breathing), chest pain (angina), fainting, palpitations or when someone can feel that their own heart beat is abnormal.
  • The test can show evidence of disease in the coronary arteries. Unfortunately, in many people who have significant narrowing of the arteries supplying the heart muscle, the ECG recording made at rest is often normal. Therefore, if a significant narrowing is suspected, an ECG recording is often made when the patient is exercising (an exercise stress test) because this is more likely to reveal the problem.
  • An ECG can be used to assess if the patient has had a heart attack or evidence of a previous heart attack.
  • An ECG can be used to monitor the effect of medicines used for coronary artery disease.
  • An ECG reveals rhythm problems such as the cause of a slow or fast heart beat.
  • To demonstrate thickening of a heart muscle (left ventricular hypertrophy), for example due to long-standing high blood pressure.
  • To see if there are too few minerals in the blood.
An ECG may appear normal even in the presence of significant heart disease. Thus, for a full assessment of the heart, other tests may be needed.

5.Echocardiogram and Doppler




An echocardiogram is a test in which ultrasound is used to examine the heart. Echocardiography is an invaluable tool in providing the doctor with important information about the following:

Size of the chambers of the heart, including the dimension or volume of the cavity and the thickness of the walls. The appearance of the walls may also help identify certain types of heart disease that predominantly involve the heart muscle.


Pumping function of the heart can be assessed by echocardiography. One can tell if the pumping power of the heart is normal or reduced to a mild or severe degree. This measure is known as an ejection fraction or EF. A normal EF is around 55 to 65%. Numbers below 45% usually represent some decrease in the pumping strength of the heart, while numbers below 30 to 35% are representative of an important decrease.


Valve Function: Echocardiography identifies the structure, thickness and movement of each heart valve. It can help determine if the valve is normal, scarred from an infection or rheumatic fever, thickened, calcified (loaded with calcium), torn, etc. It can also assess the function of prosthetic or artificial heart valves.


Volume status: Low blood pressure can occur in the setting of poor heart function but may also be seen when patient's have a reduced volume of circulating blood (as seen with dehydration, blood loss, use of diuretics or "water pill.", etc.). In many cases, the diagnosis can be made on the basis of history, physical examination and blood tests. However, confusion may be caused when patients have a combination of problems. Echocardiography may help clarify the confusion.


Other Uses: Echocardiography is useful in the diagnosis of fluid in the pericardium (the sac that surrounds the heart). It also determines when the problem is severe and potentially life-threatening. Other diagnoses (plural for diagnosis) made by Doppler or echocardiography include congenital heart diseases, blood clots or tumors within the heart, active infection of the heart valves, abnormal elevation of pressure within the lungs, etc.


6.TMT or Stress Test






Depending on the Medical History the Cardiologist may want you to do a Stress Test.


It is common to find heart patients who have normal ECG. One must remember that the ECGs are taken at rest when the heart is beating at its lowest rate. Even with 90% blocks the patients can have a normal ECG. In such cases the patient would also agree that at rest there is no pain in the chest, the angina symptoms would only come when they increase the heart rate, while doing some physical exertion like walking.

This is the condition where we need a TMT test. The patients are to gradually increase their heart rate, thus increasing the blood requirement of the heart muscles. Simultaneously ECG records are taken. If there is a blockage of approximately more than 70% ECG shows changes, suggestive of Angina. 


With all these tests and examination cardiologists will come to a conclusion whether you need a medical management or surgical intervention.


Being prepared with all of the answers to the doctor’s questions, you will be able to obtain more of the answers to questions that you might otherwise forget to ask.

Don’t be afraid to write them down and bring them with you.Some of these questions might be:

1. What is the diagnosis, what does it mean?

2. How much will this alter my life?

3. How often does it require follow-up, and by whom?

4. What is the long-term prognosis?

5. Is there anything that I can do to reduce my own symptoms or problems?

6. Will these results be communicated to my primary care physician?

7. What signs or symptoms should I be concerned enough to call about?

8. Are there any reliable sources for me to get more information about this problem?






   


2 comments:

Stacey Beck said...

This is very helpful! Thanks for sharing. I'm going to go see a cardiologist in Palm Beach Gardens and I'll admit I'm a little nervous. This has given me a better understanding of things and I think I'll be fine! Thanks again!

EECP said...

This has given me a better understanding of things and I think I'll be fine! Thanks again!