What is a cardiologist?
Cardiologists are specialists who focus on the prevention and treatment of disorders that affect the heart and blood vessels, says Dr. Donald M. Lloyd-Jones, president of the American Heart Association. He’s also chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine.
Heart disorders include:
— Heart pumping problems (any disorder that affects the heart muscle).
— Heart failure.
— Heart valve problems or other electrical problems.
— Plaque buildup in the arteries that can cause heart attacks and strokes.
“The day-to-day work of a cardiologist focuses specifically on how we can improve patients’ lifestyles to prevent heart disease from developing or worsening,” Lloyd-Jones says.
How is a cardiologist’s training different from that of a general practicioner?
General practitioners are trained in internal medicine to think about the whole body; cardiologists must complete that same training — three years of internal medicine — before they can specialize in cardiology.
Cardiologists are internists that do three to four years of additional training focusing on the heart and blood vessels, Lloyd-Jones says.
Within cardiology there are further specialties, such as doctors who specialize in:
— Catheterization lab work, also known as interventional cardiology, to open blocked arteries and implant heart valves.
— Rhythm disorders.
“Each specialist is an important member of the team caring for heart patients with a range of needs,” he says.
When talking about specialists who are surgeons it’s important to note that heart surgeons are not cardiologists, and vice versa. “Surgery is a very different training path,” he says. “Cardiac surgeons do general surgery then specialize in cardiac surgery.”
Be prepared to ask your cardiologist lots of questions.
Seeing your primary care doctor for your annual physical or because you’re being slammed with a virulent case of the flu is one thing. Visiting a cardiologist for the first time for possible heart issues is another.
About 659,000 people in the U.S. die each year of heart disease, according to the Centers for Disease Control and Prevention. That’s 25% of all deaths in the country. “Heart disease is the leading cause of death for men, women and people of most racial and ethnic groups in the United States,” according to the CDC.
“It’s intimidating to see a cardiologist for the first time,” says Dr. Claire Boccia Liang, director of the Women’s Heart Program for Morristown Medical Center, which is part of Atlantic Health System in Morristown, New Jersey. “I recommend patients come with a list of questions. This acts as an ice breaker and can help them remember issues they want to discuss.”
Don’t feel limited by your initial list — you may have more questions after the initial screening.
Here are eight questions you should ask your cardiologist during your first visit:
1. What are the symptoms of heart disease?
— Chest pain or tightness.
— Numbness in the legs or arms.
— Pain in the neck, throat, jaw, upper abdomen or back.
While most people are aware that some, if not all, of these symptoms could be a sign of a heart ailment, many patients may not know about atypical symptoms, says Dr. Julie Ramos, a cardiologist who works for AdventHealth Ocala in Ocala, Florida.
Atypical symptoms of heart disease could include:
— Leg swelling.
— Shortness of breath.
If you’re experiencing symptoms that could be a sign of a heart issue, seek medical attention as soon as you can.
2. Questions to ask your doctor about a-fib
Atrial fibrillation — also known as afib or af — is the most common heart rhythm abnormality, says Dr. Kristen K. Patton, chair of the American Heart Association’s Council on Clinical Cardiology. She’s also a professor of medicine at the University of Washington and an electrophysiologist.
During afib, the upper chambers of the heart pump irregularly. This arrhythmia is associated with stroke and heart failure. “The greatest risk of afib is stroke,” Patton says. “If you have afib, you’re up to five times more likely to have a stroke than someone who doesn’t have the condition.”
Afib can also lead to heart failure due to the weakening of the heart muscle.
Symptoms of afib include:
— A “thumping” feeling in the chest.
— Irregular, rapid heartbeat.
— Shortness of breath.
3. How is afib diagnosed?
Afib is often diagnosed with an electrocardiogram, but since episodes come and go unpredictably, your cardiologist may require rhythm monitoring with a Holter monitor (a portable electrocardiogram device) worn over a period of days to weeks, Patton says.
Some people use a smartwatch or an app to diagnose afib, but these diagnoses require confirmation by a clinician since algorithms can be incorrect.
4. Are there ways I can reduce my risk of developing afib or of having frequent episodes?
Research suggests a host of cardiovascular conditions can contribute to or exacerbate afib.
These conditions include:
— A prior heart attack.
— Sleep apnea.
Keeping your blood pressure control is one of the most important ways to prevent afib, Patton says. Getting diagnosed and treated for sleep apnea could also reduce your risk of afib.
Other habits that can help you minimize your risk include:
— Exercising regularly.
— Maintaining a healthy weight.
— Minimizing intake of alcoholic beverages or abstaining completely.
— Practicing mindfulness meditation or yoga.
5. How will my family history affect my heart health diagnosis?
Heart disease risk factors are closely linked to your family health history and genetics, says Dr. Garth Graham, director and global head of healthcare and public health partnerships at YouTube and a past president of the Aetna Foundation, which provides funding to nonprofits nationwide to carry out health initiatives.
“Think of your family history as a visual for your cardiologist to evaluate environment and genetics where diseases occurred,” Graham says. “Be sure to identify first-degree members of your family that have been diagnosed with ischemic heart disease (which is caused by narrow heart arteries) or (who) died suddenly before the age of 55 if they are men, and 65 if they were women.”
It’s particularly important for African-Americans and Latinos to provide such information, because people in these groups, some of whom live in medically underserved areas, face higher risks for:
— High blood pressure.
If you don’t know the full medical history of your family, start by asking your immediate family members. Find out if your parents, grandparents or siblings had heart disease or stroke, and if so — how old they were when they were diagnosed, and share the information you learn with your cardiologist.
6. What can I do to minimize my risk of heart problems?
Even if you have a family history of heart issues, “there’s a lot an individual can do to mitigate their risk,” says Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, California.
These are steps you can take to mitigate your risk of heart problems:
— Avoid red meat and processed meats — or eat them sparingly. These foods are high in saturated fat, which is unhealthy for the heart.
— Consume alcohol moderately or abstain from it. Research suggests that heavy alcohol use may contribute to heart problems.
— Follow a heart-healthy diet, like the Mediterranean diet, which is rich in fruits, vegetables and whole grains. For protein, consume beans, lentils and quinoa. Dark chocolate is also a good choice in moderation; it contains flavanols, which are compounds that have antioxidant-like qualities. Research suggests that consumption of flavanols boosts antioxidant activity in the body, and this reduces inflammation. Antioxidants are compounds that research suggests prevent free radicals from damaging healthy cells.
— Exercise regularly. The CDC recommends that you engage in 150 minutes of moderate physical activity, and 75 minutes of vigorous activity per week. Moderate physical activity includes brisk walking, and vigorous exercise includes jogging or running. The CDC also recommends doing muscle-strengthening exercises at least twice a week.
7. Should I take a daily aspirin? What are the benefits and the risks?
If someone has had a heart attack or stroke, they generally should take a baby aspirin daily. Aspirin thins the blood, which helps prevent blood clots from forming. That provides a fairly significant benefit to reduce recurrent problems that outweighs any risks, says Dr. Amit Khera, a professor of medicine and director of preventive cardiology at UT Southwestern Medical Center in Dallas.
However, most people who have not had a heart attack or stroke before should avoid taking aspirin to prevent one of these events. This is because on average, aspirin can cause more major bleeding problems than it can prevent heart attacks or strokes for these individuals.
“For those that have not previously had a heart attack and stroke, aspirin lowers the risk of heart attacks by about 11% but increases the risk of major bleeding by about 43%,” Khera says. “There are some people whose risk of a heart attack is higher and who are at low bleeding risk, who may still consider an aspirin. But that should only be low dose, 81 milligrams a day, and in discussions with their doctor.”
8. What should my ideal blood pressure be?
Normal blood pressure is less than 120 systolic (the top number) and less than 80 diastolic (the bottom number), Khera says. Systolic blood pressure measures the force of your heartbeat on the walls of your arteries. Diastolic blood pressure measures the reduced force on the arteries when your heart relaxes.
“When someone’s blood pressure is elevated above that, they should always start with lifestyle interventions, because they make a big difference,” Khera says.
Certain over-the- counter medications, such as NSAIDs, can also raise blood pressure. Such changes could include adopting new eating habits, such as the DASH diet, which emphasizes foods that lower blood pressure:
Cardiologists can also treat high blood pressure by prescribing certain types of medications for hypertension, including:
— ACE inhibitors. These medications block the body from producing a hormone, angiotensin II, which causes blood vessels to narrow.
— Diuretics. These help your kidney get rid of fluid.
— Calcium channel blockers. Muscles require calcium to flow in and out of muscle cells. This type of medication helps block calcium from reaching the smooth muscle cells of blood vessels and the heart. This in turn allows the heart to beat with less force, decreasing blood pressure.
9. How do I find a cardiologist near me?
There are a number of ways to find a cardiologist near you, says Dr. Michael Chan, director of complex coronary interventions and chronic total occlusion at Providence St. Jude Medical Center in Orange County, California.
You can find a cardiologist near you by:
— Getting a referral from your primary health care provider.
— Obtaining a referral from trusted relatives or friends.
— Reading your health insurance company’s list of in-network cardiologists.
— Reading the websites of medical practices with cardiologists, some of which include patient reviews.
Questions you should ask your cardiologist:
— What are the symptoms of heart disease?
— What is atrial fibrillation?
— How is afib diagnosed?
— Are there ways I can reduce my risk of developing afib or of having frequent episodes?
— How will my family history affect my heart health diagnosis?
— What can I do to minimize my risk of heart problems?
— Should I take a daily aspirin? What are the benefits and risks?
— What should my ideal blood pressure be?
— How do I find a cardiologist near me?
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Update 04/25/22: This story was previously published at an earlier date and has been updated with new information.