Who Cares for Your Heart?

Primary care physicians can help you with basic heart-health needs such as managing high blood pressure medications, providing recommendations about heart- smart foods and suggesting appropriate exercise options. But when your heart requires more attention than your primary care physician can provide, you may be referred to a heart specialist.

“Patients with symptoms such as shortness of breath, palpitations or complaints of irregular heartbeat are typi-cally referred to a cardiologist,” says Sheila Sahni, MD, an interventional cardiology fellow at the UCLA David Geffen School of Medicine. “You might also be referred if you have a family history of premature heart disease.”

What follows are among the main types of specialists in cardiovascular medicine, what they do and why you may need their expertise.

General Clinical Cardiologist

This doctor is involved with the long-term care of patients with cardiovascular diseases. As such, a general clinical car-diologist will diagnose conditions, medically manage a broad range of heart disorders, and typically care for patients ad-mitted in the coronary care unit at hospitals. The types of tests interpreted by these specialists include: electrocardiograms, exercise stress tests and echocardiograms.

Preventive Cardiologist

While all cardiologists have training in the basics of heart health, these specialists focus on the latest risk factors, re-search, and interventions to prevent heart disease. They are often resources to other physicians to help translate the growing body of preventive knowledge into clinical practice. Patients with family history of heart disease, stroke at a young age or uncontrolled cholesterol may all be candidates for a preventive cardiologist.

Preparing for Your Appointment

  • Due to the need for detailed health history intake forms, initial appointments with new physicians can be especially stressful. A prepared packet of information can ease the stress.
  • The following are some basics to take with you:
  • Heart health family history that includes siblings, parents, aunts, uncles and grandparents.
  • Documentation of your recent and past symptoms as well as a list of surgeries and major illnesses
  • Recent lab or test results, e.g., EKGs, echocardiograms or cardiac stress test results.
  • Record of all medications and/or take your prescription bottles.
  • Names of your current physicians.
  • List of questions about your heart concerns.

Place all this information into a folder along with a pad of paper and pen to take notes during your appointment. Some patients take a friend or family member to help them better communicate.

Interventional Cardiologist

These specialists perform invasive procedures for structural heart conditions, which include treatments for coronary artery disease (CAD), valve disease and other conditions. If you have a blockage and need a stent or angioplasty, you will likely be referred to an interventional cardiologist.

Electrophysiologist

As the name implies, this cardiac specialist focuses on the electrical or rhythmic disorders of the heart. These specialists are skilled at implanting pacemakers and defibrillators: The former helps speed up an abnormally low heartbeat, and the latter sends a shock to the heart muscle to reset an erratic or too fast rhythm. The most common rhythm disorder is atrial fibrillation (AFib). An electrophysiologist can help determine the causes of AFib and treat it with lifestyle modifications, medications and implantable interventions as needed.

Heart Failure Cardiologist

These specialists see patients who have heart failure and those who have had heart transplants. In the early stages of heart failure, some patients may continue to see internists, but as the disease advances, patients do better when referred to specialists. According to a recent study from the Karolinska Institutet in Sweden, heart failure affects more than 10 per-cent of the elderly worldwide, and is associated with high risk for early death and reduced quality of life. Their findings suggest that many patients would benefit from seeing heart failure specialists earlier in the disease process for evaluation and the sophisticated treatments they offer.

Understanding your doctor

There’s also a lot of jargon in cardiac care, like all of medicine. If you don’t understand what the physi-cian tells you, say so. Likewise, you can validate what the physician says by repeating what you think you heard.

Most primary care physicians know when to refer patients, this doesn’t mean you can’t advocate on your behalf especially if you feel you’re not getting the care you need. You can simply ask for a referral, or seek out a specialist on your own.

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