Editor’s Note: When to See A Cardiologist
Cardiovascular disease is the number one killer of women and men—more than twice the rate of all cancers combined. So, when I, as a primary care doctor, see a 50-year-old menopausal patient, my first thought is: What are we doing to screen her for stroke and heart disease risks? The easy parts of the office visit include lipid testing, blood pressure, and EKG monitoring; cardiovascular exams are done yearly, at least. But who do I send to a cardiologist and who gets screened by their PCP?
The patient who has no symptoms, but who has a risk of cardiovascular disease based on her history (family history, or one or more risk factors, such as elevated cholesterol), will get screening tests. If those are normal or negative, there is no need for referral to a cardiologist. The patient who goes to a cardiologist is the one with multiple risk factors—especially diabetes, brittle hyper-tensives (significant fluctuations in blood pressure that range from very high to lower than normal, for example), smokers, and women with strong family histories (meaning multiple members with heart disease—men before age 50 and women before age 60).
The patient who has chest pain with exercise, extreme fatigue, or shortness of breath, in whom my suspicion for small-vessel disease is very high, will get a screening test, such as a stress test, or a CT angiogram to visualize the coronary artery plaque, and then go to the cardiologist to consider methods for further diagnosis and risk reduction.
For the patient who sees a cardiologist, the communication between the PCP, patient, and cardiologist needs to be seamless, because a risk-reduction strategy should underlie all the medical decisions that are made in her case. For example, if she takes vitamins or other supplements or aspirin, if she needs antiplatelet therapy to prevent blood clots, and when she needs further tests to track her progress is information that needs to be available to all involved parties.
Ideally, the cardiologist and PCP practice together in the same hospital or medical center and can communicate. But, if they do not, it’s important that you, the patient, insist on having your records available in an electronic data format, so that, if you have an urgent cardiac issue, all of your information is readily retrievable by others.
—Orli R. Etigin, MD, Editor-in-Chief
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