Do I need to see a cardiologist?

DEAR DOCTOR K:

I have high cholesterol and high blood pressure, so I know I’m at increased risk for heart disease. Should I see a cardiologist?

DEAR READER:

For many people, a primary care physician (PCP) can effectively manage standard risk factors for heart disease. Your PCP also will know when you need to see a cardiologist, and can refer you to a particular one.

If you’re concerned that you might benefit from seeing a cardiologist, but your PCP has not referred you to one, here are some guidelines. If you’ve already had a heart attack, or you are at high risk for having a heart attack, I think you should have a cardiologist who knows you. Or say you haven’t had a heart attack, but you have cholesterol or high blood pressure that just won’t be controlled with standard treatment. If so, a cardiologist is in order.

Cardiologists have broad knowledge about the prevention, diagnosis and treatment of a range of heart conditions. These specialists know the ins and outs of heart attacks, heart rhythm disorders, heart valve problems and blood vessel disorders.

The increasing pace of medical knowledge and technology has led to subspecialists among cardiologists. For example, some cardiologists focus on treating and preventing heart attacks. Others focus on problems with heart rhythm, the commonest of which is atrial fibrillation. They can do tests to determine what is causing abnormal heart rhythms, and perform electrical treatments to correct them.

Then there are the interventional cardiologists. These are specialists who can diagnose blocked arteries and treat them immediately with an angioplasty and stent.

Finally, there are cardiologists who specialize in treating people with heart failure. These days, there are many new treatments for this condition. These cardiology subspecialists are on top of the latest treatments.

You can also check the websites of well-established health care institutions near your home. They can help you to identify doctors with expertise for your particular issue. In addition, many major academic medical centers have specialized clinics.

If you do see a cardiologist, make sure that he or she is board-certified in cardiovascular disease with the American Board of Internal Medicine. The American Board of Thoracic Surgery certifies cardiovascular surgeons.

There has been a growing trend toward shared decision-making around medical care, and many doctors support their patients’ efforts to take a more active role in their health care. So if you’re slated to undergo heart surgery or another procedure, you shouldn’t have any qualms about asking questions such as these:

  • How many years have you practiced in this specialty?
  • How many cases have you treated that are similar to mine?
  • What were the short- and long-term outcomes for those patients?

If your doctor recommends a non-emergency procedure, including some types of surgery and angioplasty, you may have time to consider your options. That might include getting a second opinion.