Imagine you’re seeing your primary care doctor for a routine checkup. Your doctor asks you a series of questions about how you’ve been feeling, performs a few routine tests, and maybe wants to talk about the results of your recent blood test. Your visit ends with the doctor referring you to a cardiologist and urging you to make an appointment to talk about your heart.
Should you be concerned? Not necessarily.
“It’s very common,” says Abed Asfour, M.D., director of interventional cardiology at Beaumont Hospital, Trenton. “Most of our patients are referrals.”
Generally speaking, heart specialists will start you out with a physical exam, including blood work to measure cholesterol and blood-sugar levels. Depending on your background, you may undergo tests to look for inflammation in your blood vessels. Or be asked to perform an exercise stress test while monitoring your EKG levels.
Depending on how you do, you’ll either be referred for further testing, or sent back to your primary care doc if there are no issues.
There are four main reasons physicians refer patients to heart specialists:
Many patients who are referred to cardiologists are older people with a history of things like congestive heart failure, heart attacks or atrial fibrillation, otherwise known as irregular heart rhythms, Dr. Asfour says. Men are typically at high risk for these events a decade earlier than women.
“They strike every age, but they’re worse as women get older than 60 years of age,” he says. “In the post-menopausal age, they catch their male counterparts.”
Multiple risk factors such as high blood pressure or cholesterol levels, being diabetic or smoking are all grounds for a referral to a heart doctor. So are things like being obese or overweight, a lack of physical activity and an unhealthy diet.
You could be fit as a fiddle. But if your parents or any siblings have a history of heart disease, a family physician will want you to get checked out.
A specialist will likely ask about things like worsening shortness of breath, unexplained dizziness following exertion, or tightness in your chest. And they might perform a treadmill stress test or calcium scoring to assess calcium deposits on your coronary arteries.
“In my practice, I would say one out of four patients may need further cardiac work,” Dr. Asfour says.
Having pregnancy-related complications such as gestational diabetes or preeclampsia increases the risk of future cardiac complications.
“Women in general have a very wide array and wide range of symptoms that could mimic other conditions, and it could be more related to the heart,” Dr. Asfour says. “Women often present more complex symptoms that can be challenging to diagnose.” challenge us more with the description of symptoms.”
When it comes to maintaining good heart health, the golden rules of health apply: Eat well, get an average of 30 minutes or more of exercise per day, aim for eight hours of sleep a night and avoid smoking.
“I use the metaphor, taking care of your health is like a good investment,” Dr. Asfour says. “If you do not invest in it, it’s unfortunately going to pay back in a bad way with symptoms and presentation of coronary artery disease.”