What should I do before seeing a cardiologist?
by University College Hospital London Consultant Cardiologist, Dr Oliver Segal
It is important you try to do some research on your heart condition before you arrive to inform you of questions you might like to ask. Write these down, as many people will forget everything as they walk through the door. Doctors who are put off by the patient who brings along a long list of questions is in the wrong business! Visits to a cardiologist are often the most important event in a person’s life at that time.
Expert Guide to doing your own essential Heart Research [image1]
Searching the internet for information is frought with difficulty as there is lots out there which is inaccurate. It is best to read the latest articles on the totalhealth website and also visit the website of the doctor you are visiting – many cardiologists will have their own websites which should let you know what their special interests are and what their experience is.
You should also look at websites of national or international bodies or charities. In the cardiac arena these include the British Heart Foundation and the British Cardiac Society, but there will also be specialist societies as well. In my own field of arrhythmia there is the British Heart Rhythm Society, Arrhythmia Alliance ,, the AF Association and the Syncope Trust (STARS).
In the US there is the Heart Rhythm Society and in Europe there is the European Heart Rhythm Association www.escardion.. You may also want to look at the Department of Health , The General Medical Council , NICE and Patient UK..
Once armed with your list of questions, you will hopefully find most, if not all, are answered before you have a chance to read through your list. Remember, medicine is a science but that doesn’t mean there is only one correct answer or way of doing something. It is important you feel involved in the decision making process and there will almost always be different treatment options available.
What else should I take with me to the consultation?
Cardiology is all about doing tests to diagnose different conditions. You may have already had some of these with the GP or at A&E. If you have any copies of ECGs, echocardiograms, cardiac monitors, exercise ECG tests, stress echos, MRI or CT scans, it might be helpful to take them with you.
… and then note down:
1.Your symptoms and how long you have had them
2.How you feel with these symptoms and how often they occur
3.Does anything make them better or worse? e.g. exercise, rest, foods, medications, alcohol, stress, position
4.What other medical problems do you have
5.Do you take medication already including doses and times
6.Have you tried medications before and not tolerated them
7.Do any cardiac problems run in the family – if they do can you bring details or letters from other doctors?
8.Is there is a particular treatment you have heard about you would like to discuss?
9.What you are hoping for and what your expectations might be from any available treatment?
What kind of general questions should I ask?
All patients want an explanation for their symptoms, if they have them, or an explanation of an abnormal test result, perhaps picked up unexpectedly. There are many causes for chest pain, breathlessness, palpitations, dizzy spells, black outs….it may be necessary to see other specialists as well – ask your cardiologist if this is necessary or is the diagnosis clear already.
- What tests are required to confirm a diagnosis?
- What do those tests involve?
- How likely will they give a correct answer?
- Are the tests uncomfortable or painful?
- Will they require admission to hospital?
- What does a diagnosis mean to your every day quality of life?
- What about prognosis (will it affect how long you’re going to live)?
- What is the natural history of the condition (will it get better, stay the same or get worse)?
- Can it be cured or just suppressed?
- Can it run in the family? Can I pass it on to my children?
- Is there anything else I can do to help (smoking, diet, weight, exercise, alcohol, caffeine)?
- If treatments are available:
o how successful are they?
o What do they involve?
o What are the complication rates and what can go wrong?
o Can I compare the relative risks and benefits of the options?
o Can the treatment be repeated if it doesn’t work first time?
o What happens if I decline the treatment? Can it be avoided?
o How long will I be in hospital for?
o How long is the recovery time?
o Will I be unable to work, drive, fly afterwards? How long for?
o Do I need a referral or a second opinion?
o Who specialises in the preferred treatment options / who are the relevant experts?
o What track record can the specialist demonstrate and what is the success rate and post-operative infection rate?
o What’s the next step?
o Where can I get more information?
o Is there a charity or support group that I can contact?
o Who should I call if I start to feel worse?
o What is the post-treatment plan, and what help will be available?
- If your cardiologist doesn’t offer these treatments, who will they send you to? Why do they choose them?
- Is there a choice between surgery and key-hole procedures? What are the risks and benefits of each? What would the cardiologist choose for themselves?
- If not covered by insurance, how much do treatments/tests cost? Are they cheaper at other hospitals? Are discounts available for self-funded patients?
Is your Cardiologist an Expert in your Condition?
Like all branches of medicine today, cardiology has now sub-divided into several areas of sub-sepcialisation. It is important you feel confident your cardiologist is an expert in your condition. Cardiologists who do not perform angiograms and angioplasty are unlikely to be the best people to tell you about these procedures, the risks and the benefits. The same is true if you have a heart rhythm problem and need an ablation or a pacemaker or other cardiac rhythm device – it is best you see a cardiac electrophysiologist (arrhythmia specialist) who performs ablations and pacemakers so you get the best advice.
The same applies to other areas of cardiology including heart failure, structural heart problems, inherited muscle and electrical problems, congenital heart disease and echo and cardiac imaging.
Specific specific questions for cardiologists
What does my ECG / echocardiogram / heart monitor / exercise test / CT or MRI show and what do any abnormalities mean?
- If I need a heart monitor, do you have the latest equipment and choice of different monitors?
- Can you offer implantable loop recorders if I have rare palpitations or black outs?
- Do you have access to CT coronary calcium scoring and angiography?
- Do you have access to cardiac MRI?
- If I need an angiogram can you perform this from the radial artery as well as the femoral artery?
- Do you know how to programme pacemakers or ICDs if I need one?
- Can you perform echo or trans-oesophageal echo if I need one?
- Do you perform catheter ablation if I have arrhythmia?
- Do you implant pacemakers and other heart rhythm devices?
You also need to know how you can contact your medical expert after the appointment has taken place.
Do some research before you go. Write down questions in advance and don’t be worried about asking lots of questions. Make sure you’re confident your cardiologist is an expert in the area you need. Ask about treatment options and what happens if you decline them. Establish the track record and experience of the person treating you. Find out what happens if there are problems afterwards – how do you contact them or get help? Do I feel involved in the decision making process?