When to see a cardiologist: Taking control of your heart health

Written by Dr. Nathan Lambert, medical director of Cardiology at IU Health North and Saxony hospitals

A question I am commonly asked by patients, friends and family is, “When is it appropriate to see a cardiologist?” What I hear is people don’t want to “bother” the cardiologist if their symptoms aren’t actually heart related. I also hear that they don’t want to spend time in an emergency room for a “false alarm.” These can be fatal mistakes. Heart disease remains the leading cause of death in the United States and in Indiana. Proactively addressing your heart health can help prevent serious cardiovascular issues.

Heart Disease Risk

We want to think of ourselves as healthy, and we should. However, at the same time, we cannot be in denial about our own underlying cardiovascular risk. Much of our risk is modifiable, such as smoking status, blood pressure, weight and diabetes control. But important components are not. We can’t control our age, and we can’t control our genetics. As we get older, our risk increases, even if we have a very healthy lifestyle. Likewise, if heart disease runs strongly in either side of the family, our risk is elevated.

Asymptomatic Patients

Let’s start with asymptomatic patients. These are patients experiencing no discomfort in the chest, no difficulty breathing and no abnormal heartbeats. These patients should see a cardiologist if their cardiac risk is determined to be elevated, even in the absence of symptoms. Probably the two simplest but most powerful screening tests to establish baseline risk are the LDL cholesterol (fasting blood draw) and the calcium score as determined by a heart scan (low dose CT scan). Low-density lipoprotein (LDL) cholesterol is a type of cholesterol that's often called "bad" cholesterol. High levels of LDL cholesterol can increase your risk of stroke and heart disease. Some folks with a relatively high LDL cholesterol will have an excellent heart scan result and may not need medication. On the other hand, some folks with what appears to be a reasonably good LDL cholesterol will have an abnormal heart scan and may need medication.

Lowering “Bad” Cholesterol

There is a lot on the Internet about cholesterol. Simply put, for someone with any degree of elevated cardiac risk, LDL cholesterol is bad. Do not be misled or persuaded otherwise; that can be a serious mistake. The next question is how to lower the LDL cholesterol. After diet and exercise, statins, a specific group of medications, are the mainstay. And again, there’s a lot of misleading information out there. Statins reduce inflammation inside our coronary arteries, which is a powerful way to stabilize plaque and prevent heart attacks. However, we now have several non-statin alternatives. Which medication to use for lowering LDL cholesterol (when medication is needed) is certainly something to discuss with a cardiologist.

Symptomatic Patients

Next, let’s consider patients with symptoms. Symptoms can be very noticeable, such as heavy pressure in the chest, which may (or may not) radiate down either arm, to the jaw or to the back. Symptoms can also be more subtle, including a shortness of breath or fatigue with activities that used to be easy to perform. Again, none of us want to think we may have a heart problem, but if your chest discomfort only occurs when you walk briskly or otherwise exert yourself, you should not just presume this is acid reflux or sore muscles. Any exertional symptoms that are new or different, and that include any sort of discomfort or tension in the chest, feeling of labored breathing or excessive fatigue, are very appropriate reasons to see a cardiologist.

Two old adages apply here: “it’s better to be safe than sorry” and “an ounce of prevention is worth a pound of cure.” If there is any question of heart risk or heart symptoms, come see the cardiologist – you’re not bothering us! To learn more about heart health, visit iuhealth.org/heart.