When Is It Time To See a Cardiologist?

As you reach middle age, don’t be surprised when your primary care doctor suggests a visit to a cardiologist.

For men, this is likely to occur sometime in the 40 to 45 age range. Women usually get to wait about 10 years longer. Considering that heart disease is the leading cause of death in the U.S., this isn’t the sort of advice that’s wise to ignore.

For most patients, a suspicious heart-related symptom or something that pops up during a routine physical is likely to prompt the first appointment.  A host of medical conditions – including diabetes, high blood pressure and high cholesterol – could send you to a cardiologist for a closer look.

But you don’t have to wait for something ominous to show up before making that first visit. This is particularly true if you have a family history of heart disease. Getting an early start could help reduce your risk for heart attack or give you peace of mind through proactive screening tests.

Understanding Cardiac Risk Factors

In general, your risk factors for heart disease can be broken into two categories – those that you have no control over and those that can be modified through lifestyle changes or medication. These include:

• Age: Most people who die of coronary heart disease are 65 or older.
• Sex: Men have a greater risk of heart attack than women.
• Genetics: You are at greater risk if your parents had heart disease. Also at greater risk are African Americans, Mexican Americans, American Indians and native Hawaiians.
• Smoking tobacco: Cigarette smoking is a major risk factor for sudden cardiac death for patients with coronary heart disease. There also is a danger for nonsmokers, through second-hand smoke.
• High cholesterol: Your risk of heart disease rises along with your blood cholesterol levels.
• High blood pressure: This forces your heart to work harder, causing muscle walls to thicken and function abnormally.
• Lack of exercise: Physical activity can keep other risk factors under control.
• Obesity: Excess body weight, particularly above the waist, can contribute to heart disease and stroke.
• Diabetes: The disease substantially increases risk of heart disease. Nearly 70 percent of people with diabetes over 65 years of age die from heart disease.

Heart Disease Symptoms

One of the more sobering aspects of heart disease is that, for 40 percent of people, the first real symptom of trouble is death. A silent heart attack is one that’s not preceded by the typical symptoms associated with heart attacks. People with diabetes are particularly at risk.

But traditionally, most people have obstructive coronary artery disease, where a slow buildup of plaque gradually narrows the arteries that supply the heart with blood. The first sign of trouble is likely to be some sort of chest discomfort.

But what does that mean? It’s difficult to describe with precision since it can vary from one person to the next. Among the possibilities:

• Sharp chest pains
• Pain around your lungs whenever you take a deep breath
• Pressure in the chest, like your chest is being squeezed (Women may feel like their bra strap is too tight)
• A feeling of fullness
• Searing pain that spreads to your back and other parts of the body

Other common symptoms include:

• Shortness of breath
• Difficulty exerting yourself
• Jaw discomfort
• Throat tightening
• Heartburn/Indigestion
• Swelling in your legs
• High blood pressure
• Abnormally fast or slow heart rate
• Dizziness or fainting
• Leg pain or ulcers resulting from blood vessel diseases

Your First Visit to the Cardiologist

During the first appointment, your cardiologist will embark on what amounts to a fact-finding mission, delving into both your current condition and your family history of heart problems.

A physical exam will look at typical vital signs, including pulse, blood pressure and breathing. You may receive an electrocardiogram (EKG), which uses small electrodes to record your heart’s electrical activity to look for signs of heart disease. If warranted, your doctor may suggest other tests, including:

• Blood tests
• Urinalysis
• Stress test
• Advanced imaging (MRI, CT, PET or echocardiogram)
• Coronary angiogram

The exploration of your medical history (including that of your family) is critical to building the best plan for your heart health. If you have diabetes or high blood pressure, your risk of heart disease will be elevated. The same is true if your immediate family (parents, brothers or sisters) has a history of cardiac death – particularly at a young age. If heart attacks have occurred before the age of 60, that could suggest a genetic predisposition runs in the family.