What to Expect During a Cardiac Evaluation

If you are showing signs of heart damage, or are prepping for an upcoming heart surgery, you may be referred to a cardiologist. A cardiologist is a doctor who specializes in diseases of the heart and blood vessels. A cardiac evaluation can help determine your risk of developing heart disease or having a major cardiac event during the perioperative period.

Keep reading to find out what to expect during your cardiac evaluation.

>>Don’t forget to check out this helpful Cardiac Exam Checklist to prepare yourself.

Reasons To See a Cardiologist

There are many reasons besides having an upcoming surgery that you may need a cardiac evaluation. Some reasons may be obvious, but others not so much. Here are a few reasons your heart may need a cardiology consultation:

HINT: If you have more than one of the following, you might want to make an appointment.

  • You have a strong family history of heart disease
  • You have high blood pressure
  • You have high cholesterol or dyslipidemia
  • You are a smoker
  • You have been diagnosed with diabetes
  • You had congenital heart disease as a child

The cardiologist can help you figure out what is causing your shortness of breath or chest pain. Cardiologists can also help you optimize your blood vessels and manage your lipid levels to prevent atherosclerotic heart disease. They will work with you and your primary care doctor over months to years to develop the best plan for you.

What is a Major Cardiac Event?

As mentioned above, the purpose of a cardiac evaluation is to evaluate your risk of developing CVD and ensure no serious heart events occur during or following the time of your surgery (the perioperative period).

Some of these major cardiac events include:

  • heart attack
  • stroke
  • arrhythmia
  • myocardial infarction
  • congestive heart failure
  • atelectasis (collapsed lung)
  • respiratory failure
  • death

Although this is not an exhaustive list. Other cardiac, pulmonary, and neurological events are possible following any surgery. It is important to note that not all complications are due to the surgery itself. Some complications are related to the general anesthesia you will be given.

Some patients with no prior medical history or CVD risk factors may not need an extensive cardiac evaluation. But for others, your cardiologist may spend a significant amount of time assessing each risk factor.

According to one medical review, heart complications happen in 3% of patients hospitalized for noncardiac surgery.

Additionally, an observational study shows that patients undergoing heart surgery are prone to a series of pulmonary, cardiac, neurological,
and infectious complications
.

The most common complication was atelectasis, or collapsed lung, which accounted for about 41% of cases.

The Physical Exam

During the physical exam portion, your vital signs will be taken.

This includes taking your pulse, and blood pressure, listening to heart sounds and rhythm with a stethoscope, and assessing any physical abnormalities in your chest cavity.

One important part of the physical exam is palpation. This involves the actual touching of the patient by the doctor. It can be awkward, but necessary. If you are a female, your doctor may ask you to remove your bra to better hear and feel heart sounds and vibrations around your chest.

This part of the cardiac evaluation may also involve assessing veins and arteries. This is because atherosclerosis, which is the build-up of plaque in arteries, is a common cardiovascular issue that will increase your risk of a cardiac event.

Cardiac evaluation vitals
Pictured: Nurse taking a patient’s blood pressure

Reviewing Your Medical and Surgical History

The medical and surgical history portion of your cardiac evaluation will include questions about heart problems or symptoms you are having along with your medical history. These include any past or current medical conditions and issues.

It’s a good idea to disclose any recent surgeries or conditions you’ve been diagnosed with as well.

Additionally, your doctor will ask about your family history, as genetics is a good predictor of many medical conditions.

Occasionally, patients who have had surgery before or have undergone general anesthesia may have had some minor complications afterward. Discuss any of these concerns during your exam to ensure your doctor knows how you reacted previously.

Reviewing Current Medications

You will also need to tell your doctor which medications you are taking. Bring a list or copy of your current medications with the dosing information.

If you’ve recently stopped or started any medications, this should be disclosed during your cardiology consultation as well.

If you’re having a cardiac evaluation before surgery, you may need to have certain medications adjusted or even stopped days or hours before your surgery. These may include:

  • blood pressure medications
  • anticoagulant medications
  • antiplatelet medications
  • pain medications

This is to reduce bleeding risk and prevent your blood pressure from getting too low during your surgery.

cardiac medications

Discussing Signs and Symptoms

You will also be filling your cardiologist in on any signs and symptoms you are currently having. These could be anything out of the ordinary or even things that you feel are minor, such as feeling more tired, achy, or having indigestion.

Statistically, men are less likely than women to keep regular doctor appointments. They are also less likely to report signs and symptoms they feel aren’t a big deal. Likewise, symptoms can be misdiagnosed or misinterpreted. Thus, it is important to get a cardiac specialist involved to rule out any serious conditions.

No matter which gender you are, it’s important to talk about these things. Many times signs of heart disease are silent, such as hypertension or hyperlipidemia.

If you wait too long to mention these often overlooked symptoms, the only symptom you may end up noticing is a heart attack or a stroke.

Cardiac Evaluation Tests

If your cardiologist feels you need further evaluation, you may need specific cardiac tests to get more information on how your heart is functioning. These could include tests such as an echocardiogram or stress test.

Echocardiogram

And echocardiogram (AKA echo) can sometimes be performed in your cardiologist’s office, however, you may have had one before your visit.

An echocardiogram uses sound waves to make a picture of your heart, including the chambers, valves, walls, and blood vessels around your heart. You are awake during this cardiac test and can see the ultrasound picture on a screen while the procedure is being done.

This test helps your cardiologist by showing your heart’s size, shape, thickness, and how your blood is pumping into and out of your heart.

Stress Test

You may also need a stress test. Like an echocardiogram, you will be awake during a stress test.

This test is used to analyze how your heart reacts under cardiovascular “stress”. It can help your doctor understand and explain why you may be having some of your symptoms.

There are several different types of stress tests. You may be walking on a treadmill, cycling on a stationary bike, or if you are physically restricted, you may have a medically-induced stress test. This is when medication will be given intravenously to raise your heart rate temporarily.

Related Article: For more detailed information on types of stress tests and what the procedure entails, please read “Can You Eat Before a Stress Test?

female ultrasound technician wearing facemask and standing next to ultrasound machine
Pictured: sonographer preparing for echocardiogram procedure

Bloodwork for Cardiac Evaluation

Some specific lab values can help identify and predict cardiac risk. They may or may not be ordered by your cardiologist.

The lab values and which conditions they can help identify are:

This bloodwork may also be done after your surgery to make sure your heart is functioning as it should. In general, if any of these lab values are elevated, it may indicate that your heart is compromised.

Other Factors that Determine Cardiac Risk

If you have a cardiology consultation for an upcoming surgery, your cardiologist will also consider factors such as:

  • type of surgery
  • urgency of surgery
  • duration of surgery

Knowing this information will help calculate your risk for a serious cardiac event.

For those getting an evaluation due to recent signs and symptoms, your cardiologist will also take non-modifiable and modifiable risk factors into account. Let’s talk about what these factors are below.

Non-Modifiable Cardiac Risk Factors

Non-modifiable risk factors are factors that you have no control over. These include things like your age, gender, and family history.

According to the National Institute of Health, your risk for CVD and other vascular diseases increases significantly after the age of 40 years. Males show a higher risk for CVD than females when comparing different populations. Additionally, if you have any immediate family members who have died from or are diagnosed with CVD, you are also at higher risk.

Modifiable Cardiac Risk Factors

Modifiable cardiac risk factors are ones that you have some control over. This means you can actively make changes to decrease your cardiac risk.

Reducing these risk factors involves adjusting your lifestyle behaviors.

This includes managing any other health conditions you may have. For example, if you have type 2 diabetes, you can decrease your risk of developing cardiovascular disease (and other diseases and conditions) by maintaining adequate blood sugar levels daily. You can do this through proper diet, exercise, and medication management.

Hypertension is also a strong correlating factor to the development of heart disease and vascular mortality. By managing high blood pressure, you can help stave off cardiovascular disease in the future.

Lifestyle choices are also modifiable, and have a huge impact on your overall health. These lifestyle factors include cigarette smoking, dietary habits, physical activity, having a higher weight, and psychosocial factors.

During your cardiology consultation, your cardiologist may encourage you to start a heart-healthy diet regimen or begin an exercise program that includes cardiovascular activity.

strawberries and blueberries in bowl with the sun shining behind them

Riskiest Type of Heart Surgery

The riskiest heart surgery to perform is an open heart surgery. There are different types of open heart surgeries. Some examples include:

  • CABG (coronary artery bypass graft)
  • Heart valve repair
  • Repairing damaged areas of the heart
  • Heart transplant
  • Implantation of a heart device, such as a pacemaker

How Long Does a Cardiologist Appointment Take?

You can plan for your initial cardiologist appointment to last up to one hour. This allows time for any testing done during your visit and answering any questions you may have.

Remember to also arrive at least 15 minutes early to fill out any paperwork and have the receptionist make copies of your insurance card.

Conclusion

I hope this gave you an inside look into what happens at an initial cardiologist appointment.

After all is said and done, your doctor should be able to tell you if you are at low, intermediate, or high risk for your surgical procedure or your overall risk of developing cardiovascular disease. By carefully considering all the information mentioned in this article, your cardiologist can more accurately predict your risk level.

The goal of your cardiology consultation is to enhance your health outcomes. With your cooperation, this can be accomplished and you can get on with a new and improved outlook on life.

Related Article: For information on changes you can make right now to your diet and lifestyle AND reduce modifiable risk factors, check out “5 Things You Can Do to Support Heart Health NOW!

For a handy list of what to expect, print or download the checklist below.

Cardiac evaluation prep list

Share With Me: Do you see a cardiologist regularly? What did you encounter on your first visit? I’d love to hear about it! Leave me a comment below!

1 thought on “What to Expect During a Cardiac Evaluation”

  1. My family has a medical history of heart disease, so as a preventive measure, I was thinking of getting a cardiac evaluation just to be sure that I’m in good health. I appreciate you informing us that aside from checking our pulse and blood pressure, a cardiac evaluation also involves checking our veins and arteries in case there is plaque building up in our arteries that can increase the risk of cardiac events. I’ll be sure to bear this in mind while I look for a heart health clinic to go to for a checkup soon.

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