If you are showing signs of heart damage, or are preparing for a surgery, you may be referred to a cardiologist. This is a doctor who specializes in diseases of the heart and blood vessels. A cardiac evaluation can determine if you are at low, intermediate, or high risk for 1) developing cardiovascular disease (CVD) or 2) having a major cardiovascular event happen during the perioperative period. Continue reading to find out which areas may be covered during your cardiac exam so you can prepare yourself.
To skip to a helpful checklist of what to expect at a cardiac evaluation, click >HERE<.
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 to you but others not so much. Here are a few reasons your heart may need some special attention (HINT: if you have more then 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
They 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 doctor over the course of 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 both developing CVD and ensuring no serious heart events happen to you during or following the time of your surgery. Some of these major cardiac events include:
- heart attack
- myocardial infarction (MI)
- congestive heart failure (CHF)
- respiratory failure
Although this is not an exhaustive list. Other cardiac, pulmonary, and neurological events are possible following any surgery. And its 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 who have 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 a noncardiac surgery.
And an observational study shows that patients having a cardiac 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 the cases.
The Physical Exam
During the physical exam, your vital signs will be taken.
These will include taking your pulse, blood pressure, listening to heart sounds and rhythm with a stethoscope, and assessing any physical abnormalities to your chest cavity.
One important part of the physical exam is palpation. This is 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 also may 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.
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 any medical conditions you have. These include any past or current 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 underwent general anesthesia may have had some minor complications afterwards. 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. Bringing a list of your medications with the dosing information is recommended.
If you’ve recently stopped or started any medications, let them know this as well.
If having a cardiac evaluation prior to 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 blood pressure from getting too low during your surgery.
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 waiting too long, the only symptom you may end up noticing is a heart attack or stroke.
If your cardiologist feels you are in need of further evaluation, you may need tests to get more information on how your heart is functioning. These could include tests such as an echocardiogram or stress test.
And echocardiogram (AKA echo) can sometimes be performed in your cardiologist’s office, however you may have had one prior to 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’re awake during this procedure 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.
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 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 where drugs will be used to raise your heart rate.
Related Article: For more detailed information on types of stress tests and what the procedure entails, read “Can You Eat Before a Stress Test?“
Bloodwork for Cardiac Evaluation
There are specific labs values that 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:
- Cardiac troponins T and I for myocardial ischemia and damage
- C-reactive protein for inflammation
- B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) for ventricular function
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 your heart is compromised.
Other Factors that Determine Cardiac Risk
If you are there because of 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.
And 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 ones that you cannot do much about to help reduce your risk. 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 increase significantly after the age of 40 years. They also state that 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.
These include managing any other health conditions you 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 an adequate blood sugar level on a daily basis. You can do this through proper diet, exercise, and medication management.
In addition, a large meta-analysis shows that hypertension is a strong correlating factor to the development of vascular (and overall) mortality. So, by managing your high blood pressure, you can help stave off cardiovascular disease in your future.
Lifestyle choices are also modifiable. It has long been known that the lifestyle choices you choose have a large impact on your health. These include factors such as cigarette smoking, diet, physical activity, whether or not you are clinically obese, and psychosocial factors.
Your cardiologist may encourage you to start a heart healthy diet regimen or begin an exercise program that includes cardiovascular activity.
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 for developing cardiovascular disease. By taking all of the above information into account, your risk level can be individualized to YOU.
The goal of your healthcare team is to enhance your health outcome as much as possible. With your cooperation, they can accomplish this and you can get on with a new, improved look 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.
Share With Me: Do you see a cardiologist regularly? What did you encounter on your first visit? I’d love to hear about it! Comment me below!
Kiran Campbell is a registered dietitian and entrepreneur with 13 years of experience. She has a degree in psychology as well as dietetics. She is also a proud member of the Academy of Nutrition and Dietetics’ and its Cardiovascular Health and Well-being Dietetics Practice Group among others. Kiran proudly presents and promotes the most up-to-date, science-based nutrition information on all things heart-related. She aims to serve not only individuals with heart disease, but also those wanting to protect against it. Learn more about Kiran by visiting her About Page.