Frequently Asked Questions
A cardiologist is a physician that specializes in people’s heart health. This can be varied in its scope, from preventive care to treatment of active conditions in the hospital or office. Preventive cardiology care may include proactively managing blood pressures, cholesterol levels, diabetes, or even just simple lifestyle and diet modifications to prevent the development of cardiovascular disease. Your cardiologist may talk about weight loss and an exercise regimen to prevent or treat disease. They may also talk about what medications work best for you.
A cardiologist has typically gone through medical school, followed by training in internal medicine. This is followed by several years of training in general cardiology, and possibly followed by further specialization in specific areas of cardiology such as electrophysiology, interventional cardiology, heart failure and transplant, or imaging, to name a few.
There are many different areas that a cardiologist may specialize in. A general cardiologist helps to manage a person’s overall cardiovascular health, including blood pressure, lipid, or diabetes management, or people with existing conditions, such as coronary or peripheral arterial disease, arrhythmias, atrial fibrillation, or pacemaker/defibrillator management, and others. Always ask your cardiologist what his or her specific areas of interest are.
A general (sometimes called diagnostic) cardiologist will help to manage a person’s overall cardiovascular health. This may include treatment of blood pressure, cholesterol, or diabetes, as well as treatment of arrhythmias or coronary artery disease. He or she may perform diagnostic procedures, such as cardiac catheterizations or transesophageal echocardiograms. An interventional cardiologist (interventionalist) may do all of these procedures as well, but can also treat arterial blockages by using balloons or placing stents to keep an artery open. A general cardiologist will typically work together with an interventionalist and the patient to determine the best course of action for the patient’s disease.
An electrophysiologist cardiologist, or EP, is a cardiologist that specializes in heart rhythm management and treatment. These conditions typically include bradycardia (slow heart rates), tachycardia (fast heart rates), atrial fibrillation (AFib or AF), atrial flutter (Aflutter), supraventricular tachycardia (SVT), ventricular tachycardia (VT), and others. An electrophysiologist will see patients in the hospital or office, and will offer various procedures for treatment of a person’s arrhythmias.
If you are a new patient to a cardiology practice, anticipate a longer initial visit to complete paperwork and oftentimes obtain records from your other medical providers. Also anticipate a longer visit due to your cardiologist gathering your full prior history and performing a thorough initial physical exam. You will likely have an EKG done on your first visit, and all of your medications will be reviewed. Your first visit may take 1-2 hours overall.
A follow up visit may be varied in length, depending on the nature of the visit. Anticipate up to 60 minutes for a follow up visit. This may be even longer depending if you, or even people before you, need a longer visit to ensure all your needs are addressed.
Expect an echocardiogram appointment to last 30-45 minutes.
Expect an carotid ultrasound appointment to last 30-45 minutes.
Expect an arterial/leg ultrasound appointment to last 30-45 minutes.
Expect a treadmill stress test appointment to last 30-45 minutes.
Expect a nuclear stress test (either treadmill or pharmacological/chemical) appointment to last 3-4 hours.
A cardiac catheterization can go by different names, including a cardiac or heart cath or coronary angiogram. This typically involves going through one’s wrist (radial approach) or leg (groin or femoral approach). A tube (sheath) is placed in the artery, and through that, catheters (long plastic tubes) are passed up to the heart over a wire. These catheters are then placed into the arteries of the heart (coronary arteries), and contrast (dye) is injected into the arteries. The cardiologist performing the procedure then looks under XRay for any evidence of blockages in the arteries to the heart. If there are any blockages, a decision can then be made (with the patient’s involvement) on the best way to treat the blockage. At the same time, another sheath may be placed in the vein, with catheters passed up to the heart and lung to measure pressures in both. This may help diagnose certain lung diseases.
The biggest risk of a cardiac catheterization is typically bleeding from the site of the procedure, and that risk is usually decreased by using a radial approach for the procedure. There is also a small risk for damaging the arteries that the procedure is performed through, or even of the arteries of the heart. There is also a small risk of heart attack, death, or stroke from the procedure. Because these procedures are typically performed in a hospital, in a controlled setting with physicians, nurses, and appropriate staff involved, the risks are greatly reduced. Always ask the physician performing the procedure about the risks and benefits beforehand.
Your cardiologist may order a stress test to determine your cardiovascular status, and assess your risk of cardiac events.
The most basic type of stress test is a treadmill stress test. For this, you will be asked to walk on a treadmill under supervision. Your vital signs, including blood pressure and heart rate, will be watched as you walk on a treadmill. You will be hooked up to an EKG to look at the electrical function of your heart. The speed and incline of the treadmill will gradually increase over several minutes, and you will be assessed for how long you can walk, as well as how your vital signs and EKG looks. This may give clues on signs of cardiac or coronary artery disease.
If you cannot walk on a treadmill, or your cardiologist decides this is not the best for you, you may be given medicine (Lexiscan) to stimulate the heart, and again look for signs of heart disease or coronary artery disease on your EKG. The side effects of this medicine (Lexiscan or regadenoson) include arrhythmias, chest pain, shortness of breath, palpitations, or extremely rarely heart attack or death. The test is always performed with staff and a cardiologist present, so even the rare risks are minimized.
In addition to monitoring your EKG with either a treadmill or chemical stress test, your cardiologist may want to take pictures of your heart before and after the stress for comparison. One way is an echocardiogram ( stress echocardiogram) to look at ultrasound images of your heart with rest and stress. Another way is by injecting a contrast that uses nuclear activity picked up by a special camera, to look for areas of concern with the heart.
An electrocardiogram, sometimes abbreviated as an ECG or EKG, is an electrical reading of your heart. It can tell if there are any active rhythm issues or if you are having a heart attack. It may also tell if there are signs of damage to the heart, or risk of having heart issues in the future. You will have 10 leads attached to your chest and body, for a total of a 10 second reading.
A Holter monitor is a long-term electrical reading of your heart. It is similar to an EKG, and can be worn at home for 24 hours or up to 2 weeks. It is used to detect any rhythm issues while it is being worn.
A loop recorder is a heart monitor that is implanted under the skin. Unlike external EKGs and Holter monitors that are limited in their length of time worn, a loop recorder has up to a four year battery life. As it is under the skin, your activity afterwards is not limited in any way. The loop recorder can help detect heart rhythm issues, such as atrial fibrillation, or slow or fast heart rates. It can helpful in patients with frequent symptoms such as syncope (passing out) and palpitations, as it can help include or exclude underlying arrhythmias.
After you have your pacemaker implanted, you should avoid getting it wet for a few days after the procedure. For a few weeks after that, you will have to limit use of your arm on the side of the pacemaker, including avoiding lifting your arm above your head, lifting heavy objects, and driving with that arm.
After bypass surgery, you will receive instructions from the hospital about activities you can and cannot do. For example, you will have to avoid anything that strains your chest wall for several weeks to months. This includes avoiding using your arms to get up from a chair, lifting anything heavy, or doing any swinging motions with your arms.
A CardioMems monitor is an implantable device that goes into the artery to your lung. It is implanted through a vein, typically in the leg, as a same-day procedure. Once it is implanted, it can help monitor the pressures inside of the lung to detect worsening signs of heart failure. These measurements can help guide your provider to adjust your diuretics (water pills) so that your heart failure symptoms, such as shortness of breath or leg swelling, are greatly reduced in frequency and severity.
An Impella is a device that goes through the artery in the leg to help the function of the heart. In an emergency situation, such as a heart attack, cardiac arrest, or acute heart failure and shock, it can help the heart beat stronger and take the workload off the heart. Similarly, when used electively, it can reduce the work of the heart so it pumps more efficiently, such as during stent procedures.
Blood work done prior to any procedure is usually good for no more than 30 days. Blood work in general may be good for up to a year, although this may vary depending on the situation, and at the discretion of your provider.
There is no perfect answer to this question. Just like asking for restaurant reviews, the ‘best’ cardiologist for you is the one that you are the most comfortable with, knows your history, is able to diagnose and treat you appropriately. Not every treatment plan is the best for everyone, and you should have a cardiologist that works best with and caters to you. There are quite a few cardiology groups in the Las Vegas area that have established a respected reputation with patients. Las Vegas Heart Associates, Heart Center of Nevada, Nevada Heart and Vascular Center, Nevada Cardiology, Desert Cardiology, and Intermountain Healthcare all have very well respected cardiologists that are well liked and have good outcomes for the Las Vegas community.
If you need copies of any visits, testing, or treatment done at the office, just call or ask your cardiologist’s office in person. You always have the right to see your own records. If you want to obtain your records from the hospital, just ask the medical records department at the hospital.