When To See A Cardiologist?

[Music] hi welcome to another episode of talking with docs I'm Dr Paul zalzal and I'm Dr Brad weaning and I'm Mike Heffernan Dr Mike Heffernan is a cardiologist and we are so fortunate to have him here today we were able to peel him off the golf course to come and talk to us today about some Cardiology issues okay so today we're going to talk about what happens when you're referred to a Cardiologist okay what's that encounter going to be like okay you might be sitting there going oh boy I got I was referred to a Cardiologist because I had some chest pain what's going to happen what's this visit going to be like so let's take it from there sure and I understand that there's anxiety right do you uh you might be waiting a few weeks you might be waiting a month before seeing us and uh and so you know hopefully this this will help to a degree um so number one you know when you come to an office like this and uh and you your family doctor has reported that you've had some unusual chest pain not chest pain by the way that's been bad enough to say look you go get an emergency department right away this is chest pain where they're not really sure it doesn't really sound like heart pain but they can't completely know for sure so we'll send you the cardiologist to help sort that out and is that a relatively common sort of referral it is and so um so first thing we're going to do is of course we're going to greet you we're going to try and make you feel comfortable um and uh and we're going to do a history and the history and me listening to your story is going to be the most important feature because there are some things that you're going to say that are going to make me think Yep this is absolutely heart pain we have to take this uh very seriously and go forward or this is extremely unlikely to be heart pain and uh and and we'll provide some reassurance so it's a combination of their story and then some very pointed questions that you would ask absolutely yeah and give us a give us three quick things to say that make you think oh boy this is this is sure art so that it is hard okay so uh I doc I've got this crushing as soon as they put like a fist like this rather than a finger so they go yep it's a crushing discomfort it feels heavy they use words like heavy pressure tightness and they start to say it's here they don't say oh it's a single dot right there but it's kind of more diffuse that makes us concerned so that's number one number two if they say uh yeah you know what it also happens every time I do something whenever I take the garbage out whatever I go up a flight of stairs this comes on and it gets worse it's more severe sometimes I get annoyed when I take the garbage out is that I think yeah yeah and you say you know you ask your partner okay so so exertion so if exertion brings this on in a reproducible way and then when you stop it goes away that's a really that's a big red flag okay those are three good things like that on History those are three two kind of two and a half and then and then there are some other things that can kind of come into play so if you get sweaty if you feel nauseous if you're lightheaded when these things are coming on or your heart is racing at the time um then that's definitely things that we worry about and then that would lead me then to start ordering other tests um and the tests can be as simple as a treadmill test to look for abnormal abnormalities on the ECG that the dots that we put on your chest and the paper that kind of Scrolls off to something as invasive as an angiogram that was one of the picks I said too right um an angiogram yeah where we put uh we put a small uh you know a puncture either in your wrist or in your groin and fish a small catheter up into the heart squirt some dye down the arteries of the heart and find out if there's a blockage there so can really the tests that we can do can range from a simple stretch treadmill test to a nuclear test to a CAT scan to an invasive test like an angiogram we have a lot of a lot of tools in the toolbox Mike what those tests typically have in the day of the console I guess depending where you are maybe it will order the severity um so generally not the day of the you know the treadmill test that's that's what I think that could happen very quickly and can be the day of yeah something like a CAT scan or an angiogram is usually you know a few days later or a week or two later okay yeah one thing I've noticed too our viewers will know that we always say whenever we discuss a thing we all go history physical examination tests yes but with more and more virtual medicine obviously the physical examination is a bit tricky so we just go history that's all we can do virtually and then order some tests and then eventually bring you in for a physical exam but now in this encounter let's say you are fortunate enough to have a face to face with the patient and not a virtual encounter what what kind of things do you do on physical exam you've taken a history you can do a physical exam of this patient that's come in what kind of things are you looking for there yeah so uh we're looking for their their heart rate okay so is it too fast is it too slow looking at the blood pressure you know well controlled or maybe not well controlled um and then listening to the chest are there signs and symptoms of heart failure that might be going along with something perhaps a patient had a heart attack a few weeks ago and uh and we can kind of get some Clues as to whether that happened and then and then we're listening to the heart and we're listening in particular for abnormal heart sounds what's that thing yeah I know I know as a surgeon you wouldn't be familiar with this um so we're listening for abnormal heart sounds maybe there's a valve problem for instance and uh something else that might be going on and that's a skill that I think the average patient probably doesn't appreciate like this thing can tell so much information about your heart and it's really really subtle when we're in medical school and in training you listen to hundreds of different people and half the time especially at the beginning you couldn't really hear and then someone would kind of guide you saying do you hear this extra little sound and they're like okay that means this bounce closing at this rate and yeah it's an amazing skill and it's a critical part of the test and it's called a stethoscope yeah just in case anyone out there is wondering yes and you know it's a device that's more than 100 years old amazing and and really it's quite elegant yeah yeah okay so you're gonna go see your cardiologist and you he's going to he or she is going to take a history a physical exam if it's an in-person thing will happen and then tests will be ordered and then presumably then you'll make a diagnosis say yes this is cardiac origin or no this is not a cardiac origin and then determine the treatment algorithm based on that right the test really you know I say in my letters to the family doctors who made the referral the test is going to dictate what we do it might be congratulations Mrs Smith you have normal coronary arteries don't have to worry about it or I'm sorry Mr Rogers you know you've got blockages in all three of your main coronary arteries you need an angioplastier bypass surgery just just lastly for the patient when they are getting prepared is there anything that you would um advise them to do stay at home the night before or even weeks before oh yeah what could they do to be more prepared and to make the visit more useful for both the most important thing is bring your medication okay you know I not even a list and if you if you can bring the bottles we're happy to go through it um it's a really important thing especially if you're coming into the office and you already have some other diagnoses yes if you have high blood pressure you have diabetes you have other things that kind of going on in your life I need to know the medications you're on it also changes how I feel about the story you're about to tell me if you've got some other risk factors I might be more worried so bring in your medications if you have the ability to do your blood pressure at home it's really nice when people can do that and take you take some control over your health that way you can bring in some sample you know readings then I don't have to believe the reading I get in the office sure White Coat Syndrome right that's how you've heard of that where when you're in the doctor's office and they measure your blood pressure it's much higher than typically it is when you're at home relaxed just because you're a little bit anxious because you're in the doctor's office right and so those home readings Trump whatever I get in the office so medications blood pressure and then maybe if you ever encourage them to like Journal say hey when did you get the chest pain what were you doing like try to keep track like I had a Tuesday and then I had a Thursday night yeah to a degree okay but not to a point where it's so neurotic that you know takes over the election it takes over your life go back to scrapbooking right yeah okay that's a that's an awesome summary um so you guys know what to do now be prepared for your visit um the cardiologist is going to go through many different things including a physical and some investigations and get you on the proper path for your free heart if you like this video please like it subscribe to our Channel and again thank you very much we're going to drop you back off on the 11th hole from where from where we kidnapped you to come here remember you are in charge of your own health we'll see you next time

Channel: Talking With Docs

Views: 66,240

Keywords: angina, heart attack, MI, cardiology, cardiologist, angiogram, catheterization

Id: JxDtr4zyOkw

Length: 8min 47sec (527 seconds)

Published: Sun Sep 12 2021