Role and Expertise
Cardiologists are highly specialized physicians who treat individuals with heart disease. There are several types of cardiologists; some are trained to manage cardiac (heart) problems by using only medications and cognitive skills, and others are more invasive and will do procedures such as angiograms to study the architecture of the heart's blood vessels. The most invasive types of cardiologists will perform balloon angioplasty (a procedure for the treatment of narrowed arteries where a balloon-tipped catheter is inserted into an artery to press plaque back against the vessel wall) and placement of a stent (a procedure in which a wire mesh tube is inserted through a catheter and placed in an artery to hold it open. This is usually performed right after a balloon angioplasty, while the catheter is still in place). Another group of cardiologists called electro physiologists study arrhythmias (irregular heartbeats) by using electricity to induce and treat them.
Training and Credentials
Most cardiologists complete two or three years of additional training after finishing three years of medical residency. The additional training is called a fellowship and this is usually done in a university medical center. During the fellowship, the trainee learns the intricacies of heart diseases and their management. Most cardiologists become board certified shortly after training.
Preparing for the Visit
Cardiologists usually see individuals at the initial onset of a cardiac problem such as severe angina (cardiac chest pain) or an arrhythmia (irregular heartbeat). Your primary health care provider will make a referral to a cardiologist if that is necessary. The cardiologist will make the initial diagnosis and recommend a course of treatment. Usually, after the acute problem stabilizes, your primary health care provider will manage your ongoing treatment.
Before referring you to a specialist, your primary health care provider may evaluate your heart functioning through a diagnostic tool such as an electrocardiogram. These initial test results will provide the basis of your first visit to the cardiologist. At your first appointment, the cardiologist will ask specific questions regarding your symptoms then suggest one of the following tests to assist in the diagnosis and management of a cardiac problem:
- An Electrocardiogram (EKG) studies the electricity in the heart.
- An Echocardiogram (ECHO) is an ultrasound picture of the heart showing structure and some dynamic function.
- A Stress Test is EKG monitoring while exercising.
- A Nuclear Cardiac Test shows the dynamic function of the heart.
- An Angiogram shows the structure of the interior of the coronary arteries.
In preparing to visit the cardiologist, remember that
- full evaluation might take several visits and procedures,
- follow up with the cardiologist could be long-term,
- referral to a cardiac surgeon might be necessary,
- asking specific questions about your condition will help you understand your condition better,
- if you do not have questions at the time of the first visit, you can write questions down later and have them answered by the cardiologist or cardiac nurse, and
- cardiologists are frequently called away for emergencies, so be prepared to wait at your scheduled appointment time.
Cost and Coverage
The primary health care provider usually refers people to cardiologists. Though diagnostic testing of the heart is quite expensive, the tests are usually necessary and are covered up to 80% by Medicare Part B. Individuals with supplemental Medicare insurance (Medigap) should check with their insurance providers for details on coverage of cardiology services.
Author: Joseph James, M.D.