Dear Doctors: I am 65 years old, and I have never been to a cardiologist. I am concerned about heart disease and the possibility that I may have blocked arteries. I would like to know what screenings -- an MRI? an exercise stress test? -- I should get.
Dear Reader: As someone who has not undergone the screenings commonly used to evaluate cardiac health, it's best to start with the basics. These can be done by your regular doctor.
The appointment typically begins with a discussion of your medical history. This includes information about any diseases or conditions for which you are currently being treated, and any in your past that may have a residual effect on general health. Family history, which can suggest a genetic predisposition for certain diseases and conditions, is an important factor, as well.
Your weight, and possibly your BMI, will be recorded, and your doctor will obtain readings for heart rate and blood pressure. Testing will also include a blood lipid profile and a blood glucose level. Taken together, this information offers important insights into health risks that you may face. If the test results suggest a problem beyond the scope of your primary health care provider, such as a heart condition or heart disease, they will refer you to a cardiologist.
When visiting a cardiologist, expect them to review the test results that brought you under their care, and to explain how the results are a factor in the health of your heart. Depending on those results, you may also be asked to undergo additional tests that assess various aspects of cardiovascular health. These can include an EKG, which measures electrical activity in the heart; echocardiography, which uses ultrasound to create moving pictures of the heart; and scans that measure blood flow in the veins or that identify the presence of calcium deposits. A test known as CCTA, or coronary computed tomography angiography, produces 3D images that can help detect abnormalities in blood flow and identify possible blockages. An exercise cardiac stress test measures heart rate and rhythm, blood pressure and electrical activity of the heart as the patient performs increasingly strenuous exercise.
The cardiologist will also discuss specific aspects of your lifestyle. This includes a review of your diet, exercise habits, use of alcohol or tobacco products and your perceived level of stress. You will be asked about medications you are currently taking. It's important to provide the doctor with a complete and accurate list, and to also include any dietary supplements that you may be using. They will also want to know about any family history of heart disease.
Depending on the findings, you may be prescribed medications to manage high blood pressure or high cholesterol. You may also be advised to make lifestyle changes. These can include reaching a healthier weight, exercising more or more frequently, adjusting your diet, moderating the use of alcohol and quitting tobacco products. Your cardiologist will also schedule additional appointments to evaluate the efficacy of your treatment program. For the health of your heart, and your general well-being, it's important that you follow through.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
