ARTICLES ON Cardiology

When you experience chest discomfort, breathlessness, unusual tiredness, or notice an irregularity with your heart rate, one of the first questions that may come to mind is: Do I have an emergency? Is my situation such that I should see a doctor? But the question arises: to whom?  Cardiologist or cardiac surgeon? That’s a frequent concern, especially if you’re concerned your symptoms could indicate a serious heart problem. Your cardiologist will review your lab results, medical history, risk factors and symptoms to get a sense of what may be affecting your heart. But if your condition requires surgery, the cardiologist will usually collaborate with a cardiac surgeon to determine the best plan. However, every heart condition is different. Some require immediate attention, while others can be tackled with medications.  Let this guide help you determine when to see each specialist and how surgery decisions are made in real life. Understanding The Role of a Cardiologist Cardiologists are doctors who specialize in diagnosing and treating diseases that affect the heart or vascular system (circulation) but do not involve surgical intervention.  Heart specialists have many years of training to be able to diagnose the type of problem you have with your heart, as well as to provide treatment options for those issues through the use of medications and other non-surgical treatments.  Cardiologists are typically the first physician to see when you experience chest pain, an abnormal heart rhythm, high blood pressure, etc. During a consultation, your cardiologist may ask about: Chest pain or discomfort. Breathlessness. Palpitations or irregular heartbeat. Dizziness or fainting. Swelling in the legs or feet. Your blood pressure and cholesterol levels. Diabetes, smoking, obesity, and family history. Previous heart problems or procedures. Based on your symptoms, your heart specialist will perform several tests to find out the cause of your condition and heart function. Some examples are: Electrocardiogram (ECG) .  Echocardiograms.  Stress test. Cardiac catheterization.  The results will help them decide if they need medication or if they need to make lifestyle changes. Surgery may also be an option. Think of a cardiologist as the detective who figures out what is wrong with your heart. When to See a Cardiologist? Most people are usually confused about when to see a cardiologist.  You need to see a cardiologist before undergoing any surgery. Chest pain, difficulty breathing, heart palpitations, lightheadedness/dizziness, and swelling in your legs are all symptoms that require a visit to a cardiologist as your initial point of contact.  A patient may either be referred by their primary care physician to a cardiologist, or they can search for a cardiologist near me online to find nearby specialists. The reason to see a cardiologist first is simple: surgery should be a last resort, not a first option. Finding an appropriate cardiologist has never been simpler for those living in large cities. For example, if you are in Mumbai, searching for a cardiologist in Mira Road will show you qualified specialists in your area. Hospitals and medical centers with online appointment-scheduling systems also make it easy to book an appointment with a cardiologist. What Does a Cardiac Surgeon Do Differently? A cardiac surgeon is a surgical specialist who performs surgeries on the heart and lung systems. They complete formal medical education and then spend additional years learning the operating room skills needed for this type of work. Unlike a cardiologist, a cardiac surgeon focuses on repairing heart problems through surgery when medications alone cannot help. Cardiac surgeons generally perform surgical operations such as:  Coronary artery bypass grafting.  Replacing valves within the heart.  Performing heart transplantations.  Repairing defects present at birth.  Cardiac Surgeons will oversee all aspects of your medical care from the time you enter the hospital before surgery through your post-operative recovery period. Who Decides If You Need Heart Surgery? Remember that decisions about whether you need heart surgery are rarely made by a single physician. In many cases, your treatment plan will require input from a team that may include your cardiologist, a cardiac surgeon, an anesthetist, imaging specialists, and possibly others on the health care team. A multidisciplinary heart team approach is often recommended for complex coronary artery disease. Specialists can review the patient’s medical history and evaluate all potential treatments. The American Heart Association emphasizes that when the best treatment option is unclear, patient preferences, goals, and shared decision-making are also considered.  When Might Surgery Be Recommended? Not all patients diagnosed with heart disease will require surgical intervention. Treatment for coronary artery disease (CAD) may include medication or lifestyle modifications, angioplasty to place a stent within the narrowed coronary artery, or bypass grafting of one or more coronary arteries using CABG.  CABG is typically recommended when there are multiple blockage sites within the coronary vessels, in the case of very complex blockage locations, or if coronary disease cannot be properly managed through angioplasty. Other factors such as diabetes, heart function, symptoms, and overall health can also influence the decision. The cardiologist will use results from your tests (like coronary angiography) to determine whether you have a large number of blocked arteries.  They will then combine this information with your past symptoms, your medical history, how well your heart is functioning, and any other factors that may put you at risk of another cardiovascular event. Sometimes a cardiologist may use angioplasty or stenting to treat the blockage. In many cases, bypass surgery is the best treatment. Sometimes medication and regular monitoring are enough. When Does a Cardiac Surgeon Come Into the Picture? You may be referred to a cardiac surgeon if your test results indicate a surgery. The professional will review your reports and may discuss: Why surgery is being recommended. What type of surgery will be needed. Any alternative options that may exist. The benefits expected from surgery. Risks and complications to expect with surgery. Hospital stay and your recovery time. Medications you should take before surgery and after surgery. Lifestyle changes for heart health. The heart specialist and cardiac surgeon may discuss your case; this

When you receive your TMT test (treadmill stress test) results, the word positive can instantly make you anxious.  Does it mean you have a heart problem? Is a blockage confirmed? What test comes next? Relax. Take a deep breath. A positive TMT does not confirm that you have an artery blockage or that you have a serious heart disease. The positive result simply indicates that your doctor will want additional information before making a definitive diagnosis of heart disease. Rest assured, this article explains what a TMT test is, what a positive result means, possible tests to perform after receiving a positive result, and why it is crucial to schedule an appointment with a cardiologist when you’ve had abnormal results. What is a TMT Test and Why is it Done? If you have been asked to do a treadmill stress test (TMT), you may already know what it involves. You should walk on a treadmill while your ECG, blood pressure, and heart rate are monitored during the test. A treadmill test is alternatively called an exercise stress test. A TMT test aims to see if your heart is able to function appropriately in response to physical exertion. An underlying problem may show up on your ECG if the heart doesn’t get an adequate blood supply during exertion. Your physician may also recommend that you undergo a TMT test if you have any of palpitations, unusual fatigue while walking upstairs, breathlessness during physical activity, or chest discomfort or pain. This also applies to those with a family history of heart disease or someone who has high blood pressure, diabetes, high cholesterol, or smoking history. A TMT test report can provide useful information, but it cannot confirm or rule out coronary artery disease. What Does a Positive TMT Test Mean? Getting a TMT test positive result can seem like an alarming diagnosis. However, it really depends on how you define positive. A positive TMT usually indicates a physical change on the treadmill that may suggest reduced blood supply to the heart muscle. The doctors will consider several things, including: ECG changes Your symptoms Exercise ability Your blood pressure Heart rate responses It is very important to remember that a TMT test positive does not mean that you have had a heart blockage.  False positives are possible with TMT testing. That is to say that your TMT test may have an abnormal reading even if you do not have one or more narrowed sections of a coronary artery. Because of this, doctors generally base their recommendations for treatment based on more than just the words “positive” written on your test results. What Should You Do After a Positive TMT? The first thing you should do is stay calm and not jump to the conclusion that you are in dire need of surgery or another invasive treatment. Schedule an appointment with a cardiologist. Bring all your complete TMT test results.  Your doctor will know what to do next when they have your full case history including your age, symptoms, other health conditions, general risk factors, and the results of your TMT test. Your doctor may ask questions such as: Was your chest area painful at any time during the test? When did symptoms begin for you? For how long were you able to workout during the test? Were there any ECG changes? Was your blood pressure affected too? Do you have a medical history of diabetes, high blood pressure, or cholesterol (high levels of fat)? Has there been a history of heart disease in your immediate family? These details matter because the same TMT result can mean different things for different people. Which Test Comes After a Positive TMT? There isn’t a single test that follows every time a TMT is positive. The next investigation depends on why the TMT was performed and how concerning the result is. The cardiologist has several options for tests as described below: Stress Echocardiography Stress echocardiography (also called stress echo) combines both physical exercise or another form of stress with an ultrasound of your heart. It shows the doctor how well the various parts of the heart muscle work while under stress. If a part of the heart muscle doesn’t function normally when the heart works harder, this could indicate reduced blood flow to that area. This test may be useful when your doctor wants more information after an abnormal exercise ECG. CT Coronary Angiography Coronary computed tomography (CT) angiography, commonly referred to as a CT coronary angiogram, is a non-invasive diagnostic imaging study that provides high-quality images of the coronary arteries.  This method allows doctors to evaluate whether stenoses (narrowing), plaques, and other abnormalities are present in the arterial supply to the heart. Your cardiologist may order this test based upon your symptoms, risk factors, or TMT test report, in an attempt to further define the coronary artery anatomy prior to ordering a potentially invasive coronary angiogram. Conventional Coronary Angiography Some people will require a standard coronary angiogram, for example, if they have alarming symptoms or findings suggesting severe coronary artery disease. The angiogram is an invasive procedure using a catheter to produce high-quality pictures of your coronary arteries. These high-quality images allow your doctor to assess how much narrowing there is in your arteries and what additional treatments you need. However, not everyone with a positive TMT test automatically needs it. The decision is based on the overall clinical picture. Echocardiogram Your doctor could suggest a routine (or standard) echocardiogram. Unlike a TMT test, this procedure will not require you to do any physical activity. It uses ultrasonic waves to evaluate the heart’s internal anatomy. In addition to providing information on the heart chambers, valves, and pumping function. While a regular echocardiogram cannot be used as a direct substitute for a TMT, a doctor using echocardiograms in conjunction with other tests will get much better results than if they relied on the TMT test alone. Why Your Symptoms Matter More Than a Single Test Result

Chest discomfort can leave you with one big question: Is it acidity, tiredness, stress, or something heart-related?  Sometimes chest discomfort is mild and subsides with rest.  Other times, you may experience chest pressure, shortness of breath, or pain during activity, which could lead you to consider an angiography, stress test, CT Scan, or MRI. The good news is that many individuals do not require invasive testing. The physician selects the appropriate cardiac test based on your symptoms, medical background, risk factors, and what they need to find out. A stress test will show you how the heart responds when it works hard. Conversely, CT angiography provides high-quality images of the coronary arteries. So, which test among the two is right for your needs? This guide explains and helps you understand all aspects of these tests. Why Do Doctors Recommend Cardiac Tests? The primary reason for experiencing chest pain is typically cardiac-related. However, it could be secondary to gastrointestinal issues, muscle strain, anxiety, or an assortment of other health-related concerns.  Chest discomfort in the shoulder area, arms, neck, back, jaw, or upper abdomen can result from decreased blood circulation to the heart. Some people with heart problems may experience shortness of breath or excessive fatigue. This is why it is important not to decide on your own that a particular test is necessary. Instead, have your doctor evaluate your symptoms, take your blood pressure, review your past medical history, family history, and possible risk factors (diabetes, hypertension, hypercholesterolemia, smoking, and prior heart disease). Depending on your risk level, you may need no immediate cardiac imaging, a non-invasive test such as a stress test, or an invasive angiography test. What Is Angiography?  Angiography is the process of using X-rays to see into the veins that transport blood throughout your body. Using this method to assess the condition of your coronary arteries is called coronary angiography (or a coronary angiogram). Conventional treatment uses a very thin tube (catheter) to guide itself into one of your arteries, commonly from either the wrist or the groin area. Once inside the arteries, a dye with contrasting properties is injected, and multiple X-ray pictures are then taken to provide clear pictures of whether or not you have narrowed or blocked coronary arteries. Unlike an assessment that only indicates whether blood flow to the heart may be decreased, coronary angiography gives your doctor a clear visual of the coronary arteries. Angiography can help in situations where it is suspected that a patient has severe coronary artery disease, or if test results indicate that further testing is necessary. When Might You Need Angiography? Your cardiologist may want to perform an angiography test when: You are experiencing symptoms that indicate that you likely have coronary artery disease. Previous tests on your heart reveal some type of abnormality indicating that there could be a serious problem with your coronary arteries. You know you have coronary artery disease, and now your symptoms have changed in such a way as to require further testing. Your doctors believe that there is evidence that there is significantly less blood flowing through your heart than it should. Your doctor needs a clearer picture of what’s going on so they can make informed decisions about how best to improve your circulation. Angiography has one big advantage: it can also be part of your therapeutic pathway. In many cases, if blockages could significantly impact your heart function, your cardiologist will determine the best treatment option for you from among medications, angioplasty, stent placement, or other options. Angiography is an invasive procedure and therefore carries some risk. Most patients feel that this is an extremely low-risk procedure. The major risks include bleeding or bruising around the area of the body in which the catheters are placed (the insertion sites), allergic reaction during the procedure, and other serious complications. What Is CT Angiography? CT coronary angiography (CCTA) is a non-invasive method of obtaining diagnostic images using computed tomography (CT) scans. It also uses a contrast dye for better visualization of the coronary arteries. This angiogram type uses a venous route and captures images of the heart and surrounding blood vessels. It allows physicians to determine whether there are narrowed areas or plaques within the coronary arteries. This makes CT angiography a useful option for selected patients, particularly when the doctor wants anatomical information about the coronary arteries without immediately proceeding to an invasive catheter-based procedure. When Might CT Angiography Be Recommended? Your physician will consider whether or not you should undergo a CT angiography if: You are experiencing chest pain or other related chest problems that would suggest you may have coronary artery disease (CAD). Your initial evaluation has not clearly determined the cause of your symptoms. Anatomically assessing the heart’s blood vessels (non-invasively) using an imaging modality is appropriate. Your physician believes there is either a need to determine the presence of plaque buildup (atherosclerosis) or to confirm stenosis within the coronary arteries. Prior studies have produced results that warrant additional testing. The 2021 AHA/ACC chest pain guideline notes that CCTA can be useful for selected patients with chest pain who are at intermediate risk after an initial evaluation. What Is a Stress Test? A stress test examines how your heart will perform under increased workload. During a typical exercise stress test, you’ll either be walking on a treadmill (or exercising on a stationary bike) as they monitor all of the important functions of your heart, including  Heart rate.  Blood pressure.  Heart rhythm.  ECG signals.  Monitor your symptoms to determine how well you can handle the physical exertion. Unlike an anatomical scan, a stress test doesn’t create images of your coronary arteries. It helps doctors see whether you have symptoms or changes in your heart during exercise that could indicate poor circulation (reduced blood flow) to your heart. Depending on your situation, your doctor may recommend an exercise ECG or a stress test combined with imaging. When Might a Stress Test Be Useful? Stress testing may be indicated