Questions to ask your consultant cardiologist April/May 2009 edition

Find out the best questions to ask your consultant cardiologist with Dr Foster Health

If you have been referred by your GP to hospital for treatment related to your heart and circulatory system, Dr Foster Health's Questions to Ask Your Consultant Cardiologist series will help you get the most out of your consultation experience.

Introduction

Cardiology covers many different types of conditions and treatments related to disorders of the heart and circulatory system.

Coronary heart disease (CHD) kills over 110,000 people in England alone each year ⁽¹⁾. Figures from the 2006 Health Survey for England suggest that about eight per cent of men and three per cent of women aged 55 to 64, while approximately 14 per cent of men and eight per cent of women aged 65 to 74 have or have had angina ⁽²⁾.

What are the risk factors for coronary heart disease (CHD)?

If you smoke, do little exercise or eat an unhealthy diet your chances of developing CHD increase significantly. For example, according to the Department of Health, 20 per cent of CHD-related deaths in men and 17 per cent of CHD cases in women are attributable to smoking ⁽³⁾.

The incidence of CHD is highest in obese people. Regular exercise, at a level sufficient to make you slightly breathless, for 30 minutes two or three times a week reduces the risk of cardiovascular disease mortality in general and mortality related to CHD. Doing no exercise effectively doubles your risk of developing heart disease ⁽³⁾.

Many advances have been made with regard to surgical and medical treatments for heart disease. As a result, cardiologists increasingly specialise in particular areas within cardiology.

General questions to ask your consultant cardiologist

Do I have a high cholesterol level?

High cholesterol levels are an important contributor to development of coronary artery disease, which is why improving your diet is so important.

Biscuits, cakes, pastries, red meat, hard cheese and butter all tend to be high in saturated fats and should be avoided. Foods that contain hydrogenated oil should also be avoided. Increasing the intake of essential fatty acids by eating nuts, seeds, oily fish and olive oil has been shown to reduce cardiovascular risk.

Eating at least five portions of soluble fibre per day also helps reduce cholesterol. Soluble fibre is found in fruits and vegetables, beans and oats.

Some people develop a condition called hypercholesterolaemia, where their levels of cholesterol become very high, even though their diet may not contain high levels of saturated fat.

In addition to changing your diet, very high cholesterol levels can be reduced by taking cholesterol lowering drugs such as statins.

Do I have high blood pressure?

High blood pressure is another important risk factor for coronary artery disease that can be modified with the right treatment. A healthy diet, regular exercise and lower salt intake have been shown to help reduce blood pressure.

Previous research has shown that only half of people with high blood pressure have it checked and go on to be treated for the condition. Only half of those people receive treatment for hypertension and only half of those people receive optimal treatment ⁽⁴⁾.

You can read about the latest National Institute of Health and Clinical Excellence (NICE) guidance to doctors about monitoring and controlling high blood pressure.

What is my blood glucose level?

Having diabetes is highly correlated with coronary artery disease. It is detected by having a fasting blood glucose test in which you fast from midnight and then have a blood test in the morning.

The risk of developing diabetes can be reduced by maintaining a healthy weight, regular exercise, and a healthy diet that does not contain too many sweets and other sugary foods.

Can I be referred to a smoking cessation service?

Stopping smoking is the single most effective way to prevent coronary heart disease. Evidence shows that smoking cessation services and the use of nicotine replacement therapy (NRT) can increase your chances of giving up smoking ⁽⁵⁾. You can phone the national NHS smoking helpline on 0800 022 4 332.

Do I need to make any dietary changes?

Most people know that avoiding too much unhealthy food in their diet is important. However, less people are clear about the best way of achieving these changes.

You can ask to be referred to a dietician or nutritionist to get further advice on how you go about making safe and effective dietary modifications that can help to lower your risk of heart disease.

Angina-related questions to ask your consultant cardiologist

Do I need an angiogram?

A Coronary angiography involves injecting a dye into the arteries that supply the heart with blood to see if any have become narrowed. The dye in the arteries is viewed on an X-ray monitor.The procedure provides the most reliable diagnosis of coronary artery disease. It allows decisions to be made regarding suitability for angioplasty or coronary artery bypass grafting (CABG).

Coronary angiography is not necessary for every patient with chest pain and the procedure carries some risk. If there is doubt as to whether your symptoms are due to angina, you will often be advised to have an angiogram.

If I have angina, should I be taking aspirin, a statin, an ACE inhibitor and a beta blocker?

Large clinical trials have demonstrated that most patients who are proven to have coronary artery disease have a better prognosis if they take each of these four drugs ⁽⁶⁾.

Sometimes it is not appropriate for a particular person to take one of these drugs, but a good reason should be given to you for not being on any one of these drugs if you have severe angina or have ever had a diagnosed heart attack.

Can I still live a normal life if I have angina?

If you are diagnosed with angina, one of the most important things about managing it is to not allow it to take over your life. People are often surprised by how few things their cardiologist or GP will discourage them from doing. Exercise is generally encouraged, though gradually building up levels of activity is best. It is best to check with a health professional before attempting any new exercise regime.

There are very specific rules regarding driving and heart disease. You may wish to check with a cardiologist whether you need to make any changes to your work or lifestyle.

You may be referred by a cardiologist to a Cardiac Rehabilitation Programme for further guidance on improving your lifestyle if you have severe angina or have had a heart attack.

What symptoms should prompt me to call an ambulance?

If you experience chest pain ⁽⁷⁾:

• Stop what you are doing, rest, and try and stay calm. Take one to two puffs of glyceryl trinitrate (GTN) spray or one GTN tablet under your tongue
• Wait five minutes
• If the pain or symptoms persist after taking this, take the GTN again
• Wait five minutes
• If the pain or symptoms persist after taking this, take the GTN again
• Wait five minutes
• If the pain or symptoms continue after this dial 999 and ask for an ambulance, stating that you think you are having a heart attack
• If at any time the pain becomes unbearable or is accompanied by any of the following: nausea/vomiting, breathlessness, palpitations, sweating, grey/blue skin colour, dial 999

Note: GTN sometimes causes a fall in blood pressure, which can make you feel dizzy. Therefore try and sit down for 10-20 minutes if you have taken more than two puffs of GTN - even if the chest pain has gone.

If the pain is not thought to be coming from the heart, what should I do if it gets worse or changes in character in the future?

If your cardiologist tells you that the chest pain is not thought to be cardiac in nature you may want to find out what you should do if things change in the future. For instance, if you start to get a lot more chest pain, should you see a cardiologist again?