Heart Health

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First Visit to a Cardiologist

- Summary
- Before the first visit
- Arrival at the office
- History and physical exam
- Feedback
- After the first visit
- Questions for your doctor

Reviewed By:
Sumit Verma, M.D., FACC
Abdou Elhendy, MD, PhD, FACC, FAHA
Robert I. Hamby, M.D., FACC, FACP

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Arrival at the cardiologist’s office

You may be asked to arrive a little early for the appointment in order to sign in at the reception desk and fill out some paperwork. If you brought all the necessary information, you will probably save some time. If you have any questions about your health insurance policy and/or what it will cover, the people at the front desk can answer those questions for you.

When you are called in from the waiting room, staff members other than the cardiologist may be involved in the process. For example, blood pressure and weight might be taken and recorded by a medical assistant or another staff member rather than the cardiologist. Similarly, a nurse or cardiology fellow may obtain a medical history and give a physical examination. To avoid any confusion, be sure that you know the name and role of each person who is involved in the process.

History and physical examination

A staff member will obtain the medical history of you or your loved one. Most medical histories cover the following areas:

Personal medical history. The personal medical history is information about the current problem (chief complaint) that prompted you or your loved one to seek medical attention, as well as the patient's past history of illnesses, surgeries, allergies and other relevant information. For example, "What were the symptoms or event that prompted you to seek medical attention?" It is often helpful to write down the symptoms beforehand and read them to the physician. After hearing these vital clues, the physician may ask some follow-up questions that could take about 20 to 30 minutes in an initial visit. The physician will also conduct a review of symptoms, which is a "laundry list" of symptoms related to various organ systems in the body. These questions are designed to discover additional information that you or your loved one may have forgotten to tell to the physician.
Family medical history. A family medical history is detailed information about the present and past health of the patient's family members. The patient's family medical history can greatly increase (or decrease) the risk of the patient developing certain medical conditions, including heart-related problems. Even family illnesses that do not seem important to the patient may ultimately allow a physician to make a more accurate diagnosis or to begin screening for certain conditions as soon as possible. A little documentation can go a long way towards preserving an individual's health, prolonging life and preventing the development of certain familial illnesses such as young-age heart attack. A complete family tree traces the medical history of an individual (and his or her spouse, if applicable), through at least several generations.
Social history. A staff member may also ask about the social history of you or your loved one, which might include information about diet, exercise, smoking or sex. The physician may also inquire about work or family life. This information helps the cardiologist to make better decisions and offer more effective counseling regarding current prevention and early treatment. By law, such information cannot be shared with anyone else unless written permission has been obtained.

You or your loved one will then be given a cardiovascular exam, which is far more focused on the condition and function of the heart and blood vessels than a more general physical examination. This exam will concentrate on the function and performance of the heart, veins and arteries.

A healthcare professional will listen to the heart, lungs and various blood vessels through a stethoscope (a process called auscultation) to detect any unusual sounds. For example, a crackling sound in the lungs (rales) could signify congestion in the lungs and, possibly, heart failure. Or a heart murmur could be a sign of valvular heart disease. Similar, a particular sound called a bruit in the carotid artery in the neck could be a sign of carotid artery disease, increasing the risk of stroke.

In addition to listening through the stethoscope, the healthcare professional will also use a finger or two to lightly press (palpate) the area over certain arteries and veins to feel the blood flowing just beneath the skin. A weakened or abnormal pulse in any part of the body could be a possible sign of heart-related disease. For example, a paradoxical pulse may be a sign of pericardial effusion, and a water hammer pulse is a telltale sign of aortic regurgitation.

Lastly, the healthcare professional may use a bright light to look into each of the eyes, examining the health of the tiny blood vessels present there. These blood vessels are particularly vulnerable to damage or disease if the patient has diabetes.

As part of a cardiovascular exam, an electrocardiogram (EKG) may be performed to painlessly record the heart's electrical activity. Additional tests that may be performed, which are also painless, include a chest x-ray and an echocardiogram. If an exercise stress test or nuclear stress test was scheduled in advance, then this test will also be performed.

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Review Date: 11-30-2006