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Top Questions for your Cardiologist

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I didn’t ask any of the questions listed below when I met with a cardiologist. I was diagnosed with chemotherapy-induced cardiomyopathy in late December of 2010. I have lived with cancer since my diagnosis in early 1994 so I’m well-versed in all things cancer. But my heart problems-

  • Chemotherapy-induced cardiomyopathy 
  • Atrial fibrillation (Afib)
  • Chemotherapy-induced hypertension
  • Heart valve disease

are not in my day-to-day routine of research and writing. I had appointments with two different cardiologists. I didn’t ask any of the questions listed below and the results of my cardiology appointments were disappointing to say the least.

Both of the cardiologists that I met with focused on prescribing me metoprolol. I’m not saying that the cardiologists could not have answered the questions below, I’m saying that both oncologists were not directed to speak to the issues below because… well, I don’t know why. I’m simply saying that the doctors didn’t speak to issues I cared about so my disappointment is on me.

What are some of the different types of heart disease?

Heart disease is an umbrella term that encompasses a variety of conditions that affect the heart’s structure and function. Some common types of heart disease include:

  1. Coronary artery disease (CAD): This is the most common type of heart disease, caused by the buildup of plaque in the coronary arteries, which supply blood to the heart muscle. It can lead to chest pain (angina), heart attacks, and heart failure.
  2. Heart failure: Also known as congestive heart failure, this condition occurs when the heart muscle becomes weakened or damaged, leading to an inability to pump enough blood to meet the body’s needs.
  3. Arrhythmias: These are abnormal heart rhythms, which can cause the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly. Arrhythmias can range from harmless to life-threatening.
  4. Heart valve disease: This occurs when one or more of the heart’s valves don’t function properly, either failing to close completely (regurgitation) or not opening fully (stenosis). This can lead to symptoms such as shortness of breath, chest pain, and fatigue.
  5. Cardiomyopathy: This is a disease of the heart muscle itself, where the muscle becomes enlarged, thickened, or stiffened, impairing its ability to pump blood effectively.
  6. Congenital heart defects: These are structural abnormalities of the heart that are present at birth. They can range from simple defects that cause no symptoms to complex defects that require surgical repair.
  7. Pericardial diseases: These are conditions that affect the pericardium, the sac that surrounds the heart. Pericardial diseases can include inflammation (pericarditis), fluid buildup (pericardial effusion), and thickening or stiffening of the pericardium (constrictive pericarditis).
  8. Myocarditis: This is inflammation of the heart muscle, often due to a viral infection. It can cause symptoms such as chest pain, shortness of breath, and fatigue.

Please don’t misunderstand me. I’ve learned a lot about chemotherapy regimens that can damage the patient’s heart aka cardiotoxicity. But this education has taken years. I could have learned much faster. Learning things such as heart healthy nutritional supplementation. Supplements and lifestyle therapies that enable me to manage my heart health without conventional medications such as metoprolol.

Have you been diagnosed with chemotherapy-induced cardiomyopathy? Are you a cancer survivor? If you’d like to learn more about heart healthy therapies let me know David.PeopleBeatingCancer@gmail.com

Hang in there,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

The 6 Best Questions to Ask Your Cardiologist

Question 1:  What is my risk of having a cardiovascular problem in the future?

Why You Should Ask Understanding your risk for future heart disease, stroke, aneurysm and the like drives much of your care, Dr. Pollak says. Someone whose cholesterol is borderline but who has diabetes and a family history of heart disease will need their cholesterol treated much more aggressively than someone with a lower risk, for example.

Doctors use several types of risk calculators to determine your 10-year risk of developing heart disease. But you can also get a sense in advance of seeing your doctor by utilizing the American Heart Association and the American College of Cardiology’s ASCVD online risk calculator. You plug in your most recent blood pressureand cholesterol readings, along with basic health information. Although Pollack warns that the information offered by a risk calculator is not perfect, it will be a good beginning for a more meaningful conversation with your cardiologist.

Question 2: What symptoms might indicate a worsening of my specific condition?

Why You Should Ask “This is a really smart question because heart disease is such a big umbrella term,” Pollak says. Someone with a leaky valve, for instance, will have different symptoms indicating that the condition is worsening than someone with a heart rhythm issue.

You may think you know the symptoms for some conditions, like chest pain indicating a heart attack, but a large percentage of women, and even some men, never experience these signs, Pollak says. Instead, they get shortness of breath, sweats, nausea, or discomfort in the neck, jaw, shoulder, or back. That’s why it’s important that your doctor goes over all the warning signs that are personalized for you.

Question 3: How important do you think it is to adopt new treatments and procedures?

Why You Should Ask You don’t want a doctor who just jumps on the bandwagon because every new technique needs to be studied and confirmed, says Constantine Athanasuleas, MD, professor of cardiothoracic surgery at the University of Alabama in Birmingham. But equally important, you don’t want someone so stuck in their ways that you don’t receive the benefits of medical advances.

For example, Dr. Athanasuleas points to several procedures developed or advanced by the late cardiothoracic surgeon Gerald Buckberg, MD, who lamented in the book Solving the Mysteries of Heart Disease that most doctors’ treatment for heart attacks has not changed over the years, even though giving patients a specially developed solution in the cardiac catheterization lab has been shown to dramatically reduce death. Similarly, he writes about a unique surgical procedure for congestive heart failure that too many doctors have not adopted, even though a study of 1,200 patients published in the Journal of the American College of Cardiology found it increased survival over conventional treatments.

The best doctors aren’t the first to try something new, nor are they the last, Athanasuleas says. Instead, they are “tweeners,” as he calls them, staying up on advances and adopting those that have proven their value.

Question 4: Why are you recommending I take this test?

Why You Should Ask Most tests are important, Athanasuleas says, but in an effort to be comprehensive, sometimes cardiologists order a test that is not necessary and won’t change your treatment. “Patients should ask whether a test is accurate and reproducible, and will lead to a specific recommendation or change in therapy,” he says.

You might also ask if the doctor co-owns the testing facility, a possible red flag for overtesting. Guidelines for appropriate tests can be found in medical journals online; if you look up a prescribed test and have questions about its value, call the office to ask more questions, he says.

When Pollak recommends a test, she says that she always explains what it involves and what her patient will experience. “I view the doctor-patient relationship as we’re partners in the journey toward your health and health goals,” she says. She also lets her patients know that no test is completely accurate, “even if it is an excellent test interpreted by a well-trained eye,” she says.

Question 5: Why are you prescribing this medication?

Why You Should Ask Doctors — not your friends or social media buddies — are best positioned to explain the pros and cons of a drug based on the science, Pollak says.

In fact, the editors of more than two dozen cardiology-related scientific journals recently published an editorial in the February 2019 issue of the journal JAMA to “sound the alarm” over patients deciding whether to take statins and other medications based on incomplete information they have read online. Be honest with your doctor about any hesitations or concerns, Pollak says, so they can explain the benefits proven in research.

Carefully going over your prescriptions can also help you handle any medication hiccups later. “Your doctor can explain potential side effects and create a plan if any do occur,” she says.

Question 6: Will any changes in my lifestyle make a difference?

Why You Should Ask Cardiovascular disease is an area where changes in lifestyle — diet, exercise, stress reduction, sleep — can greatly impact the course of the condition.

For example, the Mediterranean diet — which is high in vegetables, fruits, and healthy fats, and low in saturated fats and added sugars — was shown to improve many of the risk factors associated with heart disease in a study published in December 2018 in JAMA Network. The right diet is especially important if you are overweight or obese.

Some doctors will go over lifestyle information with you, while others will refer you to dietitians, physical therapists, and other professionals they work with. Be sure to talk to your cardiologist about lifestyle changes to develop a plan that works for you.

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