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What Type of Cardiologist Should You See for Specialized Care? Although many physicians manage CV risk factors very well, there may come a point when you would benefit from seeing a heart specialist.

Heart disease is so common that it's on the radar of every primary care physician. When a patient develops a cardiovascular risk factor, or a known risk factor worsens, most physicians take immediate action to prescribe medications or lifestyle interventions designed to prevent cardiovascular disease from developing or progressing.

"Most primary care physicians do a very good job of managing common risk factors, such as hypertension, high cholesterol and metabolic syndrome," says Cleveland Clinic cardiologist Leslie Cho, MD.

When You Need a Cardiologist

But there are times when an opinion from a cardiologist is warranted--for example, when heart disease is diagnosed, or risk is excessive.

"When patients start having atrial fibrillation, valve disease or coronary artery disease, they should see a specialist at least once," says Dr. Cho.

Most physicians will quickly refer any patient who might benefit from seeing a specialist. But it's also perfectly acceptable to seek an opinion on your own.

"If you aren't getting satisfactory answers from your primary care physician, or you are worried about your health, a cardiologist can provide the answers you seek and put your mind at ease," she says.

Education Matters

Training in the various medical and surgical subspecialties of cardiovascular care is standardized nationwide.

Cardiologists complete four years of medical school, followed by three years of residency in internal medicine before serving three or four years in a cardiology fellowship. One or two years of additional training may follow if they choose a subspecialty such as interventional cardiology, electrophysiology, heart failure or imaging. Some cardiologists do interventional procedures such as stenting, but they do not perform surgery.

After medical school, cardiac surgeons traditionally complete a five-year residency in general surgery, followed by two to three years of cardiothoracic (heart and lung) surgery fellowship. Some programs now offer four years of general surgery plus three years of cardiothoracic surgery. Other programs combine general and cardiac surgery into a single six-year program. The subspecialty of heart transplantation requires one additional year of training.

Extensive education and hands-on experience enable these specialists to become familiar with evidence-based best practices for diagnosing and treating various forms of heart disease and individualizing care.

"Education doesn't stop after formal training is completed," says Dr. Cho. "Medical knowledge changes so fast that education must continue for life."

They Are on Your Team

By adding the appropriate cardiovascular specialist(s) to your care team, you can have confidence everything possible is being done to protect your heart health. You may need only an occasional visit to the specialist. With some diseases like heart failure, however, the specialist may take over your care.

Rest assured that your heart team will communicate regularly with the primary care physician coordinating your overall health care.

"Having heart disease does not exempt you from developing other medical problems that may need attention. That's why you should continue seeing your primary care physician unless instructed otherwise," says Dr. Cho.


Clinical Cardiologists: Clinical cardiologists can diagnose, confirm and manage heart disease. This is the specialist you need if you develop symptoms such as angina or an abnormal heart rhythm or have a heart attack. A clinical cardiologist will coordinate your care with other physicians and surgeons, if necessary.

Interventional Cardiologists: Interventional cardiologists specialize in invasive, but nonsurgical, procedures for treating coronary artery disease, valve disease, peripheral artery disease and carotid artery disease in the large vessels leading to the brain. Their procedures are performed in the cardiac catheterization laboratory (cath lab).

Electrophysiologists If you develop a very fast, very slow or irregular heart rhythm, an electrophysiologist (EP) is the specialist you need. EPs perform catheter ablations and implant electrical devices such as pacemakers and cardioverter-defibrillators.

Cardiac Imaging Specialists: These doctors use advanced imaging modalities to diagnose heart disease. These include stress tests with imaging, echocardiography and cardiac MRI and CT scans. They also treat patients with image-guided therapies.

Heart Failure Specialists: Due to the complex nature of heart failure, patients with this disorder may benefit from seeing a heart-failure specialist. These specialty cardiologists have experience and expertise in managing symptoms and delaying the progression of heart failure. When symptoms reach a certain degree of severity, a heart failure specialist will provide counsel on sophisticated treatments such as a left ventricular assist device or heart transplantation.

Congenital Heart Specialists: A congenital heart problem is an abnormality present at birth. Some congenital diseases become apparent shortly after birth or in childhood. Others, including a hole in the heart known as a patent foramen ovale, may go unnoticed until late adulthood. These specialists can be either pediatric or adult cardiologists.

Cardio-Oncologists: This subspecialty arose from the need to treat heart disease in patients with cancer. Some chemotherapy agents and forms of radiation therapy are toxic to the heart. Involving a cardio-oncologist in the care of a patient needing radiation to the chest or receiving a toxic form of chemotherapy can minimize cardiac risk and help ensure the best outcome for cancer without harming the heart.

Preventive Cardiologists: If you have a history of heart disease or stroke at a young age, or an extensive family history of cardiovascular disease or risk factors for it, you may want to see a preventive cardiologist. These specialists will evaluate your risk and develop an individualized plan to minimize it.

Cardiac Rehabilitation Specialist: These specialists design and monitor supervised exercise and nutrition programs designed to help patients safely return to optimal functioning after a heart attack, heart surgery, interventional procedure or diagnosis of heart failure.

Cardiac Surgeons: If you need coronary artery bypass grafting, surgery on your aorta or a valve replacement or repair that cannot be done through a catheter, your cardiologist will refer you to a cardiac surgeon. Cardiac surgeons also repair deformities in the heart and perform heart transplants.


The disease process that clogs arteries in the heart often affects other arteries in the body. If you develop coronary artery disease, you may need to see one of the following specialists, in addition to a cardiologist:

Nephrologists: When hypertension is not easily controlled, a patient may be referred to a nephrologist (kidney doctor) for care. Nephrologists also monitor the health of the main arteries leading from the aorta to the kidneys, which can become blocked with plaque. If the arteries need to be opened up to improve blood flow, a vascular surgeon will perform the procedure.

Endocrinologists: Most primary care physicians successfully treat diabetes. If blood sugar levels fail to stabilize, however, a visit to an endocrinologist specializing in diabetes (diabetologist) may be helpful.

Vascular Surgeons: If an artery in a limb needs to be opened or bypassed, or surgery is needed to repair an abdominal aortic aneurysm, a vascular surgeon will perform the procedure. If the arteries leading to the brain become blocked with fatty plaque, a vascular surgeon may open the artery, remove the fat and sew the artery shut.

Vascular Disease Specialist: These specialists diagnose and treat diseased arteries and veins in the legs, feet and arms.

Neurologists: When cardiovascular disease affects the arteries in the head and neck, a neurologist may become involved. These doctors recommend medications and lifestyle measures to prevent stroke ("brain attack") and care for patients after a stroke occurs.

Caption: Cardiovascular care has become so sophisticated that many cardiologists choose to concentrate on a single aspect of the disease.
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Publication:Heart Advisor
Date:Jul 1, 2019
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