1. General adult cardiologists
Why you might need one: You have symptoms of heart disease, such as chest pain, fainting, a fluttering sensation in the chest, or shortness of breath. Or, you don’t have symptoms, but you are concerned about a risk factor such as high cholesterol, a history of smoking, or a family history of heart disease.
What they do: General adult cardiologists diagnose and treat general problems that affect the heart and blood vessels, including high cholesterol and high blood pressure, as well as heart attacks, valve problems, abnormal heart rhythms, and congestive heart failure, among other conditions. Cardiologists also help to prevent the onset of heart disease.
General adult cardiologists perform physical exams and order blood work and other tests to evaluate the heart’s health and function, including electrocardiograms, echocardiograms, stress tests, and MRIs of the heart. They can help you make lifestyle changes, as well as recommend medications (such as cholesterol-lowering statins) and procedures (such as inserting stents and pacemakers, as well as performing ablations of abnormal heart rhythms and replacing heart valves).
What else you should know: If you are a woman concerned about your cardiac health, you should know that heart disease is the number 1 cause of death in women. Women may experience symptoms of heart disease differently than men commonly do—for instance, they are more likely to have symptoms other than chest pain, such as indigestion, unusual fatigue, and discomfort in the abdomen, jaw, neck, or upper back.
One type of heart disease, called “broken heart syndrome” (a temporary condition that can be caused by extreme emotions and situations), is more common in women than in men. Cigarette smoking is also a bigger risk factor for heart disease in women, especially in those who are pre-menopausal. “If you are a woman, it’s important to find a cardiologist who will listen to you and take your symptoms seriously,” says Yale Medicine cardiologist Erica Spatz, MD, MHS.
2. Cardiac imaging specialists
Why you might need one: Your doctor suspects heart disease or wants to monitor a condition that has already been diagnosed. Imaging may be used to evaluate your heart’s anatomy and function. Your doctor may want an imaging test if you have symptoms of a heart problem such as chest pain, irregular heartbeats, heart flutters, or shortness of breath. “Multimodality cardiac imaging uses a comprehensive approach to choose the best test for a patient when there is concern for cardiac disease,” says Lauren Baldassarre, MD, cardiology director of Cardiac MRI and CT at Yale Medicine. Heart imaging may also be used as part of cardiac treatment.
What they do: Cardiac imaging specialists provide imaging that can help in diagnosing, evaluating, and treating the heart. Sophisticated imaging tests use different approaches for a variety of problems, from chest pain and valvular heart disease to cardiac tumors and heart device infections, among others. For example, an echocardiogram, a common test, uses high-frequency sound waves to make pictures of the heart’s chambers, valves, walls, and blood vessels. Cardiac nuclear medicine involves an injection (depending on the type of exam) of small amounts of radioactive materials that travel to the area in the body being examined, providing a picture that helps the doctor evaluate for coronary artery disease or cardiomyopathy, among other things.
What else you should know: Today, cardiac imaging is such a broad field with so many choices that you may need to find a specialist within it that has very specific training. The appropriate imaging subspecialist can help determine whether one prescribed test might be used in combination with another to provide better information. Or an imaging specialist may provide imaging during surgical treatment—MRI and CT scans are commonly used to guide surgeons in some heart procedures, which makes the surgeon’s work more precise and less invasive, resulting in quicker recoveries for patients.
Why you might need one: You have heart rhythm abnormalities (also known as arrhythmias), where heartbeat sequences are too fast or slow—or a heartbeat that is otherwise irregular. Your heartbeats may be traveling through the heart on an abnormal pathway, and you may be experiencing symptoms like weakness or fainting. (Arrhythmias are electrical abnormalities that can occur in the setting of heart disease, but may also occur in otherwise completely normal hearts. They can affect patients of all ages.)
What they do: Electrophysiologists diagnose and treat arrhythmias. “It can be critical to treat an abnormal heart rhythm, because some arrhythmias can be potentially life-threatening or carry an increased risk of stroke,” says Joseph Akar, MD PhD, chief of cardiac electrophysiology for Yale Medicine. Electrophysiologists may provide tests such as electrocardiography or wearable monitors—or long-term, implantable monitors—in order to record heart rhythm and diagnose the condition. They provide treatment ranging from lifestyle changes to medications to cardiac ablation, which deliberately creates scar tissue to eliminate electrical short circuits and even out erratic rhythms. Electrophysiologists also implant artificial pacemakers and cardiac defibrillators, which could be life-saving—they protect against sudden cardiac death, and improve heart function.
What else you should know: Radiation has been a recent concern with fluoroscopy, an imaging technology that provides electrophysiologists with a continuous X-ray image, so they can visualize their progress in performing a real-time procedure. Yale Medicine electrophysiologists use cutting-edge ultrasound and 3-D mapping technology to minimize radiation exposure to patients. Yale Medicine electrophysiologists have significant expertise in implanting leadless pacemakers, as well as other devices that prevent blood clots from forming in the heart and migrating to the brain during certain arrhythmias.
4. Adult congenital heart specialists
Why you might need one: If you were born with a heart issue (called a congenital heart problem), you will likely need specialized and ongoing care through adulthood. Adult congenital heart specialists help with the transition from pediatric to adult heart care—and will schedule a first visit at any age. New issues can surface at any time in life—even if you are feeling healthy—and these specialists can monitor you to detect them early and treat complications or new issues as they arise, helping to avoid urgent interventions. They can discuss exercise, fertility, and childbearing issues, and other lifestyle topics, and advise on scheduling routine checkups with them, depending on your situation.
What they do: Adult congenital heart specialists provide lifelong care if you have ever been diagnosed with a problem with your heart’s structure that developed before you were born, whether the problem was treated in childhood with surgery or catheterization procedures—or found years later. “When we routinely monitor an adult patient with a congenital heart defect and identify new symptoms as early as possible, we can limit complications or avoid them altogether,” says Robert Elder, MD, director of Yale Medicine’s Adult Congenital Heart Program.
What else you should know: A congenital heart specialist can advise on how your condition could affect the choice of medications for certain conditions—for women, for example, a congenital heart defect can affect the type of birth control they choose.
While some women who have had mild heart defects have successful pregnancies, they should still ask about any issues that could threaten their safety during pregnancy and labor—and about possible genetic risks for their baby. (Both men and women are at risk for passing congenital heart disease along to their children.)
5. Interventional cardiologists
Why you might need one: You are having chest pain that could indicate a blockage of an artery and you need an emergency evaluation. Or you have chronic symptoms, like chest pain or shortness of breath, and need to be evaluated for disease in the arteries or valves that call for further treatment. Interventional cardiologists treat a long list of conditions, from angina to aortic stenosis to heart attack. If you have a highly specialized condition, like congenital heart disease, valvular heart disease, or chronic total occlusion, you can seek out one with special training in that area.
What they do: Interventional cardiologists assess and treat heart conditions using nonsurgical, catheter-based procedures that involve inserting a thin, flexible tube through a small incision in the skin and through the blood vessels to the heart. They use this approach to place a stent to open a blocked artery, repair or replace a damaged heart valve, and perform other procedures. While open-heart surgery is still the most appropriate treatment in some cases, “many patients can’t undergo open-heart surgery due to their general medical health or age, and some don’t want to,” says Yale Medicine interventional cardiologist Yousif Ahmad, BMBS, PhD. “We’re able to improve their prognosis and make them feel better without open-heart surgery.”
What else you should know: There have been advances in interventional cardiology in the last five to 10 years. Notable ones are transcatheter aortic valve replacement (TAVR), which involves the insertion of a new heart valve, leaving the old one in place. (The new valve, which is collapsible, is inserted into the original valve, then expanded so that it can take over the job of controlling blood flow.)
Another is MitraClip™, a small clip that is attached to the mitral valve to help it close more completely. In addition, there is percutaneous coronary intervention (PCI), commonly known as angioplasty, for chronic total occlusion—angioplasty improves blood flow to the heart in patients with a 100% artery blockage who would otherwise need bypass surgery.
Why you might need one: You are about to begin cancer treatment and have a personal history of cardiac disease; you are about to begin or are already undergoing cancer treatment with a therapy that has the potential for cardiac side effects; you are undergoing cancer chemotherapy, radiation, immunotherapy, or another therapy, and are experiencing cardiac issues; or, you are a cancer survivor who had these treatments at some point in the past.
What they do: Cardio-oncologists care for cancer patients by detecting, monitoring, and treating heart disease that occurs as a side effect of such cancer treatments as chemotherapy, radiation, targeted therapies, and immunotherapy. While these treatments can be effective for cancer, they can also affect organs and organ systems, including the heart and cardiovascular system. If a patient is showing signs of heart issues, cardio-oncologists may recommend closer monitoring, cardiac medications, or adjusting the cancer treatment.
What else you should know: Cardiac health is important for cancer survivors to be aware of years—and even decades—after their cancer was treated. “Survival of cancer patients has significantly improved as cancer treatment has improved,” says Dr. Baldassarre, who is also director of the Cardio-Oncology Program at Smilow Cancer Hospital. “They are living longer, and as a result, we’re now thinking about cardiac side effects not just as an immediate concern, but for years later.”