When to See a Cardiologist: 9 Reasons to Schedule an Appointment

Heart disease can be serious. In fact, heart disease is the leading cause of death in the U.S. for both men and women. It’s responsible for more deaths than cancer. Given these statistics, you may wonder what you can do to keep your heart healthy. Or maybe you want to know whether you need to see a heart specialist to make sure your heart is OK. 

Cardiologists are doctors who are experts in heart conditions. They care for people with heart disease, symptoms that might be from heart disease, and risk factors for heart disease. But not everyone needs to see a cardiologist. In many cases, your primary care professional can often provide the care you need. Here we’ll help you decide whether you need to see a cardiologist, and when.

What is a cardiologist?

Cardiologists specialize in diseases of the heart and blood vessels. After 4 years of medical school, they have 3 years of training in internal medicine. That’s followed by at least 3 more years in cardiology. After that they’re able to get board certification as a cardiologist. 

Cardiologists have a wide range of skills. Some of these may require extra training and certification:

• Some cardiologists have additional training in imaging of the heart. That includes echocardiography and nuclear cardiology. 

• Others train for several extra years so they can perform cardiac stenting and heart valve procedures.

• There are special programs for cardiologists who take care of complicated heart failure and transplants. 

• Some cardiologists go on to become electrophysiologists, specializing in treating heart rhythm problems.

Cardiologists must stay up to date with frequently changing guidelines and research in order to maintain their certification. This means they have an advanced understanding of:

• Managing and treating risk factors for heart disease, including high blood pressure and cholesterol

• When and how to use tests like heart scans and stress tests to diagnose and treat heart disease

• Heart disease treatment options, and how to decide which treatments are best for each person

• How to prevent serious complications of heart problems, like heart attacks and strokes

• When to refer a patient for heart surgery

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When to see a cardiologist instead of a primary care physician 

Your healthcare usually begins with your primary care professional. But there are many different reasons you might also need to see a cardiologist. In this section we’ll explore those in detail.

1. You have a diagnosis of heart disease

If you’ve received a diagnosis of heart disease, you may have already seen a cardiologist. Depending on the type of heart problem that you have, you may need to continue to see a cardiologist periodically. Keeping in touch with your cardiologist allows them to monitor your heart’s health. That way they can make changes to your treatments if necessary. This will help to keep you well and prevent problems over time.

Some types of heart disease that may need regular follow-ups with a cardiologist include:

• Atrial fibrillation and other heart rhythm problems

• Heart failure

• Coronary artery disease

• Heart valve disease

2. You’re experiencing heart symptoms

Certain symptoms may be signs of heart trouble. If your symptoms are mild or have been going on for a while, your primary care professional is often the best place to start. But if your symptoms are serious or come on suddenly, you may need to call 911 or go to your nearest emergency room. Some heart symptoms include:

• Chest pain or chest discomfort: If this is severe, new, or doesn’t go away, then it could be a sign of a heart attack. In that case, call 911 and get checked out in an emergency room. If it’s not an emergency, a cardiologist may be able to evaluate you at an office visit. That could include testing to check your heart for blockage.

• Shortness of breath: Like with chest pain, this can be a sign of an emergency. Sometimes it’s caused by blockages, blood clots, or congestive heart failure. But it could also be related to a lung condition. If your symptoms feel serious or come on suddenly, it’s important to get checked out in the emergency room. 

• Heart palpitations: If your heart is racing and won’t stop, then go to the emergency room or call 911. The same warnings apply if you feel dizzy, weak, or if you faint. But if you have palpitations from time to time, a cardiologist can help. They can work up the causes and come up with a treatment plan.

• Slow heart rate: If your heart rate is always below 60, this may be a sign of trouble with your heart’s electrical system. That’s especially true if you get dizzy or lightheaded. A cardiologist can help with this problem.

3. You have risk factors for heart disease

Even if you don’t have a history of heart disease or any symptoms, it’s important to know your risk factors. Risk factors are conditions or behaviors that make heart disease more likely. Your primary care professional can often take care of these risk factors. But if your risk is high, a consultation with a cardiologist may be helpful. 

Common risk factors include:

• Age and gender — risk for heart disease naturally starts to rise at around age 55 for men and around age 65 for women

• Blood pressure

• Diabetes

• Cholesterol

• Obesity 

• Dietary habits

• Lack of exercise

• Tobacco use 

• Drinking too much alcohol 

4. You have a family history of heart disease

Heart disease can run in families. This means that if you have any first-degree relatives who had heart attacks or heart artery blockages at a young age (before age 55 in men and age 65 in women) — you may be at greater risk of heart disease. First-degree relatives include your parents, your siblings, and your kids. 

If early heart disease runs in your family, your risk may be more than double that of someone whose family doesn’t have heart disease. This is especially true if you’re younger and have additional risk factors.

5. You have high blood pressure that’s hard to manage

Most of the time your primary care professional can take care of your blood pressure. But when it’s hard to manage, or if you need several medications to keep your blood pressure level down, a cardiologist can be an important member of your healthcare team. 

6. You have high cholesterol that doesn’t respond to usual medical treatment

As with blood pressure, your primary care professional can usually take care of your cholesterol. But sometimes special medications are needed, or you may have high levels of a high-risk cholesterol called lipoprotein(a), or Lp(a). In those cases, a cardiologist with expertise in lipids (cholesterol and blood fats) can help.

7. You have peripheral arterial disease, leg pain, or ulcers

Certain conditions that affect the legs can be a sign of trouble with the heart or blood vessels. These are problems a cardiologist can help with:

• Leg swelling: Swelling in both legs may be a sign of heart failure. It’s a good reason to see a cardiologist. But if it comes on suddenly, or if it involves only one leg, then it’s often best to go to the emergency room. Swelling in one leg may be a sign of a blood clot or infection.

• Leg cramps with walking: If your legs cramp when you walk, that may be a sign of blocked arteries in your legs. This is also known as peripheral arterial disease. People with peripheral arterial disease are also more likely to have heart blockages. Cardiologists can test for and treat peripheral arterial disease. 

• Varicose veins: Varicose veins are very common. Most of the time they’re not dangerous, but they can cause pain and swelling. And sometimes they can make it hard for your legs to heal from injuries. A cardiologist can test for this condition. Some cardiologists may treat varicose veins with a procedure called venous ablation.

8. You have preeclampsia or hypertension during pregnancy

Preeclampsia is a serious condition that can happen in the last few months of pregnancy. It causes high blood pressure and can harm your kidneys and liver. It can also be dangerous to your unborn child. If you have preeclampsia, your obstetrician may refer you to a cardiologist to help with the blood pressure. Even if your pregnancy was years ago, preeclampsia puts you at risk for heart problems later in life. 

You can also have high blood pressure during pregnancy even without preeclampsia. It’s important to treat it and keep a close eye on it. Often a cardiologist will work with your obstetrician to keep your blood pressure down with medications that are safe during pregnancy.

9. Your primary care professional recommends a cardiologist

Even if you have none of the conditions mentioned above, your primary care professional may refer you to a cardiologist. Other reasons for a referral may include:

• Heart murmur: This is an abnormal noise that your healthcare professional hears when listening to your heart. Some heart murmurs are “innocent”, but others may be more serious. A cardiologist can evaluate you and decide whether you need testing for your heart.

• Inactivity: Maybe you haven’t been active for a long time. If you want to start an exercise program, you might be referred to a cardiologist. The cardiologist will check your heart to be sure that you can safely get started.

• Gum disease: It turns out that there’s a link between gum disease and your heart health. That may be related to inflammation. So if your gum disease is serious, your primary care professional may want you to see a cardiologist.

• Cancer: Certain types of cancer, chemotherapy, and radiation can be hard on the heart. Survivors of childhood cancer have a higher risk as well. So your cancer specialist or your primary care professional may want you to get checked by a cardiologist.

Do you need a referral to see a cardiologist?

A cardiologist is a specialist. So if you have insurance through an HMO or a POS plan, you’ll probably need a referral from your primary care professional. Most PPOs don’t require a referral. But if your cardiologist is out of your network, it may cost you more money. It’s always a good idea to check with your insurance plan and be certain that your care will be covered. 

Even if your plan covers an office visit, blood work and other tests may not automatically be covered. If your cardiologist orders testing, their office will usually work to get it approved ahead of time. Depending on your insurance, some tests might not be approved. Or you may need to go to an in-network facility to get them done.

Costs and coverage are concerns for most people. It’s always OK to discuss them with your healthcare professional. 

At what age should you see a cardiologist?

The right age to see a cardiologist depends on your symptoms, your family history, your risk factors, and your concerns. Heart disease can occur at any age. But many types of heart disease are more common as you get older.

What to expect at a cardiologist appointment

Most visits will start with a check of your blood pressure, heart rate, weight, and height. Your cardiologist will want to know about your symptoms and what brings them on, if anything. They’ll ask you about your medical history and family history. So it’s a good idea to be prepared with this information. You should bring a list of all of your medications, including supplements. You’ll also be asked about whether you smoke, drink alcohol, or use recreational drugs. 

The visit will include a physical exam focused on the heart and vascular system. You’ll probably get an electrocardiogram (EKG). This is a quick and painless test that tells your cardiologist about your heart rate and rhythm. Your cardiologist may order blood work and additional testing.

Types of tests a cardiologist may perform

Your cardiologist may recommend certain tests to check your heart. Some tests may be done in your cardiologist’s office, and others may be done at a hospital or radiology center. Below are some of the tests your cardiologist may recommend or perform:

• Echocardiogram: An echocardiogram is an ultrasound of the heart. It tells you about your heart valves and about the strength and pressure in your heart.

• Stress testing: Stress testing is done to find out how the heart reacts when it has to work harder. There are different types of stress tests. Some use medications and others involve monitoring the heart while you exercise.

• Coronary artery calcium (CAC) scoring: CAC scoring helps your cardiologist check your risk of heart disease. It’s done by taking pictures of the heart using a CT scan. A high amount of calcium buildup in your blood vessels can suggest a higher risk for a heart attack.

• CT angiography: CT angiography, or CTA, uses contrast dye and CT scanning to look at the heart’s arteries. This can identify blockages or narrowing in the blood vessels.

• Invasive coronary angiography: This is also called a cardiac catheterization. In this procedure, a specially trained cardiologist threads a small tube into your heart’s arteries. The tube enters your body through an incision in your wrist or groin. The test uses contrast dye to look for blockage in the arteries. If needed, you may get a stent in a heart artery to open a blockage at the same time.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, the American Society of Nuclear Cardiology, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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