Dr. Juan Carlos PORTUGAL, your cardiologist in Barcelona

What’s the role of a cardiologist?

A cardiologist is, as other specialists, a doctor with the will to relief and help patients. The difference lies in the focus of disease. Cardiologist will focus in the diseases of the heart and its artereries. Cardiovascular disease is still the main cause of death worldwide, therefore cardiologist have an unique oportunity to intervene and prevent heart disease or its progression.

Of course, this is my personal opinion as a cardiologist in Barcelona, where we have the possibility not only to treat or cure but also to prevent disease.

 

Which symptoms should prompt a cardiology consultation?

• • • Chest pain: It’s probably the most common and certainly is the most feared. Related to ischemic heart disease (obstruction of the coronary arteries that will impair blood flow to the heart ultimately causing myocardial infarction or chest angina) as of the myocarditis or pericarditis. Fortunately, most of the times chest pains in the office are not related to any of those conditions. However, it’s important to visit a doctor specially if the pain is triggered by exercise, exertion or it is intense and invalidating. If you have a prior history of heart disease, diabetes, hypertension, high cholesterol or you are older than 35 years old is also important to
    • Fast heart beating, palpitations or abnormal heart beating: One of the most common symptoms of patients suffering arrhytmias. MOst of the time they are of a benign nature but certain triggers like when they occur while exercising or ar associated to dizziness and fainting should immediately prompt a consultation
    • Shortness of breath .  This symptom is really concerning and can have a variety of different causes, some even not related to the heart like with some lung conditions. Heart failure occur when the heart is impaired to pump blood flow into the arteries, due to obstruction of the coronary arteries (the ones pumping blood into the heart itself) or abnormal heart rhythm. If this shortness of breath occurs while lying down (ortopnea) or it wakes up during the night (nocturnal paroxysmeal dyspnea) prompting us to sleep with several pillows or half seated the cause may be cardiac. However, if its exercise related it can be either metabolic, pulmonary or cardiac related. If any of these symptoms occur, an urgent consultation must be performed.

  Juan Carlos Portugal del Pino – Doctoralia.es

Are there any other symptoms to consult a Cardiologist?

• Swollen legs (edema): Its a typical finding of heart failure, altought heart failure is not the only cause.
• Exercise intolerance: Patients unable to exercise or tolerate certain efforts might have a heart, lung, metabolic, neurologic or muscular problems. Sometimes this is related to cardiac condition and a CardioPulmonary Exercise test can clearly determine the source of the intolerance.

Which conditions are treated by a cardiologist?

On top of the ones mentioned above, here is a list of some other common pathologies.

• Artheriosclerosis (referred as the plaque deposition into the arteries of any territory not only the heart) and its effects. For example angina pectoris and myocardial infarction (heart attack) secondary to coronary arteries obstruction reducing blood suply to the heart. However, this can also occur in other territories like the brain (stroke), the legs with pain while walking short distances (intermmitent claudication) and even sexual dysfunction. 
• Arrhytimias with slow heart beating (heart blocks, sick sinus syndrome) or fast heart beating like atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia among others.
• Myocardiopathies being cardiac muscle disease like hyperthropic myocardiopathy, dilated myocardiopathy or cardiac amyloidosis.
• Valular heart disase that will involve an impairment in the opening or closing mechanism like mitral valve prolapse, aortic stenosis or bicuspid aorta among many others.
• Great Vessels diseases like aortic aneurysm, aortic coarctation, aortitis and many others.
• Pericardial disease which is the surrounding tissue of the heart, like in the pericarditis and perimyocarditis.
• Heart failure which can be caused as complications of any of the above diseases.

What test can be performed by a cardiologist?

The test that can be perfomed as an outpatient in the office are the following:

• 12 lead Electrocardiogram as a first screening test to have a first impression of the heart.
• Cardiac Doppler ultrasound or echocardiogram that will allow us to see the heart structure and function (wall thickness, wall contractility), the valvular function, the great vessels of the heart and of its surrounding tissues.
• Cardiac Stress Test that will evaluate the heart as its maximal performance. It will detect ischemic heart disease, arrhytmias and abnormalities of the  blood pressure.
• Holter ECG or cardic rhythm 24 hours recording of the heart to detect arrhytmias.
• Blood Pressure Holter or ABPM (Ambulatory Blood Pressure Monitoring) the ultimate diagnosis test to rule out or control hypertension.