When should you see a cardiologist?

Most people who come to a cardiology clinic have been wondering for weeks whether they should. The difficulty is that heart symptoms overlap heavily with things that are not the heart at all — acidity, anxiety, anaemia, thyroid problems, muscular pain from the chest wall. Waiting is sometimes reasonable and sometimes dangerous, and the difference is not always obvious from the inside.

This is a guide to sorting symptoms into three groups: go now, book an appointment, and reasonable to raise at a routine visit.

1. Step 1

   Is any of this happening right now?

   • Chest pain or pressure lasting more than a few minutes
   • Chest discomfort with sweating, nausea or breathlessness
   • Breathlessness at rest
   • Fainting
   • Sudden weakness, facial droop or difficulty speaking

   If yes

   Call 108 now

   Do not drive yourself, and do not wait to see whether it settles. 108 for an ambulance, or 112.

   What to do while you wait
   If none of these
2. Step 2

   Does one of these patterns fit?

   • Chest heaviness or tightness that comes on reliably when you walk uphill or climb stairs, and settles within minutes of stopping
   • Breathlessness doing something that did not make you breathless six months ago
   • Needing extra pillows to sleep, or waking at night short of breath
   • Palpitations with light-headedness, or lasting many minutes without settling
   • Both ankles swelling, worse by evening, with breathlessness or rapid weight gain

   If yes

   Book an appointment

   These are the patterns worth booking for rather than watching indefinitely. Bring dates, and what you were doing at the time.

   Book a consultation
   If not, but
3. Step 3

   No symptoms, but any of these apply?

   • A parent or sibling who developed heart disease before 55 in men or 65 in women
   • Diabetes
   • Blood pressure that stays high despite treatment, or has never been formally assessed
   • An abnormal lipid report, particularly a very high LDL
   • An ECG or echo finding nobody explained to you
   • Planning to start serious exercise after years of inactivity, with risk factors

   If yes

   Worth an assessment

   South Asians develop coronary disease at younger ages and at lower thresholds than many other populations. Waiting until your fifties for a first check is later than ideal.

   Cardiovascular risk assessment
   If none of the above
4. Step 4

   Something you have noticed but none of the above?

   • Brief sharp pain lasting a couple of seconds
   • Pain reproduced by pressing on the chest wall
   • Pain that changes with position or breathing
   • Occasional awareness of your own heartbeat, with nothing else

   If yes

   Reasonable to raise at a routine visit

   Less likely to be cardiac — though still worth a proper look rather than self-diagnosis. A large proportion of cardiology consultations end with reassurance and an explanation. That is a good outcome, not a wasted appointment.

Source — Adapted from this practice’s patient guide, When should you see a cardiologist? This flow is an aid to deciding when to seek care. It is not a diagnosis, and it cannot account for your own history.

Symptoms that warrant an appointment

These are the patterns that bring people to cardiology and are worth booking for rather than watching indefinitely.

Chest discomfort that follows a pattern

The detail cardiologists listen for is not how severe the pain is but what provokes it. Discomfort that appears reliably when you walk uphill or climb stairs, and settles within a few minutes of stopping, is the classic description of angina. It is often described as heaviness, tightness or a band rather than as pain, and people frequently dismiss it for exactly that reason.

Sharp pain lasting a couple of seconds, pain reproduced by pressing on the chest wall, or pain that changes with position or breathing is less likely to be cardiac — though it still deserves a proper look rather than self-diagnosis.

Breathlessness that is new or worsening

The useful question is not whether you get breathless, but whether you get breathless doing something that did not make you breathless six months ago. A gradual decline in what you can manage is easy to accommodate without noticing. Needing extra pillows to sleep, or waking at night short of breath, is more specific and should be mentioned explicitly.

Palpitations with other features

Almost everyone feels their heart occasionally, and most palpitations are benign. They become worth investigating when they come with light-headedness or fainting, when they last many minutes without settling, when the pulse is irregular with no pattern, or when there is known heart disease.

Swelling and unexplained fatigue

Both ankles swelling, worse by evening, together with breathlessness or rapid weight gain over a few days, is a combination worth assessing. One swollen leg that is painful, red or warm is a different problem and needs prompt attention for a different reason.

Reasons to come without any symptoms

• A parent or sibling who developed heart disease before 55 in men or 65 in women.
• Diabetes — it accelerates coronary disease and blunts the warning symptoms at the same time.
• Blood pressure that stays high despite treatment, or that has never been formally assessed.
• An abnormal lipid report, particularly a very high LDL, which can indicate an inherited disorder.
• An ECG or echo done for another reason that came back with a finding nobody explained to you.
• Planning to start serious exercise after years of inactivity, if you have risk factors.

South Asians develop coronary disease at younger ages and at lower thresholds of conventional risk factors than many other populations. Waiting until your fifties to have a first check is later than ideal.

What actually happens if you come

A consultation is mostly conversation. The history — what you noticed, when, what makes it better or worse — carries more diagnostic weight than any single test. Examination and an ECG usually follow in the same visit. Further tests are ordered where the result would change the plan, not as a matter of routine.

A large proportion of cardiology consultations end with reassurance and an explanation. That is a good outcome, not a wasted appointment.