What should I expect from this cardiologist visit
January 29, 2020 8:35 AM   Subscribe

My PCP has referred me to a cardiologist because I have PVCs and am interested in trying a stimulant medication for my ADHD (if it’s safe to do so, hence seeing a cardiologist). To help manage my anxiety about doctors, I would like to know what to expect when I see a cardiologist: tests they might run, what they’re checking for, questions they might ask.

I’ve had a few ECGs in the ten years since a provider first noticed them but never went to a cardiologist for a variety of reasons: I’ve been broke/underinsured for most of this time, doctors told me they’re generally not cause for concern as they don’t cause any symptoms and didn’t push me to go, and as mentioned I have a lot of anxiety about doctors. I’ve had some very traumatizing experiences in the past, particularly with specialists.

I know every case is different and am not asking for medical advice, but I would also particularly love to hear your experience if you also have PVCs and take a stimulant medication and what went into your decision to do so.

My primary care provider has lost my trust in this process (I’ve ranted about her here) and I’m feeling like I need help navigating this while I find another and get a call back from a psychiatrist who I’d like to manage my ADHD treatment going forward. Thanks for any help you can provide in preparing for an appointment I dread!
posted by the thorn bushes have roses to Health & Fitness (5 answers total) 2 users marked this as a favorite
I have PVCs and a cardiologist but do not take stimulant medications. I have had to drastically cut back my caffeine intake due to the PVCs. The complicating problem for me is that I can't take the most commonly prescribed medications for PVCs - beta blockers - because I have asthma. My cardiologist isn't comfortable with the contraindications. My PVCs leave me exhausted and full of anxiety so stopping the main contributor of them just made sense for me.

When you have your appointment, your doctor will likely ask you how many episodes you have in a any given day. When I made my appointment, the person I spoke with suggested I keep a PVC diary for the time before the appointment. I found it really helpful and it ended up being the main reason he had me cut back on caffeine. So I do recommend starting a PVC diary: everything you eat and drink during the day, plus records of any episodes and how long they last/their severity.

Depending on the timing of your last ECG, the doc may run one. You may be requested to wear a Holter monitor for 24-48 hours. It's basically a portable ECG machine and you get hooked up to it in the office. It records all your heart activity and gives the doctor a lot more information to work with.

The good thing about PVCs is that diagnosis, treatment, monitoring...isn't terribly invasive. It's a lot easier for me to go to the cardiologist than it is for me to go to the hematologist for my chronic anemia treatments.

Good luck!
posted by cooker girl at 8:44 AM on January 29, 2020 [3 favorites]

I was surprised in how many places he checked my pulse and listened to my heart. He even looked at my feet and toes. I know it doesn't really matter, but I was a little embarrassed because I wasn't expecting my feet and legs to be examined and I hadn't shaved in months. It sounds like a silly thing to mention, but I have had bad experience with doctors so that little thing was enough to throw off my confidence in my ability to advocate for myself during the visit.
posted by ilovewinter at 9:10 AM on January 29, 2020

I have PVCs. My PCP noticed "something" on an ECG in her office, so had me wear a Holter monitor. This was a comedy of errors, as I was apparently about 900% more active than most people wearing them, so the thing would alert the service, and they would call me to find out what I was doing, and I'd be saying things like "I'm in the middle of a bike race." It was an annoyance, but ultimately didn't give her a diagnosis. Then I had a huge period of life stress and kept having a "fluttery" feeling in my chest, so I ended up being referred to the cardiologist. He did an echocardiogram (like an ultrasound, it's non-invasive and a fairly easy procedure.) I think I answered all the standard questions about diet, exercise, etc, just maybe in more detail than at the PCP. He definitely asked a lot about when I was feeling them, if I had thoughts as to triggers, etc. As a result I was diagnosed with PVCs.

The cardiologist basically told me that given my age (late 30s at the time), general health and activity level, that it would be "borderline malpractice" to medicate me for them. And that only a very slim margin of super type A people even noticed the physical sensation of them (that was said with a great deal of empathy, as apparently, he is also such a person). Then, once my life calmed down, I've only felt them a few times in the several years since that period of time. (I can kind of "will" myself to notice them, but they don't strike me out of the blue as they used to.) He even went to so far to say that if I felt like caffeine was influencing them, I should cut back, but that he wasn't even all that concerned about that.

My PCP isn't an alarmist in any way, but she definitely strongly deferred to the cardiologist once she noticed the oddity on the ECG, and pretty much went 100% with what he said at that point.

I am not on stimulants, but am on Wellbutrin, which has some stimulant effects. That prescription came after the diagnosis with PVCs and no one batted an eyelash about it.
posted by pixiecrinkle at 9:35 AM on January 29, 2020

I don't have pvcs but I am regularly tachycardic and got my very own cardiologist because of it.

Mine did an ekg right off the bat. I came in with one from a few days prior but they went ahead and did another.

They asked me alot about medication and stimulent intake (caffeine being the suspect) . There were lots of questions because some people don't realize how much caffine they already consume, you'll likely be asked these no matter why you are coming. So tea, energy drinks, doda, etc tree all different questions. They did an echo or of an abundance of caution which is an ultrasounds of the heart. It takes awhile but it's painless and way less scary than pelvic ultrasounds. You do have to be unclothed in the chest area on the left side for them to do it the entire exam though.

There were way more questions than I expected about activity levels, how far I can walk and stuff like that. I'm also lazy so a felt guilty about my answers of I'm lazy. They weighed me, asked about wieght fuctuations. Then talked about medicines that can treat my problem.

My doctor did a good job explaining the heart and why these things happen. Lots of people have wierd little heart things which are abnormal but pretty harmless. He did some reassurance, prescribed me appropriate meds and sent me on my way.
posted by AlexiaSky at 10:50 AM on January 29, 2020 [1 favorite]

I've had a cardiologist check my feet too. I think they check if the circulation is good there.

Having had all too much cardiologist attention in the last six months (for reasons very different from yours), I've had the insight that they are fixit guys. They look to see if there is a problem and, if so, fix it. They are neither reflective nor contemplative. They are also very smart, but like any group of doctors, some communicate better than others.
posted by SemiSalt at 2:17 PM on January 29, 2020 [4 favorites]

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