If you're sent for one, here's what to expect at the cardiologist:

• He will take your medical history and do a physical examination. Since obesity is an important risk factor in heart disease, he will determine your height and weight. The doctor will also examine your eyes for changes indicating arterial damage due to hypertension or diabetes mellitus. He will feel your pulse in your neck, groin and legs in order to determine whether the arteries supplying these regions are functioning normally. He may also use his stethoscope to listen for the noise (bruit) made by blood p

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  assing over an atherosclerotic plaque, or to listen for any heart sounds indicating that a heart valve is not functioning optimally.
• He will measure your blood pressure. A person is regarded as suffering from hypertension if his blood pressure is higher than 140/90mmHg. Hypertension is usually symptom-free until a significant clinical complication results. Hypertension is an important risk factor in heart disease and stroke. One in four South Africans between the ages of 15 and 64 suffer from high blood pressure, according to MRC studies. More than 6.2 million South Africans have blood pressure higher than 140/90mmHg.
• Blood tests to determine cholesterol and other blood lipid levels. Cholesterol levels higher than the recommended 5.2mmol/l are regarded as posing a risk for heart disease and stroke. Blood may be drawn after an overnight fast for what is called the lipoprotein profile. This almost always includes total cholesterol, triglyceride and HDL-cholesterol, and glucose determinations.
• Urine samples may be examined for sugar and protein to rule out diabetes or kidney problems.
• He will perform an ECG (a recording of the electrical activity of the heart) and a stress ECG to determine if the heart is functioning effectively. An ECG allows a cardiologist to determine whether the heart is contracting with the correct rhythm and in the correct manner. He will also be able to pick up any problems related to damage to the heart muscle, as well as valve defects.
• Other heart tests may involve more sophisticated imaging techniques, such as an angiogram. This technique involves catherisation (threading a catheter with a special camera and even a stent on the front end, through a vein in the groin, right into the heart and then into the coronary arteries) and injection of a dye into the coronary arteries. It is usually done under local anaestetic, but you will be lightly sedated. With this (and other techniques involving ultrasound and imaging), the cardiologist can literally look inside your coronary arteries.
• In some cases and if possible, the cardiologist will place a stent into the coronary artery to open the blockage immediately. In other cases, coronary bypass surgery will be performed soon after the procedure. Heart catherisation may also be used to establish the extent of other heart problems such as valve defects. Angiograms of the brain or kidneys can also be performed to show blood flow problems in these organs. There is always a risk that someone with a heart problem can have a heart attack during an angiogram. A cardiac surgeon is therefore usually on standby to perform open heart surgery in case of such an emergency.

The signs of coronary artery disease
The first symptoms of coronary heart disease will only appear once the arterial narrowing significantly reduces blood supply to an organ. The first symptom of a narrowed artery is generally chest pain (angina) during exercise, or leg cramps. These symptoms usually develop gradually and episodically as the artery is slowly narrowed. Other symptoms may include fatigue, shortness of breath, sweating, lightheadedness, nausea and palpitations.

- (Health24, updated May 2008)

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