Coronary Artery Disease: Roles of Different Doctors

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Coronary Artery Disease: Roles of Different Doctors

Topic Overview

What health professionals are involved in taking care of people with coronary artery disease?

Following the diagnosis of coronary artery disease (CAD), you should visit your primary care physician every few months to track your condition and ensure that your treatment is going as planned. If you develop complications or need special procedures (such as cardiac catheterization or open-heart surgery), you may require treatment from a variety of specialists.

Understanding your health professionals' roles

Depending on the severity of your CAD and whether you have already developed complications, you may need a team of health professionals to help treat your disease and manage your treatment plan.

The following table outlines the types of health professionals who may be involved in the treatment of CAD and any related complications.

Health professionals for CAD

Health professional

Who are they?

What is their role?

When would you see them?

Primary care physician Internist, family physician Manage medical care Regular visits (about 2 to 4 per year)
Cardiologist Heart specialist

Provide specialty medical care

Sometimes for regular visits or whenever CAD worsens
Other physicians Nephrologist (kidney specialist), cardiovascular surgeon (heart surgeon), neurologist (brain/nerve specialist) Provide specialty medical care for complications of CAD Whenever complications arise or special procedures need to be performed
Nurse educator Specific type of nurse Educate you and help you take control Whenever medications, diet, or self-management needs to be explained
Physical therapist or rehab nurse Specific type of nurse or other professional Help you to build strength and improve functioning for daily activities During hospitalization and after discharge
Psychiatrist, psychologist, or social worker Mental health professional Help you cope with psychological aspects of disease Regularly (perhaps weekly), for as long as you need
Dietitian Nutritional expert Help you with heart-healthy diet Initially, and whenever diet needs to be changed

Although you may not require assistance from all of these providers, it is helpful to be aware of the full range of professionals you may encounter at some point during the course of your treatment. If you need the assistance of other health professionals, you should keep in constant contact with your primary care doctor and report any changes in the way you feel or any medication-related side effects. Each individual's experience with CAD and its complications is different; your health professionals will help tailor your treatment to best suit your needs.

What is the role of a primary care physician in caring for people with coronary artery disease?

In some cases, your primary care physician (PCP)—usually an internist or family medicine physician—will serve as your care coordinator and be responsible for the day-to-day medical management of your coronary artery disease. In such circumstances, your PCP will be the one who evaluates your risk factors, performs diagnostic tests, and looks for evidence of other diseases.

Once you are diagnosed with CAD, your PCP will help you develop a treatment plan and will also decide whether you need to start taking medications or whether you need certain procedures to diagnose the severity of your CAD. For this reason, it is important that you are open with your doctor and make sure that he or she knows of any changes in your symptoms.

In general, you should visit your PCP once every few months to make sure that you are on track with your CAD treatment and to continue with your general medical care. In addition to a physical exam at each visit, you and your doctor should review your progress with lifestyle modifications and, if applicable, experiences with your prescribed medications. If you have new or changing symptoms, your PCP may perform or request the following tests:

  • An electrocardiogram (EKG, ECG) looks at the electrical rhythms of your heart and provides evidence that your heart may not be receiving adequate blood flow (ischemia), that a heart attack has occurred, or that one or more of the chambers of your heart are enlarged.
  • An exercise stress test monitors the heart's activity during exercise and helps assess the severity of CAD.
  • A chest X-ray provides evidence of heart failure.

Most primary care physicians are qualified to develop and manage treatment plans for chronic diseases such as CAD. However, if you develop complications or have more severe CAD that needs a procedure or surgery as treatment, your primary care physician may refer you to a specialist.

What is the role of specialists in caring for people with coronary artery disease?

In some cases a cardiologist will serve as your primary point of contact in treating and managing your CAD. Whether you work more closely with a primary care physician (PCP) or a cardiologist depends on a number of factors, including the nature of your condition and the relationship you may already have with either physician. Whether you see your cardiologist to treat mild atherosclerosis or to provide follow-up care after a major surgery, this specialist will add heart-specific expertise to your treatment plan.

There are also specialists within cardiology. For example, an interventional cardiologist can perform a cardiac catheterization, an invasive procedure used to take X-rays of your arteries and diagnose any narrowed areas in your coronary arteries. An interventional cardiologist can also perform an angioplasty and place stents during a cardiac catheterization to open narrowed or blocked arteries.

What is the role of a cardiac surgeon?

In more advanced stages of coronary artery disease, open-heart surgery may be recommended to bypass the blocked vessel and allow blood to reach the heart. In the event that medications and/or catheterization are not enough to diagnose and treat CAD, or in some emergency cases (such as a heart attack), open-heart surgery may be necessary.

A cardiothoracic surgeon (also called a cardiovascular surgeon or a cardiac surgeon) is a specialist trained to perform these procedures. The two main circumstances in which you might see a cardiothoracic surgeon are as follows:

  • Your cardiologist, after performing more extensive diagnoses and evaluations, decides that you need surgery to restore proper blood flow to your heart.
  • You have a medical emergency, such as a heart attack, and your physicians decide that surgery is necessary to save your life.

One of the more common surgical procedures that cardiothoracic surgeons perform is called a coronary artery bypass graft (CABG) surgery. During a typical CABG surgery, the surgeon will remove a healthy vessel from another part of the body, most commonly the leg or chest wall, and graft, or attach, it to the coronary artery to create a new path of blood flow to the heart.

What is the role of other specialists?

If you develop certain CAD-related complications, you may need to see a number of other specialists to treat your specific conditions. For example, you may need to see a nephrologist (kidney specialist) if you develop kidney problems or a neurologist (brain and nervous system specialist) if CAD leads to a stroke. Your primary care physician will direct you to the specialists who are skilled in treating your specific condition. You may be referred to the following specialists:

Nurse educator

While primary care physicians serve as central coordinators of care for many people with CAD, nurse educators are valuable resources as well.

Nurse educators usually have more time to devote to your care and to make sure that no aspect of your treatment falls through the cracks. In addition to serving as a care coordinator, your nurse educator will serve other important functions. For example, a professional educator may be the first one to help you understand CAD, begin your treatment plan, teach you about the effects of various medications on your condition, and help you with lifestyle changes.

One of the nurse educator's most important roles is to provide you with the information you need about your disease as you are ready to handle it. You will have CAD for the rest of your life, and your nurse educator can be there with the information that you need to adapt to changes in your condition.

Physical therapist/rehab nurse

Should you have a sudden (acute) event, such as a heart attack, or need emergency surgery for a complication of CAD, a physical therapist or rehabilitation nurse can help you get back to a healthy and active lifestyle after you are discharged from the hospital. If you have been hospitalized, it is likely that your body will have undergone a considerable amount of stress. You may need to work slowly to build up your strength after an acute event or major surgical procedure, and your physical therapist or rehab nurse will be able to help you reach this goal by guiding you through special exercises and stretches.

How much physical therapy you may need depends on how serious your condition is, and your physical therapy team can tailor a training program to your specific case.

Dietitian

Because what you eat has a large effect on your coronary artery disease, you may seek the aid of a dietitian or nutritionist to help you develop a heart-healthy diet. If you also have high blood pressure (hypertension) or diabetes, it may be important to limit salt and sugar intake as well.

Dietitians are trained in nutrition and are experienced in helping individuals make lifestyle changes. They understand that adjustments to your eating habits can be the hardest changes to make, and they can help you take small steps toward the larger goal of a balanced diet.

Exercise physiologist

Exercise often becomes an important part of treatment for people with CAD, so you may benefit from the assistance of an exercise physiologist. These professionals can help you customize an exercise program appropriate to your own fitness level.

Like physical therapists, rehab nurses, and dietitians, exercise physiologists have experience working with people of varying levels of strength and aerobic capacity, so they understand how to motivate people in different ways.

Mental health professional

Many people with serious conditions such as CAD experience depression, either independently or as a result of their physical condition. Psychiatrists, psychologists, and clinical social workers can help you deal with the mental challenges associated with any CAD-related complications that you may have. In addition, they can help you learn to manage the stress in your life, which can have a direct bearing on the success of your treatment plan.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised May 10, 2010

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