What to ask Cardiologist on Weds?

[siliconcover]

Posted under diff name about Ds last year. He had LVSD from severe PeriMyocarditis.
Small hospital with very poor care. Now doing formal complaint via PALS & MP.

4 weeks ago I (f, 57) had sudden severe chest pain an 'electric shock' which ran from my right ankle (previous surgery for congested nerves) up the inside of my right leg, 'crossed over' my pelvis up sternum & out to left arm (it was properly weird!). Chest pain & pressure, sob, banging headache.
Went to A&E & BP of 207/115. Had Echo & CT thoracic & dx Pericarditis with effusion, Hypertension & Hyperlipidemia. Given 5mg Ramipril, 60mg Atorvastatin, 1000 mcg Colchicine. BP currently still varies 178 - 197/110 range

I don't have much faith in the Dept.
What do I need to ask please?
(Size of effusion? Meds re BP? MRI?)

Grateful for any input.

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Sorry you’ve had such a rough time of it, OP.

I’d expect the doctor to discuss the cause of your pericarditis (which might not be known), how it’s progressing, and the ongoing treatment you might need. Whether your condition is related to your son’s, or if this seems to be coincidental. I’d expect your blood pressure medication to be adjusted, as it doesn’t seem to be controlled on your current tablets.

I completely understand that you don’t have huge confidence in the team, but it will really help if you don’t go into the consultation with an attitude of suspicion or mistrust - that tends to put everyone on a defensive footing, and those conversations are often unsatisfactory. Write down the questions you have in advance, and don’t be afraid to interrupt the consultant to ask for clarification on any point.

@AppropriateAdultThank you for replying. I agree with your general points. However my stay was full of contradictory info - I was told I'd need transferred to nearest big city for an Angiogram. Then it was 'musculoskeletal' & that I 'just needed to go on HRT' (by a Cardiac nurse). Then Consultant said no heart attack as pains / pressure over a few days & he took away the GTN I'd been given for Angina & seemed annoyed I'd been given soluble aspirin (15 hrs after arrival as 'forgotten on shift change') . After my Echo & CT thoracic he said he could see Pericardial effusion & some plaque on right artery but my discharge letter only says suspected Pericarditis so GP says nothing wrong with heart & BP is anxiety (it's not). I appreciate that cardiac issues can be an evolving dx but, as with Ds experience (which PALS say was likely negligence) I feel that it's not exactly confidence inspiring.

Just ask for a referral to a cardiac centre. If you’ve lost faith in them. Then you have a right to go elsewhere.

Are you monitoring your bp twice daily? Take those readings with you. It's possible you need your bp meds to be titrated or a new med added.

I'd ask why it was felt that an angiogram was no longer needed and also for them to confirm the results of the echo?

Did they check troponin on admittance? What about cholesterol etc.

Have they offered a 24/48hr holter monitor?

I'd want to know if it's possible that the issues are hereditary and what tests could be done and what further tests they advise.

You can also ask for a second opinion.

@RachelsPeevesyes, Troponin normal. Referring to Lipid clinic as Cholesterol high. No Holter offered (but it took 6m for Ds to have one & he was much more ill than me)

@Toddlerteapleasewhere I am you have to have permission for referral from your original Consultant. I would like this (I can't 'afford' to be ill when Ds still is). But I'd like to go in with a list of Qu's to make this point.

so I will ask:
causes & extent of Pericardial effusion.
why the angiogram was stood down as I have Hyperlipidemia.
for BP meds to be looked at as GP not interested.
why the GTN spray was taken away & why 'not angina' when I have angina like pain & history of heart disease in the family?

Just spent an hour on sofa with new book (dozing). checked BP: 168/108, pulse 48. So, its a bit better but still too high. My chest hurts, my head aches. I'm tired.

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Dare I suggest that you go onto chatgpt?!

I have used this prior to cardiology appointments. They give loads of useful info and will write a list of questions to ask the consultant that you can print out and take with you. Or indeed send to the cardiology department beforehand, as I have done. You can delete any bits that you do not want to ask.

It helps if your head is in a whirl as AI tends not to suffer with that and is of course analytical which is what you need at the moment.

Is the info from them accurate? I have found it to be so by following up with searching for peer reviewed research.

You can say to it that you are in a muddle, don't know what to ask and need help with it. I have also said on one occasion that one of the consultants was rude to me and chatgpt came up with some very tactful ideas for approaching this.

It's worth a look, even if you decide it is not for you. It has access to vast quantities of information.

I've got high BP OP, and it's taken some time to get the medications right. I take 2.5mg of ramipril am and then the same again pm as the 5mg makes me too light headed, and I also take 1.25mg of Indapamide. This took around 2 years to get right, I hate to say as every GP I saw prescribed me something different. I had a few meds that made it worse... and one made my legs all swell up so badly I couldn't get shoes on.

DH is under a cardiologist at the moment and I always make him take a list of questions in on his phone and get answers to them. They can be a little too breezy for my liking if you don't.

It will also cope with lots of information at one time and go through it in a logical way which really helps when you are feeling battered and puzzled. Ask it why the medics might have done what they did. Say you have no faith in the department - they will respond to that too.

I have worked my way through several cardiologists as each time A&E sent me in I saw different people. I used to get really exasperated when they just piled on more drugs with no explanation or concern about the side effects I was getting. and gave me GTN spray when I no longer had angina. They have an algorithm - they plough through it.

I am now under an excellent cardiologist - he is kind, he listens. It has taken me a year to get to this point.

@MischanceThank you. I hope you are getting the help you need now.

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Do you have anyone to go with you?

No matter what the cardiologist says, ask for copies of the reports they're referring to.

Good luck, @siliconcover

@echtit'll be just me there. I'll take notes & go via records on way out (30 days for notes). I'm in a fair amount of pain, & they only see you every 6m, so it feels like a lot is riding on this. Fingers crossed.

How did it go @siliconcover?

Through only if you want to say.

The reason I said ask for copies is that even though I go private (Australia) I still have to ask!!! I've paid for the fecking things!!

And breathe.

Hi @echt thats kind of you to ask x I was just sitting down with coffee to update

I had an ecg & a 5mins echo. I was told both were 'fine'. I asked to see but was firmly told 'time to see or to discuss not both'. Apparantly no sign of Pericarditis at all now. I was asked why I walk with a stick, how do I sleep, am I anxious.
I insisted that I have 1month new chest pain & pressure, enough to wake me up, to make me cry on occasions, at rest as well as exertion, plus a headache (& recent slightly 'heat haze' vision) My BP is still high 170's/100+ & high Chol too.

There was discussion about BP & 'windy weather' & indigestion (he said that his reflux has affected his cardiac artery before) both of which I found really irritating

He added a medicine Felodipine to help my BP (which he says will help any reflux too) I asked if I could try the GTN spray that I'd used on the ward which had been helpful & he said Yes, that can help reflux. I showed him a small chart of the big family history of angina, heart disease & MI but he barely looked.

I reminded him that he had said on ward that there was plaque showing on my previous CT thoracic so he said he'd arrange a CT angiogram 'in a month or so'.

He concluded by saying 'probably not Peri now but I don't rule it out. It could be Angina, could be reflux. It is not structural/functional so a differential diagnosis'.

I found it frustrating at the time but typing this out I suppose I have a new med re the BP, some GTN to try & a CT Angio in pipeline so he was trying to help me?

@echt sorry re copies - you have to apply for them via 'patient records' (provide ID, say why you want etc) It can take 'up to 3m' & they can charge £50)
I am in Scotland. I understand in England there is an App so sometimes you can see your results in 'real time' on your phone on the ward, & copies of letters too!

I’m sorry to hear they wouldn’t show you results.

Yes we have an nhs app in England. I’m currently titrating up on a drug called verapamil (funnily enough licensed for angina and high BP but I’m taking it off license for Cluster headaches via neurologist)

I have to have an ecg every 2 weeks before each increase (increase of 1 dose of the 3 per fortnight) and my ecg was on the nhs app within 2 hours. I mean - I have no idea what any of it means except it was fine! But it also clearly states exactly what they did, the leads etc.

I can imagine the gate keeping to your own health information is frustrating and really not helping your sense of trust.

I really hope you get some answers soon.

Thanks @echt I do wonder why they've been so vague with both Ds and me. Perhaps it's a 'vague' specialty but surely things are either on a scan or not??