New cardiologist

[thomas999]

My cardiologist has retired and I have been passed on to a new cardiologist in his office who is on the younger side. I really liked my cardiologist as he was very experienced and was sort of a proactive type of personality. He gave me confidence with his methodology. Now I have been seeing the new cardiologist for the second year and I can't seem to gain that much confidence in him. The first visit I had with him he really didn't do any testing at all except an EKG and said everything was fine, and I'll see you next year. The second annual visit, which was about a month ago, he did another EKG and an echocardiogram. Now those are good tests and he said everything was all right but one of the questions I asked him was what my INR range should be. I already knew it should be between 2.5 and 3.5, at least that's what I've always been told by the last cardiologist, but when I asked this particular cardiologist he told me he did not know what it should be and referred me to my primary care physician. This seems a little odd to me that a cardiologist wouldn't have this information and would defer to a primary care physician for such information. My primary care physician does allow me to self-monitor and self-adjust which I enjoy doing, but it seems like a cardiologist should know this information? Not having the same outgoing personality as my last cardiologist is something for me to get used to, but having him not know what my INR range should be instills a bit less confidence in him. Should I expect him to know this information or should it be the primary care physicians responsibility? I have been self-monitoring and adjusting for 35 years now, so I am okay doing it myself and we'll stick to the 2.5 to 3.5 range.

 

[tommyboy14]

Honestly, I think it is strange that a Cardiologist wouldnt know this basic information. In your shoes I would probably look for someone who is more experienced with Mech valves (though I thought all cardiologists were).

 

[Chuck C]

Now those are good tests and he said everything was all right but one of the questions I asked him was what my INR range should be. I already knew it should be between 2.5 and 3.5, at least that's what I've always been told by the last cardiologist, but when I asked this particular cardiologist he told me he did not know what it should be and referred me to my primary care physician.

That's a big red flag in my view. Your cardiologist should be the expert in this area. Your GP may also be very well versed in INR ranges, but this is not an area where a cardiologist should pass the buck to the GP.

Should I expect him to know this information

Yes

 

[Superman]

Many adult cardiologist are heart attack folks. It’s not easy to find one that specializes in congenital heart defects that isn’t a pediatric cardiologist. We had a group start here a couple years ago now prior to that it was a lot of self advocacy.
You want to find one that specializes in adults with congenital heart defects if you can.

 

[pellicle]

Hey
this is a good point, and one I hadn't thought of

Many adult cardiologist are heart attack folks. It’s not easy to find one that specializes in congenital heart defects that isn’t a pediatric cardiologist.

I grew up only seeing a surgeon or later his registrar, I'd never heard of a cardiologist (not that I'd bothered searching) until I met one when they discovered my aneurysm in 2010.

Your above point solidifies my views that cardiologists are basically the step between General Doctors and actual specialists such as surgeons.

My current (only ever) cardiologist is a nice bloke, but seldom offers much in the way of deeper explanations than I have dug up myself (although I admit I'm "special") even with the latest rounds of actually needing some inputs.

We had a group start her a couple years ago now prior to that it was a lot of self advocacy.

I think that there should be more of this but my recent findings here and on other forums is that this is increasingly vexed because many people simply don't know when they're swimming out of their depth and being able to parrot what they've learned is no substitute for actually learning (rather than latching on to and confirming what they first thought).

That COVID thread was a prime example.

 

[Eva]

Look for someone else. Ask your primary doctor to recommend someone.
Good luck.

 

[oo0My_Valve0oo]

Just throwing this into the mix, I do not recall ever discussing INR with my cardiologist.

Unless I have overlooked it the OP has not stated whether they have a biological or mechanical valve. I figure it is mechanical. I have a biological and my time with blood thinners was limited.

That said, I was assigned to something going by The Coumadin Clinic. My health insurance is through Kaiser. I was not concerned about it. I have not researched the details.

They got the job done. Nurses at the clinic contacted me each week following the receipt of my weekly lab results. We would discuss the results and my diet. Interesting, that routine discussion was consistently more constructive than my interaction with the cardiologist after the first couple of consultations. In the beginning it was all new to me so I had no foundation to judge. Later after perhaps the third consultation with the cardiologist I began to see how what he had to contribute was very general information that is widely available using Google. He would also schedule my appointments which the lowest level clerk could have managed. I thought it was too menial a task for someone with his credentials.

The only entity above the cardiologist is the heart surgeon. Briefly post-surgery there is a general practice doctor assigned to you while you are an inpatient. I do not consider the heart surgeon a specialist. He is a surgeon specializing in the heart. There is a difference. He is not versed in managing patients before and after surgery. There is a limited time to accomplish a limited objective. If there are no complications then he is forever out of the picture. Any future surgery you might have on the heart could be done by any surgeon in the cardio department. I am not this surgeon's patient for the rest of his career.

In my view I would think a PCP refers you to the physician specializing in your need, in this case a cardiologist. The cardiologist manages your heart treatment and is the one who connects you with a surgeon for the specific task of surgery period. I would not expect to be handed back to the PCP unless your heart was 100% healthy and you did not even require periodic tests or monitoring. I expect to be monitored and have tests for the rest of my life especially because I chose the biological valve option. It is not impossible but unlikely that I will not have to have that replaced some day somehow. (Sorry for the confusing double negative).

When I was in my teens I had a softball sized tumor in my leg. A surgeon removed it. It was benign. Other than to check how the incision was healing and to have an X-ray done, post-surgery I never saw anyone about this other than the guy who refreshes the cast. Of course things would be different had it been malignant but the surgery took care of the problem and I did not have it for the rest of my life. It made sense that I would not continue to see a doctor about this. I guess it is common to get a benign tumor and never see another in your lifetime.

I will have "a heart condition" to manage for the rest of my life. Whether bio or mechanical it would be the same but with different ongoing attention. I could have lost a leg dealing with a tumor. That is life changing. But you only have one heart. You can function without a leg. You cannot live without a heart. That is significant and to me warrants the ongoing attention of a heart specialist not some general practitioner. If that is to be the case then this has only been round 1 and I am back in my corner awaiting the next bell. The condition and procedure may be noted in my medical history but I am back to being just another patient until there is a new flag waving "Look at me!"

That has already been set in motion. I have had a slower than anticipated recovery. I reached out to the surgeon, cardiologist and PCP describing details and my concerns. I got a consistent everything looks OK. See the PCP. The PCP wanted me in as though I was fresh off the street with no history of having the heart condition. I had reason to hesitate relying on the cardiologist and PCP and the surgeon's role became apparent soon enough that I stopped contacting him. To complete this longer than should have been post, I analyzed and experimented on myself. Whether the direct result of that or coincidence, within 1.5-2 months I experienced an exponential burst of rejuvenation and have not felt anything as bad as I did the previous year and a half post-surgery.

 

[tom in MO]

My cardiologist has retired and I have been passed on to a new cardiologist in his office who is on the younger side. I really liked my cardiologist as he was very experienced and was sort of a proactive type of personality. He gave me confidence with his methodology. Now I have been seeing the new cardiologist for the second year and I can't seem to gain that much confidence in him. The first visit I had with him he really didn't do any testing at all except an EKG and said everything was fine, and I'll see you next year. The second annual visit, which was about a month ago, he did another EKG and an echocardiogram. Now those are good tests and he said everything was all right but one of the questions I asked him was what my INR range should be. I already knew it should be between 2.5 and 3.5, at least that's what I've always been told by the last cardiologist, but when I asked this particular cardiologist he told me he did not know what it should be and referred me to my primary care physician. This seems a little odd to me that a cardiologist wouldn't have this information and would defer to a primary care physician for such information. My primary care physician does allow me to self-monitor and self-adjust which I enjoy doing, but it seems like a cardiologist should know this information? Not having the same outgoing personality as my last cardiologist is something for me to get used to, but having him not know what my INR range should be instills a bit less confidence in him. Should I expect him to know this information or should it be the primary care physicians responsibility? I have been self-monitoring and adjusting for 35 years now, so I am okay doing it myself and we'll stick to the 2.5 to 3.5 range.

Your cardio is not managing your INR, thus he's not responsible nor does he know your INR history. The cardio practice I go to has a coumadin clinic run by a doctor other than my cardiologist. Not all cardios do warfarin therapy.

My clinic does not support home dosing and disallows it, but stated that if my specific cardiologist allows it, that's between him and I. He does allow home dosing, sets my INR and looks at my data every year.

 

[thomas999]

A few points to be added to my original post are:
*My aortic valve is a St Jude mechanical valve that was installed in 1987.
* Secondly, I have been told by a primary care physician years ago that the range for my particular valve is INR 2.5 to 3.5. I now have a different primary care physician, and that information was passed along to him by me. He was in agreement with what info I gave him with regards to the INR value. It has been years since it has been discussed, so I thought I would ask my cardiologist just to make sure the range is still where it should be. He wasn't sure, so that is why I started this thread.
* Thirdly, my present day primary care physician has given me the authority to self-monitor and I am just fine with that because I do a very good job. I enjoy taking care of adjustments when needed and doesn't seem difficult at all. I have been on the same Warfarin dosage now for probably 10 years.
* Finally, I just figure a cardiologist should be up on such things and have that info at hand, or at least get that info for me. He basically referred me too my PCP for the correct information, which I then deferred to myself because I figure I will just stay on the same dosage and stay within the same range. What brought all this questioning about was that he is a young cardiologist that I have just started with basically.

 

[Eva]

Both of my PCP and my new cardio check with me about my INR and the dose I’m taking!
My ex-cardio (I fired recently) didn’t seem to me as a competent cardio since I started seeing him about 3.5 years ago. I wish I followed my guts and left him earlier before he failed me when I most needed him this year.
Follow your guts!