When to see a cardiologist, and when your GP is enough

This is one of the most-asked questions our reception gets: *"Doctor, mujhe direct cardiologist se milna chahiye?"* (Should I see a cardiologist directly?) Here is a clear answer.

See a GP first when

• The symptom is new but mild — occasional fluttering, light dizziness, a tight chest after climbing stairs you used to manage easily.
• You have no prior cardiac diagnosis and no first-degree family history of early cardiac death (under 55 in a male relative, under 65 in a female relative).
• You smoke, are overweight, or have hypertension — your GP can stratify your risk with a simple Framingham score and decide whether you need a cardiologist or whether a lifestyle plan plus annual review will do.

A good GP visit for early cardiac concern includes: a full history, blood pressure check, basic ECG, fasting lipid + sugar profile, and a written plan. If that workup is clean and you fit a low-risk profile, you do not need a cardiologist yet.

See a cardiologist directly when

• Pressure-type chest pain that radiates to the jaw or left arm, especially if it comes on with exertion and eases with rest. This is angina until proven otherwise.
• Fainting (syncope) with no clear cause — especially during exercise.
• Palpitations with shortness of breath, especially if they last more than a few minutes or come with chest discomfort.
• A family history of sudden cardiac death in a first-degree relative under 50.
• You already have a cardiac diagnosis (post-MI, post-angioplasty, valve disease, known heart failure) and are due for a structured review.

Go to the emergency department (do not see a GP first) when

Crushing chest pain lasting more than 15 minutes. Chest pain with sweating, nausea, or breathlessness. Sudden severe headache with vision change. Sudden weakness on one side of the body. Loss of consciousness.

**For these — dial 1122 (Rescue) or get to a tertiary hospital ER (Aga Khan, Liaquat National, South City) immediately.** Do not call our clinic, do not WhatsApp us, do not drive yourself.

The middle path — internal medicine consultation

A lot of cardiac-flavoured concerns are not actually cardiac. Anaemia, thyroid disease, anxiety with somatic chest sensations, oesophageal spasm, costochondritis — all present like cardiac symptoms and waste a cardiologist's time. An internal-medicine consultation can sort these out in 45 minutes with a focused history and the right investigations.

If you're unsure which way to go, WhatsApp the practice and describe what you're feeling in two lines. We'll suggest where to start.