What do you do when your cardiologist lies to you?

[Protimenow]

I'm faced with a bit of a dilemma.

My cardiologist seems to think that I need to be 'handled' and not actually told what's going on with my heart.

No, I'm not crazy. Somewhere along the line, he decided that I'm one of the patients who should be told that 'everything is okay' -- even when it isn't.

I have had a St. Jude aortic valve since 1991. As a result, I can hear my valve closing when I pay attention to the click.

I can hear when I have normal sinus rhythm, and when my rhythm isn't right.

I have an Apple Watch 7 that takes an EKG (they call it an ECG). Much of the time, I'm seeing rhythm irregularities on the ECG that the watch takes.

Sometimes I feel the effects of these arrhythmias.

My Merlin At Home device, which takes a snapshot of the information it reads from my pacemaker, goes off many mornings. I was told by St. Jude that the device detected something that the cardiologist should know about and that a report is sent, but my cardiologist says that everything's fine.

I saw him yesterday. Even with my untrained eyes, I could see that the EKG taken in the doctor's office showed arrhythmias. He didn't even LOOK at it.

He interrogated my pacemaker, and told me that he didn't see any PVCs.

I hear arrhythmias (because my valve clicks). I detect them on my watch. I saw them on the EKG taken in the doctor's office.

But he persists in telling me that everything's fine.

Should I challenge him on this?
Should I threaten to go to someone else who would be honest with me?
Should I just switch cardiologists?

Should I have my PCP take and see what he thinks?

This is a good cardiologist. He answers calls after hours. He seems responsive - but I'm convinced that he's 'handling' me, telling me what he thinks I want to hear. It's nice to give this 'rosy picture' to my wife so she doesn't worry, but am I getting a disservice when the information is wrong?

Vitdoc, Nobog, and others, I'd like your opinions about what to do.

Thanks

 

[nobog]

All I can tell you is it's not the valve. The valve leaflets react to pressure, proximal and distal, and then move accordingly. In other words if your heart wants to beat fast, slow, or irregular, you will hear (most/some people) the change.

 

[tommyboy14]

To be honest, I think it is time to switch Cardiologists. Everytime I have an inkling of an arhytmia, my cardiologist insists on a 24 hour holder. Last time I thought there was a problem, he read my ECG on the plane back from a conference.

If I was you, I would switch Cardiologists to somebody who you can have an honest conversation with.

 

[jeffp]

If I was you, I would switch Cardiologists to somebody who you can have an honest conversation with.

This says it all. Unless you’re in an area with only one cardiologist available within a reasonable travel distance, why stay with someone that’s not treating you as a part of your own care?
Maybe he’s caring for you clinically correctly, but you’re not a box of gears and widgets you can run a diagnostic on and be done. Communication (two way) is key to proper medical care. I was in a similar situation and my new (now current for about a decade) cardiologist did all the needed records requests and made the transfer of care seamless.

 

[MdaPA]

Perhaps get a second opinion with another EKG before deciding to switch?

 

[pellicle]

If I was you, I would switch Cardiologists to somebody who you can have an honest conversation with.

good advice, and if you can have a conversation with them, then you can also get a good feeling for their competency too.

 

[Protimenow]

All I can tell you is it's not the valve. The valve leaflets react to pressure, proximal and distal, and then move accordingly. In other words if your heart wants to beat fast, slow, or irregular, you will hear (most/some people) the change.

I'm not concerned about the valve. I know the valve is functioning properly.

One of the things I was saying was that I can hear the arrhythmias because I can hear the valve closing - not that the valve is the cause of the arrhythmia.

What bothers me is I KNOW that I have an arrhythmia and my current cardiologist won't level with me. The EKG he took in his office showed it. The EKG on my watch shows it. I can hear it when I listen to my valve closing.

What bothers me is that he won't tell me and, apparently, thinks I can't handle the obvious information about the valve.

 

[Protimenow]

good advice, and if you can have a conversation with them, then you can also get a good feeling for their competency too.

I have no doubt that he's competent. He saw me through some difficult rhythm issues.
What bothers me about him is his current unwillingness to be honest with me.
And, yes, I'll have my PCP do an EKG - and see if HIS results are any different. But, FWIW, I can HEAR when my heart goes out of rhythm - it's obvious - and is definitely something that my cardiologist is seeing - but not mentioning.

He currently owes me a phone call about my ejection fraction - he ordered an echocardiogram when I saw him on Monday and I'm supposed to get a report on the ejection fraction.

When I speak to him he always acts so busy - I'll tell him that I don't want to be 'handled' - and I want truth instead of what he thinks I can handle.

 

[carolinemc]

I'm faced with a bit of a dilemma.

My cardiologist seems to think that I need to be 'handled' and not actually told what's going on with my heart.

No, I'm not crazy. Somewhere along the line, he decided that I'm one of the patients who should be told that 'everything is okay' -- even when it isn't.

I have had a St. Jude aortic valve since 1991. As a result, I can hear my valve closing when I pay attention to the click.

I can hear when I have normal sinus rhythm, and when my rhythm isn't right.

I have an Apple Watch 7 that takes an EKG (they call it an ECG). Much of the time, I'm seeing rhythm irregularities on the ECG that the watch takes.

Sometimes I feel the effects of these arrhythmias.

My Merlin At Home device, which takes a snapshot of the information it reads from my pacemaker, goes off many mornings. I was told by St. Jude that the device detected something that the cardiologist should know about and that a report is sent, but my cardiologist says that everything's fine.

I saw him yesterday. Even with my untrained eyes, I could see that the EKG taken in the doctor's office showed arrhythmias. He didn't even LOOK at it.

He interrogated my pacemaker, and told me that he didn't see any PVCs.

I hear arrhythmias (because my valve clicks). I detect them on my watch. I saw them on the EKG taken in the doctor's office.

But he persists in telling me that everything's fine.

Should I challenge him on this?
Should I threaten to go to someone else who would be honest with me?
Should I just switch cardiologists?

Should I have my PCP take and see what he thinks?

This is a good cardiologist. He answers calls after hours. He seems responsive - but I'm convinced that he's 'handling' me, telling me what he thinks I want to hear. It's nice to give this 'rosy picture' to my wife so she doesn't worry, but am I getting a disservice when the information is wrong?

Vitdoc, Nobog, and others, I'd like your opinions about what to do.

Thanks

Depends on how confident you are of the cardio, do you feel comfortable in the way you are being treated by this cardio. If he is making you feel uncomfortable and unsure, I would get another cardio that would treat me with respect, for we need to be on the same page, patient and doctor. I had one who took my blood pressure and did not know how to read the pressure. So it is all up to you. Luck to you on what you finally decide.

 

[vitdoc]

There are arrhythmias and there are arrhythmias. Some are benign and some can be serious. For example A. fib generally is not lethal but may lead to strokes if not detected and treated with anticoagulation. It can be annoying if the rates are either too high or low. Ventricular tachycardias can be relatively benign if they are isolated and not in multiple groupings. One can have atrial tachycardias with extra beats coming from the atrium. These can be annoying but generally they are not life threatening either. They can be handled with medication or sometimes ablation.
So when you look at the electrocardiogram (EKG to ECG depending on your use of the German K or the English C) you are looking for patterns - are the extra beats singular or do they come in runs? Are they from the atria or from the ventricle? Is there an overall normal rhythm or a clearly irregular rhythm (A. Fib).
I suspect you are either having super ventricular beats or isolated ventricular beats which are fairly common in people with heart issues but not usually too worrisome.
My only issue is why the cardiologist didn't discuss any of this with you. If you said you were having runs of fast extra beats then a Holter monitor might be helpful in seeing what is going on. But if the beats are primarily isolated and can be seen on the EKG then a lesser degree of concern would be appropriate.
In my journey with my heart issues there were times years ago that I got lots of extra beats but these subsided after the heart settled down when my valves were dealt with.
So if you have not already done so ask the cardiologist about these extra beats and what he is thinking about them. Hopefully he will explain these issues.

 

[Protimenow]

Vitdoc - thanks. I used to have frequent PVCs, and my cardio increased my pacing to 90, with the goal of making my heart beat before the PVCs could happen.
He told me that my pacemaker reported NO PVCs - perhaps what he was seeing was bigeminy, or other rhythm abnormalities (not actually PVCs) - but these DID show up on the EKG in the office, on my watch (yes, just a one lead EKG), and I can hear them. They may not be PVCs, but are STILL troubling to me.
He was apparently not concerned with these other, frequent, arrhythmias - it would have been good if he confirmed that I was having arrhythmias but he wasn't concerned about them. This would have been better than leaving me in the dark because I KNOW (hear and feel) that I'm having arrhythmias - and he has said nothing about them.

 

[Eva]

I'm faced with a bit of a dilemma. ?

I have an Apple Watch 7 that takes an EKG (they call it an ECG). Much of the time, I'm seeing rhythm irregularities on the ECG that the watch takes.

I saw him yesterday. Even with my untrained eyes, I could see that the EKG taken in the doctor's office showed arrhythmias. He didn't even LOOK at it.

He interrogated my pacemaker, and told me that he didn't see any PVCs.

… I saw them on the EKG taken in the doctor's office.

Should I have my PCP take and see what he thinks?

This is a good cardiologist. He answers calls after hours. He seems responsive - but I'm convinced that he's 'handling' me, telling me what he thinks I want to hear. It's nice to give this 'rosy picture' to my wife so she doesn't worry, but am I getting a disservice when the information is wrong?
…

Re iWatch7: don’t trust it 100 percent!
I was hooked to a monitor every time I went to my cardiac rehab exercise session at UCLA last summer. My iWatch7 warned me, more than a few times, that my pulse elevated to 167, 170, and 180 bpm. Guess what: false alarm…the monitor was in the 90s!

Re ECG: with all respect and out of experience, it takes a very professionally-trained eye to detect Arrhythmia.

At the hospital, just before my cardio version procedure, the technician told me I had no AFib.
I was happy!
Guess what: the electro physiologist pointed to the technician and to me the where the arrhythmias were, which the technician missed! so, It takes very professionally trained eyes to see the arrhythmias on a ECG printout! After my procedure, electrophysiologist gave me copies of the before and after the cardio version ECGs! yes, i saw the difference then!

On other occasions, I pointed to my cardio what I thought arrhythmias, but they were not. And I consider myself smart and informed!

So, in brief, no matter how technology is improving, I personally (from experience) would listen my doctor if I have confidence in him. Your doctor seems good and caring. Yet, you can still seek another opinion.

I know you like your Ovaltine. Just try to skip it for a week and check if your heart/arrhythmias will calm down or not. You mentioned you’re used to it! Our bodies’ reaction change over the years! Again, I, personally, feel arrhythmias after every time I drink Ovaltine!

 

[Eva]

@Protimenow
Check the below 12-lead ECG, which is informative about heart rhythms! Given to me by a student cardio doctor.

 

[Eva]

 

[mecretired]

I would definitely consider changing cardiologists. You need a cardiologist who has time for you, listens to you, takes you seriously and one that you have confidence in. You know your body better than anyone else.

 

[BicuspidBuddy]

Being an ex-CCU nurse and able to read rhythm strips well, I completely agree with Eva and vitdoc.

If you believe your cardio to be competent, ask for a Holter monitor. Ask him to explain what he doesn't see as an issue, but you feel is a big issue. It may be that explaining some benign minor arrhythmia and why it is benign and what it looks like, etc., etc., may be too in-depth and too time consuming for him.

Ask questions. Get a Holter, get a repeat EKG or a copy of your EKG. Make an appointment to discuss these reports with him and say you want to understand in a very rudimentary way why he is not concerned, not that you want to become an expert in reading arrhythmias.

A strong opinion on this forum regarding rhythm strips via wrist watches is that they are not accurate compared to technology performed in hospital.

 

[Protimenow]

I'll take the advice about skipping Ovaltine - I'm taking vitamins that give me whatever Ovaltine gives me. I don't really need it.

I don't absolutely trust my watch to detect my heart rate - although it's pretty consistent, detecting the rate my pacemaker is set at. When I had PVCs, it would occasionally show slower rates - because it couldn't deal with accurate measurements when I had PVCs.

I DON'T have AFib. I've had tachycardia, but the ablations took care of this problem.

I don't get extra beats - my heart just doesn't fire completely at times (spikes are smaller, or my beats feel as if they're ineffective (I can see, hear, feel, and verify with an EKG when I have them). I don't know enough about reading an EKG, and it's hard to trust a one lead EKG (like my watch records), so I don't know if these are serious or not - but I DO get winded easily and need midday naps.

It could just be heart failure (my Ejection Fraction is below 40 - and I'm waiting for my cardiologist to tell me what he saw on Monday's echo), or it might somehow be related to my weird rhythm. I don't know.

It would be good if I can get my cardiologist to explain things to me - what these arrhythmias are, if I should be concerned about them (at least to put my mind at ease - because these things are REAL) - and that he's giving me a complete picture, rather than telling me what he thinks I should hear (and isn't giving the whole picture).

 

[BicuspidBuddy]

It would be good if I can get my cardiologist to explain things to me - what these arrhythmias are, if I should be concerned about them (at least to put my mind at ease - because these things are REAL) - and that he's giving me a complete picture

Absolutely. I wish you the very best in getting these answers to your important questions.

 

[Eva]

I’d like to hear back from you after you stop the Ovaltine! It took me a long time to detect its *disturbing new* effect on me. I think also the ingredients/quality of ingredients may have changed during the last few years!

I’d be anxious too in your position. Your doctor seems caring from your description. I’d give him the benefit of the doubt re his last attitude. Try to go and see him again. Tell the secretary what you said in your last paragraph when you make the appointment!

Keep us posted.

 

[Protimenow]

I've stopped the Ovaltine. I started drinking it years ago when a doctor friend said that I should.

It's basically a sort-of-chocolate flavored drink with some vitamins in it. I was drinking it, boosted with about 1/4 tsp of chocolate powder (for taste), 1/2 tsp of instant cold brew coffee, and often with 1/4 tsp of cinnamon.

I'm taking a multivitamin/mineral pill that probably gives me more than the Ovaltine does.

I'll see what, if anything, this does to my arrhythmias and report back.