Today I want to tell you why it is sometimes necessary for one patient to be treated by two or three doctors: a cardiologist, an endocrinologist, and so on.
I meet such patients almost every day in my office. Heart problems and complaints do not always originate from the heart. Most of the time, the cause of patients' complaints lies in hormones. When you have heart-related complaints — fatigue, shortness of breath, pain in the chest area, palpitations, fluctuations in blood pressure, arrhythmia — do not be surprised if the cardiologist requests endocrinological studies and the involvement of an endocrinologist alongside standard cardiological examinations, and vice versa — if the endocrinologist schedules a visit to a cardiologist with relevant tests.
For example, in the case of thyroid pathologies When critical hormones such as T3, T4, and TSH are disrupted, hyper- or hypothyroidism manifests (mononodular, multinodular, or diffuse goiter). Along with the aforementioned complaints, the patient experiences anxiety, sometimes fever, sleep disorders, tachycardia, arrhythmia, general weakness, fatigue, and shortness of breath. Atrial fibrillation—a paroxysm of flickering arrhythmia—often develops, which already poses a risk of stroke. Additionally, bradycardia, pericardial effusion, edema, and dyslipidemia may develop, leading to atherosclerosis of the heart or brain blood vessels. In such cases, if the cardiologist only calms the heart rhythm while the hormones remain unregulated, we should not expect results from the treatment.
The same happens, for example, in the case of diabetes mellitus Diabetes mellitus damages the inner lining of the blood vessel — the endothelium, which is a prerequisite for the development of atherosclerosis. The heart muscle stretches and thickens, and such a patient may not feel pain in the heart area — "silent ischemia" occurs because the nerve endings are also damaged (this is called diabetic neuropathy), and a heart attack can develop quietly. After a heart attack, the heart's contractility decreases, and ischemic cardiomyopathy with severe heart failure gradually develops. Therefore, we must not miss a diagnosis of diabetes, and appropriate laboratory tests must be conducted in a timely manner.
In addition, diabetic patients often feel complaints such as fatigue even without a heart attack, as chronic deregulation of glucose levels constantly inflicts micro-damage on the heart and the blood vessels that nourish it — the so-called coronary arteries. Along with this, work capacity and quality of life decrease. Diabetic patients belong to the high-risk group for developing heart attacks or brain infarctions (i.e., ischemic strokes).
Arterial blood pressure cannot be regulated, no matter how advanced the new-generation antihypertensive treatment prescribed by a cardiologist may be, if the patient does not normalize their glycemia with the help of an endocrinologist.
Menopause — Decreased estrogen and heart protection during this time Before menopause, women are protected from cardiovascular complications by natural hormones — estrogens. These hormones maintain normal lipid metabolism in the body, ensure vascular elasticity, and suppress inflammatory mediators in the blood vessel walls.
During menopause, estrogen levels begin to decrease, and consequently:
Increase and fluctuation of arterial blood pressure;
Disruption of lipid metabolism;
Metabolic syndrome often develops, and the risk of cardiovascular disease complications increases.
Therefore, if a patient of this age presents with heart complaints, cardiological examinations alone are not enough. The hormonal profile must be investigated, and consultations with a gynecologist and an endocrinologist should be scheduled if necessary.
It should also be noted here that hormonal disorders often cause aggressive hypertension, such as: Conn's syndrome, pheochromocytoma, adrenal adenoma, etc.
An example from practice A 55-year-old woman complained of episodes of heart palpitations, pain in the heart area, and fluctuations in blood pressure. Cardiological examinations were performed: ECG, Echocardiography, physical exercise stress test (treadmill), laboratory studies, and cardiovascular CT scan; however, cardiac pathology was completely ruled out. Based on the laboratory results, the patient was referred to an endocrinologist, where a thyroid pathology was diagnosed. In other words, if this patient had been treated only by a cardiologist with antiarrhythmic and blood pressure-regulating medications, her condition would not only have failed to improve but would have worsened. The timely involvement of the endocrinologist completely improved her condition — she is no longer bothered by palpitations, fatigue, blood pressure fluctuations, or pain in the heart area.
My goal with this conversation is for the patient to receive necessary information and services through complex examinations and approaches in a timely manner. Such patients always require the coordinated supervision of an endocrinologist, and/or a gynecologist, and/or a psychologist, and/or a psychiatrist to improve the patient's general status, work capacity, and quality of life.
