Detecting and treating heart diseaseThe doctor can often tell whether a patient is suffering from heart disease just by observing the symptoms closely. For a precise diagnosis of heart disease – for example, which areas of the blood vessels and heart muscle are affected and to what extent – extensive examinations are often necessary. For this purpose, the physicians have various methods at their disposal.
Early diagnosis of heart disease is important because many heart conditions can be treated well in the early stages. There is then also the possibility of influencing the further progression favorably. However, symptoms usually only occur when serious changes have already developed. As soon as a heart disease is suspected, it should be investigated by means of special cardiac diagnostics.
Diagnosis begins with the patient's medical history
As with other diseases, the diagnosis of suspected heart disease usually begins with the patient's medical history, i.e. the exact symptoms and medical history of the patient. How long have symptoms been present and what are they?? When do they occur. How are they experienced? These are typical questions the doctor may ask. The doctors use this to try to determine whether there are any concrete indications of a particular form of the disease. They go on to ask about risk factors, such as high blood prere, smoking, or stress, that promote the onset of heart disease. And they often ask whether similar symptoms may be present in close relatives of the patient (family history) or whether a family member has been diagnosed with heart disease.
This is followed by a physical examination to determine the patient's general state of health. The doctor will listen to the heartbeat with a stethoscope, among other things. This often provides important information about the possible presence of valvular defects or other cardiac disorders. In addition, laboratory tests are performed and pulse and blood prere are measured.
Routine ECG examination
If heart disease is still suspected, an electrocardiogram, or ECG, will be performed to confirm the diagnosis. The heart current curve is recorded. The heart's actions produce a typical picture that changes when, for example, the heart's blood flow is no longer properly transmitted due to a deficiency in blood flow. The ECG is usually performed at rest, in case of certain complaints an ECG examination under stress (ergometry) may also be necessary. In most cases, the examination is performed on a bicycle ergometer, which is similar to the familiar exercise bikes. But there are also devices where the patient pedals while lying down. The pedal resistance is gradually increased during this process. This increases the circulatory load. The simultaneously recorded ECG provides information about the changes in heart activity in relation to pulse and blood prere. If the aim is to detect a disturbance in the heart rhythm, a long-term ECG is usually ordered. The cardiac current curve is recorded for 24 hours using a small device that the patient wears on a belt.
Echocardiography – getting to the bottom of heart disease by ultrasound
Information about the size and function of the heart is also provided by echocardiography (cardiac echo), a diagnostic procedure for heart disease in which the heart is examined with ultrasound. For this purpose, an ultrasound probe is placed on the chest wall. Ultrasound allows the doctor to observe the heart in action. The structure of the heart can be viewed. The heart itself as well as the blood flow can be tracked in real time. A heart echo is possible at rest and under stress, then as a so-called stress echo. There is also an option to bring the ultrasound probe even closer to the heart for more detailed observation of heart condition and function. For this purpose, similar to a gastroscopy, a catheter is inserted via the esophagus up to the level of the heart. At its tip there is an ultrasound probe, through which the heart can then be examined. In the Lifeline dictionary, diagnoses from A for angiography to Z for cystoscopy are detailed. Even for medical laypersons understandable described.
Detect circulatory disorders with cardiac scintigraphy
In special cases, a nuclear medicine examination of the heart, myocardial scintigraphy, may also be required to diagnose heart disease. This procedure is used to examine the blood flow to the heart muscle. Circulatory disturbances can be detected. For this purpose, a weakly radioactive substance (thallium isotope) is injected into a vein. It spreads throughout the body. Accumulates in the heart muscle. The enriched radioactivity is measured above the heart muscle and displayed graphically, creating an image of the blood flow conditions. The examination is carried out at rest and under stress, and the computer-assisted evaluation subsequently provides indications of regions with reduced blood flow.
Coronary angiography shows advanced changes
The coronary arteries can also be assessed by means of a catheter examination – this is helpful in the diagnosis of heart diseases caused by vasoconstriction. For this purpose, a very thin tube (catheter) is inserted via the inguinal artery – in rare cases also via the brachial artery – up to the branch of the right or left coronary artery from the aorta, and the patient is injected with a contrast medium into the coronary vessels. The procedure is also known as Cardiac catheter known. It provides information about the condition of the heart and blood vessels. This is how a contrast medium can be injected into the coronary arteries via cardiac catheterization.
The X-ray image is then monitored to see how the contrast medium is distributed in the arteries, whether it fills them evenly or whether there are any irregularities. The procedure is called coronary angiography. With the help of this image, constrictions in the examined vessel can be visualized. They can be expanded in the case of the case not rarely even directly.
You know how much you are at risk of suffering a sudden heart attack, stroke or similar acutely threatening event of this kind?
Diagnosis by vascular ultrasound
For a more precise analysis of vascular constrictions, an ultrasound examination can also be performed directly from inside the blood vessel to confirm the diagnosis of heart disease. In this procedure, the physician also inserts a thin catheter through an artery into the coronary arteries. This catheter carries a fine ultrasound probe at its tip. By looking inside the vessel, it is possible to distinguish which sections of the vessel wall (inner lining, muscle layer, outer layer) are affected by vascular calcification (arteriosclerosis). In addition, it can be seen whether it is harder material (lime) or softer deposits (especially fat deposits).
– cardiac arrhythmia – atrial fibrillation (AF, AFib) – chest pain (thoracic pain)
Computer tomography enables diagnosis at early stages of the disease
For many heart diseases, there are certain options for diagnosis. Less stressful than cardiac catheterization. The vascular ultrasound is for the patient the computed tomography of the heart (cardiac CT). The procedure provides tomographic images that give a three-dimensional picture of the heart and coronary vessels. In contrast to the other examinations, the heart CT also shows early changes in the vessel walls. This procedure can be used to detect calcifications in the vessel wall -. So that an arteriosclerosis – directly visualize. In addition, the doctor can determine what kind of deposits are involved by means of computed tomography of the heart, which, however, is associated with a certain radiation exposure, similar to the X-ray examination.
Magnetic resonance imaging – accurate pictures of the heart
Another diagnostic procedure for heart disease is magnetic resonance imaging, or MRI for short. The procedure provides even more accurate images of the heart's anatomy than cardiac CT and also does not require radiation exposure. Cardiac MRI can track the wall movements of the heart and can be used to visualize blood flow and assess the vitality of the heart muscle. For example, it is also possible to check where and how much tie was damaged during a heart attack, i.e. how large the resulting "infarct scar" is is. Such information can be indicative for further treatment. Both computed tomography and magnetic resonance imaging allow imaging of the heart and vessels. Unlike cardiac catheterization, however, these diagnostic procedures do not allow direct measurements to be made "on the spot" can be performed. It is also not possible to react to the special conditions in case of changes in heart diseases and possibly even to treat them directly.