How cardiologists recognize heart disease
Basic cardiological diagnostics
The electrocardiogram, or EKG for short, is a tried and tested method of cardiac diagnostics. This procedure records the cardiac tension curves at rest. Every heart muscle fiber is excited by electrical energy - starting from the heart's clock (sinus node) - so that it then contracts (contracts). A tension on the body surface can be derived from the excitation of all heart muscle fibers. Depending on the time, a so-called 12-channel ECG is derived from which the doctor can obtain information on various heart diseases, circulatory disorders and rhythm disorders.
Approximately 8500 resting electrocardiograms are performed annually. The data is stored in our clinic's own information system. Every clinician can call up the data from there. This means that electrocardiograms that were recorded at different points in time can also be compared directly and provide the treating doctor with valuable information.
Examination procedure: The resting ECG is made while lying down. With a bare upper body, a total of 12 electrodes are applied to the patient using negative pressure. After a few seconds, the device has read the voltages and the test is finished.
The exercise EKG records the cardiac tension curves under physical exertion. The bicycle ergometer is used in our clinic. This method is part of the basic cardiological diagnosis of coronary heart disease (narrowing of the coronary arteries). The technical principle corresponds to that of the resting ECG. Attention is paid to the patient's symptoms and changes in the ECG. Specific changes indicate circulatory disorders in certain areas of the heart. The stress ECG can also be used to assess blood pressure and the occurrence of cardiac arrhythmias under stress conditions.
Every year we carry out around 1800 stress ECGs. The data is stored in our clinic's own information system. Every clinician can call up the data from there. This means that stress electrocardiograms that were recorded at different points in time can be compared directly and provide valuable information to the attending physician.
Examination procedure: The patient sits down on the bicycle ergometer with the upper body undressed. Sturdy shoes and sporty clothing are an advantage. The electrodes are then applied in accordance with the resting ECG. A resting blood pressure and a resting ECG are then recorded. This is followed by a gradual load according to a defined scheme - depending on gender, body size, age and constitution. During this load, an EKG is continuously recorded, and blood pressure values are also regularly determined. The doctor observes the patient's condition (sweating, shortness of breath) and regularly asks how he is. The investigation is continued until one of the defined termination criteria is reached. A full load is expressly desired - as far as possible. After the end of the exercise, the ECG and blood pressure values are recorded until the initial state is reached again.
The long-term electrocardiogram, called LZ-EKG or Holter-EKG for short, is used to continuously record the cardiac voltage curve over a day. Since certain types of cardiac arrhythmias only occur for a short time, they can often not be diagnosed by a normal resting ECG. In contrast, the long-term ECG recording often provides evidence of cardiac arrhythmias, which are classified according to their cause (e.g. disturbances in the conduction system or reentry mechanisms). Another indication is the clarification of fainting spells (syncope). The doctor can determine whether there are blockages in the electrical excitation or very rapid excitations from the heart chamber and then, if necessary, initiate appropriate therapy. Even if the patient has no symptoms, the long-term ECG is an important part of routine cardiac diagnostics. If, for example, a heart attack has occurred in the past, long-term ECG examinations are carried out to detect severe cardiac arrhythmias from the ventricle. In addition to diagnostics, the LZ-EKG is also used to control drug therapy for cardiac arrhythmias.
Every year we carry out around 1100 long-term EKG examinations in our department. The data is stored in our clinic's own information system. Every clinician can call up the data from there. This means that long-term electrocardiograms that were recorded at different points in time can be compared directly and provide valuable information to the attending physician.
Examination procedure: At the beginning of the examination, 5 electrodes are attached to the undressed upper body and connected to a 5 x 10 x 3 cm recorder. The recorder is positioned close to the body with the aid of a carrying system. With this device the patient goes home and goes about his daily activities. After 24 hours the patient introduces himself again, the device is switched off and dismantled. The data is then read into the computer and evaluated by a doctor.
Long-term blood pressure measurement
The ambulatory long-term blood pressure measurement is one of the basic examinations for the initial and follow-up diagnosis of high blood pressure. In contrast to the occasional blood pressure measurement, many measurements are carried out over the course of the day at a fixed interval, i.e. the blood pressure is measured under normal everyday conditions. This method gives very precise information about the course of blood pressure throughout the day, so that high blood pressure phases that only occur at night can be detected. The certainty that this method can rule out or re-diagnose high blood pressure is relatively high. If there is high blood pressure, an assessment of the severity is possible so that the corresponding further diagnosis and drug treatment can be initiated. If the previous therapy is not sufficient to control high blood pressure, the data obtained are used for comparison purposes after switching to other or different preparations.
Examination procedure: At the beginning of the examination, a blood pressure cuff is attached to the upper arm at heart level and connected to a 5 x 10 x 3 cm recorder. With the help of a carrying system, the recorder is positioned close to the body. With this device the patient goes home and goes about his daily activities. After 24 hours, the patient introduces himself again, the device is switched off and dismantled. The data is then read into the computer and evaluated by a doctor.
Carotid sinus pressure test
We use this examination method when patients report a brief loss of consciousness, especially after movements in the head and neck area. First, a duplex sonography of the arteries supplying the brain is performed. If severe arteriosclerotic changes are excluded in these examinations, the so-called carotid sinus can be massaged. It is a pathological test if the heart rate drops significantly during the massage or the heart stops completely. If the diagnosable disease of a "hypersensitive carotid sinus" is present, this can on the one hand be the cause of an unclear loss of consciousness, and on the other hand therapeutic methods such as the installation of a pacemaker are available.
Examination procedure: This examination is also carried out while lying down. First, the electrodes of a resting ECG are attached as described above. A resting ECG is then taken. A gentle massage then applies pressure to the carotid sinus next to the larynx. As a result, special nerve endings, the baroreceptors in the wall of the carotid sinus, signal an increase in blood pressure and report it to a nerve, the vagus nerve, so that blood pressure and pulse drop reflexively, sometimes up to cardiac arrest. During this examination, an EKG is recorded the entire time.
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