Diagnostics | Coronary heart disease (CHD)

Diagnostics

A specialist in cardiology diagnoses and treats coronary heart disease. Especially for first signs and suspicion of an ischemic heart disease, the family doctor is also a contact person. A detailed anamnesis is important at first.

In this doctor-patient consultation, the patient’s medical history, family illnesses and current complaints are thoroughly discussed. During a physical examination, risk factors for CHD can be identified and the heart can be listened to. A laboratory examination is carried out routinely and can, for example, detect an expired heart attack.

To diagnose coronary artery disease, imaging techniques are needed that show the blood flow in the heart. If coronary heart disease is suspected, ECGs are first written, once at rest and once under stress, for example on a bicycle ergometer. A coronary disease can still be inconspicuous on the ECG.

Therefore, further examination methods are usually necessary to diagnose the disease. A cardiac ultrasound examination can be performed to examine the heart chambers, the heart valves and the blood flow.The coronary arteries cannot be seen with this technique, but the movement of the muscle allows conclusions to be drawn about the blood flow. A myocardial scintigraphy is an examination that can also be performed at rest and under stress.

In a scinitgraphy, the patient is injected with a weakly radioactively marked substance into the vein, which accumulates in the coronary vessels, among other things. The radioactive radiation can then be depicted on images and any vasoconstrictions in the coronary vessels can be detected. This method usually gives better results than the ECG.

An important examination for the diagnosis of coronary heart disease is coronary angiography, also known as heart catheterization. This examination method can also be used therapeutically, for example to insert a stent. In some cases, additional imaging methods are necessary to determine the severity of the CHD, such as PET, CT and MRI.

In affected patients with coronary heart disease, electrocardiograms (ECGs) are written at rest and under stress: ECG changes usually only become apparent when the coronary vessels are constricted by at least 50 – 70%. In most cases, further examinations are necessary to diagnose the disease and its severity.

• The resting ECG, where the patient lies at rest, is inconspicuous in most patients.
• Under stress, for example on a bicycle ergometer, when the heart consumes more oxygen and the coronary arteries cannot meet this demand, the ECG changes especially when the disease has progressed considerably.

Cardiac catheter angiography is an examination in which the coronary vessels are x-rayed to detect narrowed vascular sites.

The examination is invasive, as a catheter is advanced through the inguinal or arm artery into the coronary vessels. The catheter is a very thin, long tube through which a contrast medium is injected into the coronary vessels to make them visible. Small changes in the X-ray image may already indicate advanced stages of coronary artery disease and vascular wall damage.