Medical device diagnostics are based on the patient’s history, any symptoms, and the results of laboratory diagnostics
Obligatory diagnostics
- Resting electrocardiogram (resting ECG with 12 leads) – Indications:
- Arterial hypertension (high blood pressure) or diabetes mellitus (class II a, C).
- Resting ECG may be considered (class IIb, C).
[Myocardial infarction/heart attack: new pathologic Q-spikes? ST-segment elevation?; complex ventricular arrhythmias?]Wg. transient ST-segment elevation see below “Further notes”.
- Exercise ECG (electrocardiogram during exercise, that is, under physical activity/exercise ergometry) – Indications: For intermediate pretest probability (VTW; 15-85%) of coronary artery disease (CAD) based on sex, age, and clinical symptoms; before starting a fitness program; do not use the procedure if VTW for the presence of stenosing CAD exceeds 65%Contraindications: patients with WPW syndrome, pacemaker pacing (VVI /DDD), ST-segment depression at rest > 1 mm, or left bundle branch block (due tolimited assessability of ST segments) → perform imaging here[evidence of coronary artery disease (CAD) in exercise ECG:
- ST-segment:
- Newly occurring descending or horizontal ST dips (≥ 0.1 mV, 80 msec after the J-point).
- Ascending ST segment (depression ≥ 0.15 mV, 80 msec after the J point).
- Clinical symptoms of CHD: angina (chest tightness, heart pain) and/or dyspnea (shortness of breath).
Duration of the examination: depending on the level of stress up to 15 minutes.
- ST-segment:
- Echocardiography (echo; cardiac ultrasound) – indications:
- Evidence of left ventricular hypertrophy (class IIb).
- Pathological resting ECG
- Vitium suspicious heart murmur (heart defect)
- Indication of heart failure (cardiac insufficiency)
[CHD: evidence of exercise-inducible, reversible regional wall motion abnormality secondary to myocardial ischemia/poor perfusion of the myocardium]Duration of examination: 20 to 30 minutes.
Optional diagnostics (according to symptomatology or pre-test probability).
- See below Coronary artery disease (CAD)/laboratory diagnostics.
See u. Coronary artery disease (CAD) for the following topics:
- Eligibility criteria for the different noninvasive procedures.
- CT angiography versus conventional functional testing.
- Risk assessment criteria of various noninvasive imaging modalities.