Obligatory medical device diagnostics.
- VHF opportunity screening by pulse measurement and subsequent ECG, in patients ≥ 65 years of age.
- Electrocardiogram (ECG; recording of the electrical activities of the heart muscle) [bradycardia or tachycardia (heart rate: < 60/min or > 100/min); in tachycardia: are the QRS complexes narrow or wide?Narrow ventricular complex (QRS width ≤ 120 ms) = narrow complex tachycardia; this includes:
- Sinus tachycardia
- Supraventricular tachycardia
- Atrial flutter
- Atrial fibrillation
- AV nodal re-entrant tachycardia
Wide ventricular complex (QRS width ≥ 120 ms) = wide complex tachycardia; this includes.
- Ventricular tachycardia (VT) (Always assume VT sooner in an emergency. Notice: 12-lead ECG can never reliably distinguish VT from supraventricular tachycardia (SVT) in the presence of preexcitation or aberration).
- Right bundle branch block (RSB)
- Left thigh block (LSB)
- Long-term ECG (ECG applied over 24 hours).
- For more detailed assessment of cardiac function within the day, event recorder if necessary.
- For detection of atrial fibrillation after cryptogenic stroke; ECG monitoring at least 72 hours, optimally over 30 days.
- Exercise ECG (electrocardiogram during exercise, that is, under physical activity/exercise ergometry) – detection of exercise-induced arrhythmias and abnormalities of the heart rate increase, for example, in sick sinus syndrome.
- Echocardiography (echo; cardiac ultrasound) – for suspected structural heart disease [ischemia sign (sign of reduced blood flow to the heart muscle) (regional wall motion abnormality)? Valvular vitia/valvular defects, left ventricular (LV) hypertrophy (enlargement of the left ventricle)?, right heart strain?, aortic dissection (acute splitting (dissection) of the wall layers of the aorta )?, pericardial effusion (pericardial effusion)?; estimate left ventricular ejection fraction (ejection fraction of the left ventricle per heartbeat) (LVEF)]
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnosis.
- Electrophysiological examination (EPU); e.g., by mapping catheter – special cardiac catheterization in patients with cardiac arrhythmias to detect ectopic excitation centers (ectopic focus), accessory pathways (e.g., Mahaim fibers or Kent bundle in Wolff-Parkinson-White syndrome (WPW syndrome)).
- Cardio-MRI (magnetic resonance imaging of the heart); indications see below the procedure.
- Cardio-CT (computed tomography of the heart); indications see below the procedure.
- Polysomnography (sleep laboratory; measurement of various body functions during sleep, which provide information about sleep quality) – if sleep apnea syndrome is suspected.
