The word “cardiology” is derived from the Greek and means “the teaching of the heart“. This medical discipline is concerned with the study of the human heart in its natural (physiological) and pathological (pathological) state and function, as well as the diagnosis and treatment of heart disease. There are numerous overlaps between cardiology and other human medical internal medicine disciplines such as angiology, pneumology and nephrology.

In Germany, paediatric cardiology is responsible for childhood and thus above all congenital heart problems as a subspecialty of paediatrics. There is often close cooperation with vascular and cardiac surgery. In Germany, cardiology has gained considerably in importance in recent decades due to an aging society and the ever more frequent occurrence of the metabolic syndrome (increased sugar and fat levels in the blood, overweight, high blood pressure) on the one hand, and the development of new interventional cardiological methods on the other.

Clinical pictures

In a narrower sense, cardiology deals with diseases of the heart itself. These include congenital and acquired malformations such as pathological connections between the two atria (atrium) or chambers (ventricles) (so-called cardiac vitae), or defects of the heart valves, inflammations (endocarditis, myocarditis, pericarditis), cardiac arrhythmia, myocardial diseases and cardiac insufficiency, as well as injuries. In a broader sense, cardiology also deals with the vessels that supply the heart itself (coronary arteries), the large veins and arteries near the heart (vena cava/right atrium and aortic arch), and the blood circulation (especially high blood pressure) in general. Also included in cardiology are clinical pictures that can damage the heart, or are themselves caused by a malfunction of the heart (due to a cardiac cause).

Diagnostic methods

In addition to a precise medical interview (anamnesis), the physical examination plays a major role in cardiology. Blood circulation deficiencies and cardiac insufficiency (heart failure) can be revealed by numerous signs such as paleness or blue discoloration (cyanosis) or water retention in the legs, abdomen and lungs, as can simple diagnostic tests. A prominent example is the so-called hepato-jugular reflux.

Here, the examiner ensures increased blood return flow to the heart by exerting pressure on the blood-soaked liver. If the heart is overwhelmed by the sudden increase in blood to be pumped, the excess volume accumulates back up into the neck veins, which then impress with an obvious protrusion and indicate cardiac insufficiency. A lot of information can also be gained by simply listening (auscultation) to the heart.

Any abnormalities in pulse rate and rhythm regularity can be detected by the trained medical ear, as well as any valve defects or a sticking of the pericardium due to a rubbing noise in case of an inflammation of the pericardium. The electrocardiogram (ECG) records the electrical activity of the heart derived from the chest wall at rest, under stress or in everyday life and is indispensable for many cardiological questions as a simple, fast, cheap and side-effect free diagnostic tool. Especially in cases of cardiac arrhythmia, deficient supply of the heart muscle (acutely due to an infarction or insidiously due to coronary heart disease (CHD)), but also in cases of electrolyte shifts, the preparation of an ECG is of great diagnostic importance.

Due to its advantages mentioned above and the fact that many heart diseases can be proven or at least proven by changes in the ECG, this examination method is part of the diagnostic standard if a patient in emergency or routine is suspected of having a heart-related (cardiac) problem. In some cases, the laboratory examination of a blood sample from the patient may be necessary, for example, if there is a suspicion of heart muscle damage, e.g. in the context of a reduced supply. The ultrasound device can be used to examine the activity of the heart either from the outside or from the esophagus (transesophageal).

In particular, malformations and valve defects can be displayed very well, and the heart pumping performance can also be measured.With the help of the Doppler effect, blood flows can be made visible, including those in the coronary vessels that are responsible for the heart’s blood supply. The size of the heart is often determined by means of a simple x-ray of the upper body (thorax) (which increases with prolonged overloading). In addition, individual enlarged areas of the heart can be identified and thus provide an indication of the underlying problem.

Less frequently, it is necessary to take three-dimensional images of the heart using a CT or MRI machine. In the course of a small procedure, it is possible to insert a probe into the vascular system and release a contrast medium into the bloodstream. The course of the blood vessels (for example, the coronary vessels) can then be visualized by means of a brief fluoroscopy with X-rays and any problems such as constrictions can be detected. During these so-called catheter examinations, which are carried out either via the venous system into the right heart, or via the arterial vessel path against the direction of flow through the aorta into the left heart, therapeutic intervention is also possible.