Medical history
The anamnesis, the collection of the medical history, is the first priority in diagnostics. If the patient is suspected of having coronary heart disease (CHD), the risk factors such as: should be asked and the family history of cardiovascular disease (cardiovascular diseases) should be taken from the patient’s closest relatives (grandparents, parents, siblings, biological children).
- Smoking
- High blood pressure or
- Diabetes mellitus
The leading symptom for the diagnosis of CHD is angina pectoris (chest pain, “tightness on the chest”).
If angina pectoris attacks have occurred in the patient’s medical history, the presence of cardiovascular disease is likely. However, the absence of these symptoms does not rule out coronary heart disease (CHD), since a high percentage of ischemias (lack of oxygen to the heart muscle cells) occur silently, i.e. without pectanginous symptoms. In a next step, the patient should describe the character of the pain, indicate its localization and describe in which situations seizures have occurred.
It is important to find out whether the pain has increased in intensity, duration and frequency of occurrence and whether there has been a response to the use of nitro preparations. With this information it is possible to distinguish between the stable and unstable form of angina. In addition, the patient should be asked about shortness of breath, palpitations or short periods of unconsciousness, as these can be further symptoms of coronary heart disease (CHD).
Physical examination
During the physical examination, risk factors predisposing to the development of coronary heart disease are considered. Overweight, increased blood pressure or weakened pulses in the hands and/or feet may indicate arterial circulatory disorders. Blood is taken and parameters such as total cholesterol, lipoprotein and blood sugar levels are determined.
If unstable angina pectoris is present, troponin – T or -I can be determined. Troponins are sensitive markers for an acute heart attack. In the blood, no direct “marker” for coronary heart disease (CHD) can usually be detected.
Instead, attention is paid primarily to laboratory values that promote CHD and thus make the diagnosis likely. These tests are only useful, however, if the symptoms that have been previously investigated are consistent with CHD. A particular risk factor for CHD is poorly balanced blood lipid values (cholesterol).
The higher the LDL and the lower the HDL, the more likely CHD is present or CHD can develop. Since diabetes mellitus (blood sugar disease) also plays a role, the blood sugar is also determined. The physical examination of persons with coronary heart disease is usually unremarkable at first glance.
Thus, nothing is usually noticeable even when the heart is listened to. Only if there are consequential damages due to coronary artery disease (CHD) can they be listened to. CHD is characterized by calcification of the coronary arteries. These calcifications can also occur in other parts of the vascular system. If, for example, the so-called carotides (arteries that lead from the heart through the neck to the head, carotid arteries) are affected by calcification, it may be possible to hear flow noises when listening in.
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