Heart Check: Medical Examinations

Your doctor can determine whether you have coronary heart disease using a number of simple examination methods. For example, initial information is provided by taking your pulse and blood pressure, listening with a stethoscope, and a detailed description of your symptoms. However, in order to be able to assess the condition of your heart and coronary vessels even more precisely, further examinations are often necessary. These include electrocardiogram, echocardiogram and angiography.

Electrocardiogram (ECG): recording electrical impulses of the heart.

An ECG records the electrical activity of the heart. To do this, small electrodes are attached to the patient’s upper body that transmit the heart’s electrical impulses to an ECG machine via cables. The ECG informs the physician about previous heart attacks and can detect, but not rule out, an acute heart attack. An ECG can also detect cardiac arrhythmias.

  • The normal resting ECG, however, is not very sensitive for most significant heart diseases. For example, it is not particularly informative for exercise-related symptoms.
  • A variant is the stress ECG using a bicycle ergometer or treadmill. The patient is thereby controlled as far as it is possible for him without pain. But even the stress ECG does not allow an absolute statement: it has an accuracy of about 80 percent, so the statement may be incorrect in one in five patients.
  • Sometimes a long-term ECG is also required. Because often cardiac arrhythmias occur precisely when the patient is not connected to an ECG device at the doctor’s office. The device for a long-term ECG is portable and is placed on the patient for at least 24 hours. Thus, the function of the heart can be recorded and checked during a normal course of the day and night.

Ultrasound examination: echocardiogram

An echocardiogram is an ultrasound examination of the heart. The ultrasound is reflected by the tissue so that the movement and structure of the heart can be visualized.

For example, the echocardiogram provides important information about valvular defects present and abnormalities in heart contraction. However, pathological changes in the coronary arteries cannot yet be detected by means of echocardiography.

Echocardiography also offers the possibility of performing a stress test, known as stress echocardiography. The administration of a circulatory drug increases the oxygen consumption of the heart so that, for example, a circulatory disorder of the heart muscles can be identified.

Radiologic examination: angiography

Angiography is the most accurate method of assessing the coronary arteries. Under local anesthesia, a long, thin tube (catheter) is inserted into an artery in the patient’s groin and advanced to the heart and coronary arteries.

An X-ray contrast medium is then injected via the catheter into the region of the heart to be examined, so that the coronary vessels can then be assessed with the aid of X-ray images. The X-ray film shows exactly whether, how many and where there are vascular stenoses.