Indication

Echocardiography is used for the diagnosis of numerous diseases of the heart, as well as partly for the supportive diagnosis of diseases outside the heart. Since echocardiography is a very meaningful and inexpensive procedure that is available nationwide, echocardiography is used very frequently. In addition, it is a low-risk procedure that is not very stressful for the patient.

Common indications for the performance of an echocardiography (TTE or TEE) include the occurrence of symptoms that indicate heart disease, such as shortness of breath, pain or palpitations. Echocardiography is also performed when a congenital heart defect is suspected or to check an already known congenital heart defect. Furthermore, echocardiography can be performed to diagnose a heart attack or after the occurrence of a heart attack.

Echocardiography should also be performed in patients with a conspicuous heart murmur, in whom there is a suspicion of heart valve disease.Patients who have received a heart valve prosthesis due to heart valve disease are also examined by echocardiography to document the successful replacement. Echocardiography can also provide indications of cardiac arrhythmia. A further indication is the suspicion of an inflammatory disease of the heart (e.g. endocarditis).

In addition, echocardiography can detect thrombi (blood clots) and very rarely tumors in the heart. Furthermore, diseases of the pericardium, which surrounds the heart muscle, are important indications. These include pericardial effusion (accumulation of fluid between the heart muscle and pericardium) and pericarditis (inflammation of the pericardium).

In transesophageal echocardiography (TEE) in particular, additional structures outside the heart, such as the aorta, can be assessed. Therefore, a further indication arises here, the suspicion of a pathologically altered aorta. Another indication for echocardiography (TTE or TEE) is certain diseases of the lung, such as pulmonary embolism or pulmonary collapse (pneumothorax).

In pulmonary embolism, a blood clot blocks the vessels leading to the lung, causing blood to back up in front of the heart. This is visible in echocardiography and can therefore be detected early. Especially in stress echocardiography (“stress echo”), a circulatory disorder of the heart muscle, i.e. suspected coronary heart disease (CHD), is the most common indication.

In addition to the various forms of echocardiography, such as transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and stress echo, there are several other procedures available for examining the heart, all of which can provide initial indications of heart disease. Some of these examinations take place before echocardiography is performed. If a patient comes to the physician with symptoms that indicate heart disease, a detailed interview with the patient by the physician is usually conducted first (anamnesis).

The doctor asks, among other things, about the exact symptoms of the patient (e.g. shortness of breath, pain, palpitations) and whether the patient or his family is already familiar with heart disease. In most cases, the medical history is followed by a physical examination. This includes a close examination of the unclothed chest (inspection), palpation of the pulse (palpation) and listening to the heart with a stethoscope (auscultation).

The auscultation can, for example, provide indications of heart valve disease (abnormal heart murmur) or heart failure (soft heart sounds). This is usually followed by an electrocardiogram (ECG), which can be used to confirm or eliminate potentially suspicious findings from the physical examination. In electrocardiography (ECG), six or twelve electrodes are attached to the patient’s chest to record the electrical activity of the heart.

Similar to echocardiography, the electrical activity of the heart can be recorded at rest or under stress as part of a stress ECG. In addition, there is the possibility, for example in case of suspicion of certain cardiac arrhythmias, to perform a long-term echocardiography (long-term ECG) over 24 hours. With the help of electrocardiography, heart rate, heart rhythm or the spread of excitation through the heart muscle can be assessed and thus also provide information about various diseases.

The next step is imaging diagnostics, which includes echocardiography, an X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) of the chest. These procedures make the heart visible and can provide information about the size of the heart, the thickness of the heart muscle or changes in the heart valves, among other things. Another examination procedure, myocardial perfusion scintigraphy, can be used to assess in particular the blood supply to the heart muscle.

In addition, invasive procedures are also used to examine the heart. An important procedure is the cardiac catheter examination. In cardiac catheterization, a specially shaped and flexible plastic tube is inserted under local anesthesia into a vein (called a right-hand catheter) or an artery (called a left-hand catheter) in the patient’s groin and advanced through the vessel to the heart.With the aid of the plastic tube, the pressures in the atrium and in the chamber can be measured and the blood flow in the coronary vessels can be assessed very well by administering contrast medium through the plastic tube into the vascular system.

If constricted coronary vessels are found during the cardiac catheter examination, they can be widened in the same session to prevent the development of a heart attack. Finally, a myocardial biopsy can also be performed as part of a cardiac catheter examination. This is the removal of heart muscle tissue from the inner layer of the heart.

The myocardial biopsy is performed in particular if inflammatory diseases of the heart are suspected or if congenital or acquired heart muscle diseases are suspected. For special indications, a simple examination of the blood also plays an important role. For example, in the event of a heart attack, certain heart attack markers such as troponin or creatinine kinase in the blood may be elevated and thus the suspicion of a heart attack can be confirmed by these parameters.