Heart Checkup (Heart Preventive Checkup, Heart Examinations)

Cardiac Diagnostics: What Cardiac Examinations Are Carried Out During the Heart Checkup?

A timely diagnosis of cardiovascular diseases is of significant importance because these are responsible for 45% of all deaths in Europe. The possibilities for prevention and clarification of heart diseases range from patient consultation to invasive methods in the heart. The following essential heart examinations for a heart check are briefly presented here:

• Patient consultation: anamnesis, clarification of risk factors, complaints, and symptoms
• Taking the blood pressure
• Auscultation of the heart with a stethoscope
• Blood tests
• ECG
• Echocardiography
• Heart CT
• Heart MRI
• Heart catheter examination

Patient Consultation

In the patient consultation, the doctor takes time to clarify possible risk factors and existing complaints. The specialist gets the first impression of his patient’s physical and psychological condition by asking specific questions and listening.

Which Risk Factors Encourage Heart Disease?

Risk factors and causes of heart disease are high blood pressure, increased blood lipid levels, diabetes mellitus, smoking, alcohol consumption, and kidney diseases. Heart diseases that run in the family are also a risk factor.

What Symptoms Can Indicate Heart Disease?

Since the heart is responsible for transporting blood and oxygen, indications of heart disease can be detected simply by looking at the patient. Signs of a momentary lack of oxygen are blue discoloration of the lips and mucous membranes (cyanosis). Digital clubbing and nail clubbing are changes in the hands as a result of a long-lasting (chronic) lack of oxygen, which results in growth disorders in the affected area.

Congested neck veins, edemas at the ankles, and breathing difficulties under stress, or even when lying down, can be the consequences of congestion in the vascular system, indicating a restricted pump function of the heart.

Patients often complain about reduced ability to function, tachycardia, and stumbling of the heart because the heart tends to cardiac arrhythmia (e.g., extrasystoles) when damaged and cannot increase the pumping function sufficiently under stress.

Auscultation: Check-Up of the Heart Sounds With a Stethoscope

The heart sounds can be evaluated with a stethoscope. Attention is paid to the heart rate, rhythm, and abnormal bruits between or during the heart sounds, which, depending on the time and position over the chest, indicate certain diseases. Besides, conspicuous breathing noises can be detected, which may be caused by the heart.

Taking the Blood Pressure

Since high blood pressure is a significant risk for heart diseases, its measurement is essential and must be treated if it is elevated. Not only the doctor but also patients can take the blood pressure. Arterial blood pressure is usually measured with a cuff around the upper arm, but in intensive care medicine, it can also be measured directly in the vessel with a probe.

The measuring principle of bloodless measurement using a cuff was developed by the Italian doctor Riva-Rocci towards the end of the 19th century. A cuff is placed around the upper arm and inflated with air until the stethoscope no longer detects a pulse below the cuff. While slowly releasing the pressure, the pressure indicator of the cuff is monitored until the pulse noticed again and listened to until no more pulsation can be perceived. In this way, the pressure conditions in the vessel between heart contraction and heart relaxation can be determined.

Blood Tests

A heart check-up usually includes an examination of the blood, as this already gives many indications of the patient's general state of health. In addition, some particular blood values indicate the function of the heart. Besides blood lipids and inflammation values, heart enzymes and special hormones in the blood can also be examined.

ECG (Resting ECG, Exercise ECG, and 24-Hour ECG)

An electrocardiogram is a diagnostic device that shows the electrical excitation of the heart. It involves attaching measuring electrodes to the patient's chest to measure the electrical activity of the heart on the skin surface.

Rhythm disturbances, myocardial infarctions, and many heart diseases can be diagnosed from the interpretation of an ECG. The advantage of this examination method is that it does not afflict the patient and costs little.

If the patient can walk on a treadmill during the examination, the heart activity under stress can be monitored. Patients with suspected arrhythmia can carry a long-term ECG on an outpatient basis. This allows heart activity to be recorded for 24 hours or more.

Echocardiography (Heart Ultrasound)

Echocardiography is an ultrasound examination of the heart, in which the diameter of the heart chambers and cardiac walls can be reliably measured. In addition, effusions of fluid around the heart can be made visible.

An additional examination method is Doppler echocardiography. It can show the direction and speed of the blood flow in the heart and diagnose even minor reflux and valvular heart disease.

A limiting factor for this method is the evaluability of the images, since not every patient can be well screened with ultrasound. In these cases, techniques such as CT or MRT should be used.

Heart CT

Cardiac computer tomography is an X-ray diagnostic procedure for imaging heart defects, inflammatory processes, and tumors. The heart CT has the advantage that it is gentler than a cardiac catheter examination, but the radiation exposure for the patient must also be taken into account.

Heart MRI

A very high image resolution is possible with magnetic resonance imaging of the heart, which makes it possible to view the smallest structures of the heart. This examination method requires no radiation exposure for the patient but is very cost-intensive.

Heart Catheter Examination

The cardiac catheter examination is an invasive examination method in which a tube is inserted through a large vessel in the arm or leg to the heart. This allows contrast agent to be injected into the heart or coronary arteries and made visible with X-rays. This enables doctors to assess the condition of the coronary vessels, and the blood flows very accurately. In addition, the pressure conditions in the heart and pulmonary circulation can be displayed.

If a catheter is already in the vascular system of the heart, a probe can be used to carry out an ultrasound examination of the cross-section of the vessels, and the wall layers can be displayed precisely. Besides, it is possible to take tissue samples of the heart muscle to clarify the causes of heart muscle diseases.

Sources:

• www.ehnheart.org/cvd-statistics.html
• Thieme Duale Reihe – Innere Medizin 2009