Procedures

Balloon angioplasty

Balloon angioplasty can be used to treat most coronary stenoses, that is, narrowing in the coronary arteries. During the procedure, a wire mesh tube, or stent, is usually placed at the site of the stenosis.

Using an imaging catheter, a thin wire is threaded through the stenosis or blockage in the coronary artery.  A balloon introduced to the site of the stenosis presses the stenosis against the wall of the vessel and opens it.

To complete the procedure, a wire mesh tube, or stent, is usually placed in the stenosis in order to prevent the vessel from collapsing.

The patient can generally go home on the day following the angioplasty procedure.

See video: Balloon angioplasty 1 »
See video: Balloon angioplasty 2 »

Coronary angiography

A coronary angiography will show any stenoses in coronary arteries. It is a simple test designed to obtain an image of the vessel structure by injecting a contrast medium into the coronary artery through a thin catheter.

The procedure is performed through an artery in the wrist or groin under local anaesthetic.

Coronary artery disease refers to stenoses in coronary arteries.

See video: Contrast examination »

Clinical exercise test

A clinical exercise test, or stress ECG test, is a special test that gradually strains the circulatory, respiratory and locomotor systems as well as energy metabolism using methods standardized for medical purposes and performed by a specially trained doctor with assistants.

Clinical exercise tests are used to diagnose circulatory and respiratory diseases and monitor their treatment, to evaluate working and functional capacity, to plan and monitor rehabilitation and to evaluate risks related to surgical procedures. They are most commonly used to diagnose a coronary disease and to determine its prognosis and severity.

The bulk of information during an exercise test comes from the electrocardiogram, or ECG. It is monitored continuously during the test starting from the rest phase and usually continuing through increasing stress until the end of the cooling-down period. The purpose of the test is to determine the patient’s capacity and any limiting factors, such as myocardial ischemia, arrhythmia and pumping capacity disorders, ventilatory dysfunctions, disorders of the peripheral circulation, etc.

The test always aims at a symptom-limited maximal performance. An estimate of the patient’s capacity is obtained by comparing the achieved stress with a population average.

How to prepare for the test

• Before the diagnostic test, you should stop taking medication that affects ST segments; regular medication can be used during other tests.
• On the day before the test, you should avoid abnormally high stress and have a good night’s sleep.
• On the day of the test, you can eat normally, though not immediately before the test. Avoid coffee, tea, cola beverages and smoking for the 4 hours prior to the test.
• Wear light indoor sportswear and jogging shoes.
• The test lasts less than one hour.

Echocardiography

Ultrasonic examination of the structure and functioning of the heart, or echocardiography, can be used from the foetal period throughout life. Developments in the equipment have made echocardiography the basic tool for cardiac testing. By using this tool your doctor can get an exact image of the structure of your heart quickly and easily. However, only a small section of the coronary arteries is visible.

The most common reason for testing is a heart murmur. Echocardiography can also be used for other indications, of which only some are connected with a heart murmur:

• suspicion of congenital heart disease
• heart valve diseases
• cardiac infections
• detection of ischemia or infarcts (motor disorder/scar)
• quantification of left ventricular hypertrophy (LVH)
• systolic and diastolic dysfunction

See video: Mitral incompetence »

Long-term electrocardiogram recording

Long-term electrocardiogram (ECG) recording on a portable mini-recorder is a very useful method in many situations in which the resting ECG alone cannot provide a sufficient picture of the cardiac origin of a patient’s symptoms. It is very common that a patient’s symptoms occur in certain situations only – at night, for example. Recordings can last 24 hours or, if necessary, 48 hours. The longer recording time is recommended in cases such as those involving infrequently occurring symptoms.

The patient writes down his or her activities and symptoms and can mark the occurrence of a symptom on the recording device, which shows the exact time of the occurrence of the symptom. In practice, the patient can basically do anything except swim and take a sauna, which may damage the recorder. The patient is encouraged to engage in the very activities that produce symptoms.

Most common indications

• Detection of the number and character of arrhythmia.
• Evaluation of the effectiveness of arrhythmia medication.
• Occurrence of ischemia, especially in patients who are not suited for clinical stress tests. Another significant indication is the determination of nocturnal ischemia and symptomless ischemia for the optimization of medication.
• Determination of the cardiac origin of the loss of consciousness and dizziness. Bradyarrhythmia and AV block, common in elderly people, are often found in long-term recordings when assessing the need for pacemaker treatment.