Cardiac diagnostic tests

Cardiac diagnostic tests can be classified as non-invasive or invasive. A thorough medical examination should always start with non-invasive examination. This method means that by using modern contemporary medical technology, it is possible to gather precise information about the condition of the circulatory system and the heart without injuring the body surface.

In most cases non-invasive testing is sufficient for accurate diagnosis, while patient care could be managed via lifestyle counseling and medication. Nevertheless, in some rare cases invasive testing may also be necessary (cardiac catheterization, electrophysiology, etc.). Furthermore, some of the clinical conditions may require surgical procedures.

In our practice only non-invasive diagnostic tests are used. Therefore, in our medical routine all cardiac examinations are completely safe and painless. If intervention is needed, we may refer our patients to our cooperating fellow cardiologists performing the invasive tests and, if necessary, also to heart surgeons.

Blood pressure measurement

Blood pressure is the outward pressure that blood exerts on the walls of the arteries as it flows through them. This outward pressure is determined by how much blood the heart pumps and the resistance of artery walls to the blood. Blood that enters and flows through arteries easily results in normal blood pressure. When the heart faces resistance and it must work harder to pump blood through the body, high blood pressure develops. Hypertension is high blood pressure that persists over time.

A blood pressure reading uses two numbers that represent the two phases of the heartbeat. The systolic reading corresponds to blood pressure when the heart contracts; the diastolic reading corresponds to blood pressure when the heart relaxes. Optimal blood pressure is less than 120 millimeters of mercury (mmHg) systolic and less than 80 mmHg diastolic, expressed as 120 over 80 (for example 120/80). A person has hypertension if his or her blood pressure is consistently 140 over 90 mmHg or higher.

Compared to people with normal blood pressure, people with hypertension are 3 times more likely to develop coronary heart disease, 6 times more likely to develop congestive heart failure, and 7 times more likely to have a stroke.

Electrocardiography

Electrocardiography, also referred to as ECG testing, is a noninvasive test that records the electrical activity of the heart. ECG can establish a baseline evaluation of a person’s heart and investigate newly evolving symptoms, such as chest pain, shortness of breath, or palpitations. Physicians use different forms of ECG testing, including resting, stress, and ambulatory ECG.

The patient lies down and usually 10 electrodes are attached to the person’s chest and extremities. The skin occasionally needs to be prepared in order to assure appropriate electrical conductance, it generally means simple shaving and slight abrasion. The electrodes are placed on top of a light layer of gel that conducts electricity. The electrodes record the heart’s electrical impulses and transmit them to an electrocardiograph. ECG curves can be then stored and printed out for further analysis.

Stress ECG

ECG stress test means, that the patient walks on a treadmill or pedals on a bicycle ergometer. Stress testing is a painless, safe method to measure how well the heart responds to an increase in the body’s demand for oxygen. Exercise is the most commonly used method of creating this increased stress on the heart. For those who cannot exercise, a drug that simulates the effect of exercise, such as dobutamine, may be used. The person taking the test may choose to stop the ECG stress test at any time.

A physician observes the person, monitors the exercise level, and makes recordings until the person’s heart nears a maximum predicted heart rate. The heart also is monitored during the period of cool-down or recovery that immediately follows exercise. The recordings made before, during, and immediately after an ECG stress test can show subtle changes in heart electrical activity that can help a physician to determine physical fitness, locate areas of the heart that receive an insufficient blood and oxygen supply, reveal heart rhythm abnormalities, evaluate a person’s prognosis after a heart attack, verify the effectiveness of medical and surgical therapies, and determine an appropriate exercise program for people with known heart disease.

The test is negative if the subject’s exercise tolerance matched the age-adjusted normal, no complaints occurred, heart rate and blood pressure increased adequately, and no abnormal ECG changes developed.

Ambulatory ECG (Holter)

Heart rhythm abnormalities mean disturbance in the rate or rhythm of a person’s heartbeat. Arrhythmia monitoring refers to tests physicians use to identify the type and the cause of irregular heart rhythms. Many arrhythmias occur infrequently, so to record the heart’s electrical activity under real-world conditions, physicians use continuous monitor recording, also called ambulatory electrocardiography (Holter).

The patient wears portable ECG devices that record arrhythmic events while the patient is away from the physician’s office. Holter monitors are worn for 1 to 3 days while the patient goes about normal tasks. The device uses between 3 to 7 electrodes that are attached to the patient’s chest. Wires from the electrodes lead to a small battery-powered device that can be clipped onto a waistband or belt, or placed in a small carrying case and slung over a person’s shoulder. The device constantly monitors the heart and records the heart’s rhythms into the memory of the device.

Patients keep a diary of their activities, such as sleeping or eating, so that physicians can associate any arrhythmia with a specific activity. During Holter monitor testing, patients should avoid taking showers or baths and limit the use of small electrical devices, such as electric toothbrushes or razors.

Ambulatory Blood Pressure Monitoring

Ambulatory blood pressure monitoring allows blood pressure to be continually monitored during sleep, and is useful to determine whether the patient is a dipper or non-dipper, that is to say whether or not blood pressure falls at night compared to daytime values. A night time fall is normal. Absence of a night time dip is associated with poorer health outcomes. In addition, nocturnal hypertension is associated with end organ damage such as left ventricular hypertrophy and narrowing of the retinal arteries. ABPM is a much better indicator than the daytime blood pressure reading, the reason being clinical BP measurement are referred to the marked variability of BP measurement and white coat effect.

Echocardiography

Cardiac ultrasonography (echocardiography) uses ultrasound waves to produce an image of the heart’s structure and function, to measure the direction and speed of blood flow that allows computing the blood pressure inside the heart. Standard echocardiography produces a two-dimensional image of a cross section, or slice, of the heart, its chambers and valves, and the large blood vessels of the heart. Doppler echocardiography bounces sound waves off the blood cells within the heart or blood vessels, and measures the speed and direction of flow. By using blood flow velocity data, it is possible to calculate pressure gradients between the corresponding cardiac chambers. Contemporary cardiac ultrasound technique allows high accuracy diagnosis of most abnormalities, precise evaluation of lesion severity and appropriate scheduling of coronary interventions or surgery. The test is painless and does not use radiation.

Laboratory tests

Laboratory tests are commonly required as part of regular medical check ups or in follow ups after medical interventions. Also, in diseases and in medical conditions, it is of great importance to know about different laboratory parameters. Most frequently, blood samples are drown from an antecubital vein, and due to the currently applied closed blood sampling technique, in case of experienced assistance, the procedure is almost painless. Besides blood, urine and stool sampling occasionally may be necessary.

Ankle Brachial Pressure Index (ABPI)

In case of characteristic symptoms, peripheral artery disease (PAD) can be readily diagnosed merely by history and physical examination. The Ankle Brachial Pressure Index (ABPI) is the ratio of the blood pressure in the lower legs to the blood pressure in the arms. Compared to the arm, lower blood pressure in the leg is a symptom of blocked arteries PAD. The ABPI is calculated by dividing the systolic blood pressure in the arteries at the ankle and foot by the higher of the two systolic blood pressures in the arms. Normally, the value of ABPI is between 1.0 and 1.2, and if a value under 1.0 is measured, PAD can be diagnosed.

Studies from 2006 suggest that an abnormal ABPI may be an independent predictor of mortality, as it reflects the burden of atherosclerosis.

Duplex Ultrasonography

Ultrasound is a painless, non-invasive, radiation-free diagnostic test that uses high-frequency sound waves to create images of body tissues. Duplex ultrasound also allows physicians to measure the velocity of blood flow and to see the structure of the blood vessels through which the blood is flowing. Physicians use duplex ultrasound to diagnose and examine diseases that affect the blood vessels, as well as to plan for and evaluate surgical and interventional therapies.

Duplex ultrasound is used to detect the presence and severity of numerous conditions, including, thrombosis (blood clots), blockages from atherosclerosis (hardening of the arteries), thrombophlebitis (an inflammation of the blood vessels), trauma to an artery or vein, Raynaud’s phenomenon (a spasm of small blood vessels in the fingers), and increases in the thickness of the blood vessel lining.

Cardiac rehabilitation

Rehabilitation is the sum of activities required to influence favorably the underlying cause of the disease, as well as to ensure the patients the best possible physical, mental and social conditions, in orer to preserve or resume when lost, as normal a place as possible in the life of the community. According to the recommendation of the European Association for Cardiovascular Prevention and Rehabilitation, cardiac rehabilitation programs should contain nine core components, as follows:

patient assessment, risk stratification
physical activity counseling,
exercise training,
nutritional counseling,
weight management,
lipid monitoring,
blood pressure monitoring,
tobacco cessation,
and psychosocial management.
In general, cardiac rehabilitation is beneficial for most chronic cardiac patients. Patients who are considered the most qualified include those who have experienced 1 or more of the following conditions sometime within the previous year: MI/acute coronary syndrome, heart surgery or percutaneous coronary intervention, stable angina pectoris, chronic heart failure, and peripheral artery disease.

Weight loss program

Obesity is a leading and growing contemporary health problem. Overweight is a cardiovascular risk factor and favours the development of orthopaedic disorders. The obese patient’s way of life changes, featuring shrinking physical perspectives and distorting psychical condition, resulting worsened quality of life and reduced life expectancies.

We have elaborated our special weight loss program with our partners, and it has proved to be effective in almost all cases. Hunger typically faded away in 2-3 days. The target body weight has been reached by 3-5 kg monthly weight reduction. The radical dietary restrictions implicating very low carbohydrate and fat content can be introduced and maintained, in addition, the ongoing medical supervision and laboratory check-ups guarantee safety. Nevertheless, there is no need to get hospitalized to keep this protocol, and this might be the most important for the patients!

In case you are fighting with your bodyweight, just do not hesitate, join our weight loss program! Turn to us with confidence!

Smoking cessation program

Smoking is one of the main cardiovascular risk factors, increases the frequency of a wide range of malignant diseases, leads to chronic respiratory syndromes, and what is less known; virtually all organ systems get affected. It is of note that in general, smokers die ten years earlier!

Apart from health issues, there are several other factors that emerge against smoking. Among several others, importantly, smokers seem older than their age-mates and this destroys self-esteem. The negative general opinion might lead to some kind of social marginalization and isolation. At last, we cannot ignore, that this habit is costly.

Giving up smoking is not easy. It is well known, that even in case of strong intellectual commitment medical assistance is generally needed. Our methods in concert with temporary add on drugs results 80% success rate.

If you have problems with giving up smoking and you need help just do not hesitate, join our smoking cessation program! Turn to us with confidence!

Diabetology and lipidology

Diabetes and high cholesterol level are major atherosclerotic and cardiovascular risk factors. The appropriate treatment of these widespread metabolic disorders fundamentally improves the patients’ condition, lengthens lifespan. During the long term care, the blood sugar and cholesterol are set to an optimal level according to the recommendations included in the international guidelines. We are board certified specialists of diabetology and lipidology; therefore we are ready to help with sugar and cholesterol problems either as part of a cardiovascular checking up or even in case of a lone metabolic abnormality.

Our cardiovascular screening program

In the Western World, the majority of people die due to cardiovascular disease, and from 30-40 years, cardiovascular mortality is over 50% of total mortality.

The majority of cardiovascular diseases are atherosclerosis related, and the underlying risk factors can be easily identified. Therefore, regular screening tests, risk stratification, lifestyle counseling, and appropriate drug therapy lowers the chance of morbidity, and prolongs life in health.

Cardiovascular examination to obtain or extend a driving license

Obtaining a license is in any case subject to medical suitability, and in the case of a non-professional license, the certificate is issued by the GP. However, expert advice is also required for the following diseases:

cardiologist in heart disease;
neurologist in a patient suffering from a stroke or epilepsy;
opinion of a diabetologist in case of diabetes *
From the point of view of traffic, the fact of the illness itself is not dangerous, but the sudden and acute feeling of sickness (eg. fainting, loss of consciousness, drowning, etc.) that may occur in connection with the illness while driving. If one adheres to lifestyle standards; takes the prescribed medication exactly; takes part in regular inspections; indicates the symptoms he / she perceives and therefore these are adequately corrected, then it is very likely that the disease is stable. For cardiac patients, it is important to determine the severity and functional status of the disease when obtaining or renewing the license (in addition to physical and laboratory examinations, echocardiography, Holter examination for arrhythmia, exercise ECG, etc. may be needed).

We carry out the necessary examinations at our current price list without long waiting.

* 1/2018. (I. 12.) EMMI Decree 13/1992. (VI. 26.) NM

Cardiovascular examinations at the request of an aero-medical examiner (AME)

Point 8 of the current regulation states: aero-medical opinion is the determination of whether the subject is in a state of health meeting the requirements of the regulation. According to point 9, aero-medical examination is an examination by an aero-medical examiner (AME) required to establish aero-medical fitness. *

The aero-medical examiner shall require additional cardiologic examinations or a cardiologist’s opinion in the cases covered by this Regulation or based on clinical considerations.

We carry out the necessary examinations at our current price list without long waiting.

* Minister of National Development 27/2014. (IV. 30.) NFM decree on the conditions of medical fitness of civil aviation personnel and the rules for the designation and activities of bodies responsible for the assessment of medical fitness