Echocardiography
Echocardiography is now established as a mandatory test for the assessment of the structure and function of the heart. Using modern digital ultrasound technology, real-time visualization of the cardiac chambers, pericardium, valves, and major vessels—such as the aorta and the superior and inferior vena cava—is achieved.
Echocardiography provides anatomical information related to the thickness and dimensions of the cardiac walls, the motion of individual wall segments, and the overall contractile capacity of the myocardium. It allows evaluation of the structure and function of the cardiac valves, detecting any stenoses or regurgitations (valvular insufficiencies). It also enables the identification of thrombi within the cardiac chambers or abnormal inter-chamber communications.
This examination contributes to the diagnosis of numerous cardiac conditions, including heart failure, coronary artery disease, valvular heart disease, cardiomyopathies and myocarditis, pericarditis, intracardiac thrombi, and aortic aneurysm. Additionally, echocardiography is used to monitor disease progression and assess the response to pharmacological or other therapeutic interventions. As echocardiography does not involve ionizing radiation, it is considered safe for individuals of all ages.
Transesophageal echocardiography is performed using a specialized probe similar to that used in gastroscopy. This imaging modality provides markedly improved visualization of the cardiac chambers and other structures compared to transthoracic echocardiography. It allows detailed depiction of valvular anatomy and function and detection of thrombi, particularly in cases of suspected dysfunction, regurgitation, or stenosis of the mitral or aortic valve. In this way, it provides diagnostic clarification in conditions where standard echocardiography is insufficient.
Stress Echocardiography
Stress echocardiography (stress echo) is a high-value diagnostic method for the detection and prognostic stratification of coronary artery disease. It plays a leading role in the early identification of coronary stenoses that may impair myocardial perfusion and pose a potential risk.
For each patient, a tailored stress echocardiography protocol is applied, following a standardized methodology to obtain individualized diagnostic results. Prior to the examination, the patient should abstain from food and smoking for at least three hours. Temporary discontinuation of medications that lower heart rate, such as beta-blockers, may be advised following consultation with the physician.
The procedure combines elements of standard echocardiography with an exercise stress test. The most common form is pharmacological stress echocardiography, during which cardiac workload and heart rate are increased by intravenous administration of specific drugs. The heart is continuously imaged by ultrasound, while blood pressure and heart rate are systematically monitored. The examination typically lasts about 30 minutes, and complications are extremely rare in experienced laboratories.
Holter Monitoring
Holter monitoring records the same information as a standard electrocardiogram (ECG)—that is, the heart rhythm—but over an extended period, usually ranging from one to seven days. It is used to evaluate how the heart rate responds under daily living conditions.
This device enables continuous recording of the cardiac rhythm, facilitating the detection of arrhythmias that may not appear during a routine ECG. It also allows correlation with symptoms that may be difficult to reproduce during a resting ECG or an exercise stress test. Modern Holter monitors are waterproof and discreet, allowing patients to carry on with their normal activities while being monitored.
Ambulatory Blood Pressure Monitoring
In cases where self-measurement of blood pressure at home is inadequate or unreliable, ambulatory blood pressure monitoring using a specialized device provides regular readings of arterial pressure to determine the presence of hypertension. This method can also detect nocturnal hypertension and potential drops in blood pressure that may lead to dizziness.
The examination further assists in identifying conditions such as masked hypertension—when elevated blood pressure occurs during daily activities but appears normal during clinical assessment—or white-coat hypertension, where elevated readings occur only in a medical setting due to anxiety. Ambulatory monitoring is also useful for evaluating the effectiveness of prescribed antihypertensive therapy.
Exercise Stress Test
The exercise stress test is the most widely used non-invasive method for the diagnosis of coronary artery disease. This examination evaluates the patient’s cardiovascular response to progressively increasing physical exertion.
Before the test, electrodes are attached to the patient to allow continuous electrocardiographic monitoring during exercise. Physical exertion is achieved through incremental increases in exercise intensity according to a standardized protocol, either by walking on a treadmill or pedaling on a stationary bicycle.
The procedure is painless and non-invasive, but its diagnostic accuracy is relatively limited.
Tilt Table Test
The tilt table test is a non-invasive diagnostic examination designed to investigate the causes of fainting or syncopal episodes. Syncopal episodes are characterized by a brief loss of consciousness caused by a temporary reduction in cerebral blood flow, which may result from an abnormal regulation of heart rate or blood pressure.
Neurocardiogenic syncope occurs when the autonomic nervous system—which regulates heart rate and blood pressure—fails to function properly. The tilt test promotes venous pooling, which can provoke neurocardiogenic syncope and reproduce associated symptoms such as nausea, dizziness, pallor, hypotension, or bradycardia.
This examination aids in distinguishing between different types of syncope and differentiating common vasovagal syncope from other potentially serious causes.
Cardiopulmonary Exercise Testing
Cardiopulmonary exercise testing is a dynamic evaluation performed during exercise that assesses the functional capacity of the respiratory, cardiovascular, central nervous, and skeletal muscle systems.
Cardiopulmonary exercise testing is an important clinical tool for evaluating exercise capacity and predicting outcomes in patients with heart failure and other cardiovascular diseases. It can assist in the differential diagnosis between cardiac and pulmonary causes of exercise intolerance and is valuable in the assessment of patients with advanced stages of heart failure.
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