The ECG is used to check the electrical activity of the heart. In the ECG, we can detect your heart rate, rhythm problems, or abnormalities that suggest your heart may need treatment. The process of obtaining an ECG is simple. A nurse puts electrodes on your chest, arms, and legs, and within a few seconds the ECG device records the necessary measurements.

Sometimes it is necessary to wear the ECG for a longer period of time, which may be 24 or 48 hours. During that time, the ECG will continuously record your rhythm. This way, we are able to catch rhythm problems that you might only have occasionally, for example daily or every other day. The 24- or 48-hour ECG comes with an easily wearable device, so you are able to - and should - pursue your regular daily activities. The goal is to see, if you develop any rhythm abnormalities during your every day life. In rare cases, we may use a 7-day monitoring device.

An external event recorder is a small device that you can carry in your pocket for about 3 months. Each time, when you feel that your rhythm problems might be happening, you can activate the device to record your rhythm. It is ideal for patients who experience rhythm problems rarely, with symptoms like racing heart and palpitations (when your heart makes extra beats and pauses). This way, we are able to catch those moments and review them carefully, to evaluate if specific treatment is necessary.

Implantation of an event recorder is a minimally invasive procedure in which a very small device is implanted under the skin of your upper chest. Since the implantable event recorder is a minimally invasive procedure, it is only used for a specific group of patients who are asymptomatic but suspected to have rhythm problems. Those patients would not be able to activate an external event recorder, as they would not feel when their rhythm is abnormal. Therefore, an implantable event recorder is a better option for those patients.

In order to get a good overview what your blood pressure looks like during the day, we use a device that you can carry for a total of 24 hours. It is not large and can be worn at your hip. The device is connected to a blood pressure cuff that will measure your blood pressure every 15 minutes during the day and every 30 minutes during the night. This way we are trying to find out if there are times during the day, when your blood pressure is too high or too low. This helps us to optimize your blood pressure medications.

Exercise-stress test is a great way to objectively test your physical fitness. Also, it can provide us with the information, if you are at risk for arrhythmias that may develop specifically when you exercise. Furthermore, we can detect, if your blood pressure gets too high during exercise – often a cause for limited exercise tolerance. ECG changes during exercise stress testing or symptoms of chest pain may be a sign of your heart vessels being narrowed, which may require further evaluation.

During echocardiography we perform an ultrasound of your heart that will visualize the size and wall motion of your heart chambers, chamber function, and valve function.
Also, we can estimate the pressure in the heart and check if there is leakage or narrowing of the heart valves. This information is very valuable for diagnosis and treatment. During echocardiography, an ultrasound probe sends out ultrasound waves to your heart, which will be reflected by structures of your heart. Through collection of those reflected waves, the ultrasound probe creates an image of your heart. This examination does not have any known relevant side effects.

This test is used to find out if vessels in your heart may be partially or completely blocked. With dobutamin-stressechocardiography, we are trying to reduce the risk for heart attack in patients in whom we suspect that their heart vessels may be diseased. You will receive a medication called Dobutamin that may make your heart beat faster and harder. That way, we can assess how your heart performs under stress and how much reserve your heart vessels have. If we see in the ultrasound of your heart/the echocardiography that areas of your heart don’t pump well during stress, we may recommend you to have cardiac catheterization/coronary angiography to check, if some vessels may be narrowed and may require stenting. If the test is negative and all walls of the heart contract well, then no further diagnostic workup is needed in most cases. In addition to wall motion, we can test dysfunction of your heart valves with this technology.

In certain clinical scenarios, we may have to check if your carotid arteries or other arteries of the body are healthy or if they have narrowings that may require intervention. We are able to examine arteries and veins.

Magnetic resonance imaging of the heart will allow us to detect structural abnormalities, inflammation, storage diseases or poor blood supply to the heart. These findings will affect your therapy. Also, CMR may reveal prognostic information.

PET is a technology that we use in particular for patients with sarcoidosis. Sarcoidosis is an inflammatory disease of the heart that can be categorized as a subtype of myocarditis and inflammatory cardiomyopathies. PET CT is important to monitor treatment response in sarcoidosis as it is an ideal method to detect metabolic activity in sarcoid granulomas, which reflects active disease. Before patients undergo PET CT, they have to eat a special diet for 2 days, which is rich in fat and low in carbohydrates. On the third day, the patients receives a glucose solution that will help detect areas in the body that contain active sarcoidosis lesions.

If the suspicion for narrowed or obstructed vessels in the heart is high or if you have been diagnosed with a relevant valve disease or other types of structural heart disease, we may recommend you to have a coronary angiography or cardiac catheterization. Under local anesthesia (with numbing medication similar to what you get at the dentist’s office), a small catheter (diameter of a spaghetti) will be inserted either in the artery in the area of your wrist or your groin. Then contrast fluid will be injected in your heart vessels under continuous X-ray/fluoroscopy to see if there are any narrowings or occlusions of the arteries. If there are obstructions of the arteries, we will try to open them during the same procedure with a stent. A stent is a metal mesh sitting on a deflated balloon on the inserted catheter, which will expand into your vessel and remain there, once the balloon is inflated. After that, balloon and catheter will be removed and the stent will remain. After that, the vessel is expected to be 100% open in the area of the stent. The procedure usually does not hurt, since pain medication will be used.

In patients, in whom the cause for their illness of the heart could not be identified with standard diagnostic methods, we may recommend to perform an endomyocardial or heart biopsy. Typically, we obtain 4 to 6 samples that are about 1mm big. The procedure usually does not hurt, since pain medication will be used. You may feel a few extrabeats while the samples are taken. This procedure is also done under local anesthesia and similar to cardiac catheterization is a minimally invasive procedure through a small catheter.

If the pump function of your heart is severely decreased, we can offer a protective device with the ability to terminate severe arrhythmias should they ever occur. With severely decreased function, the risk of severe arrhythmias is increased. If the pump function of your left chamber/the left ventricular ejection fraction is 35% or less, in most cases we will offer this wearable cardioverter defibrillator device for at least 3 months. During the first 3 months after diagnosis of severely decreased pump function (not caused by vessel problems), we have the highest chance for improvement of your heart with medical therapy. Therefore, the LifeVest is a good temporary solution to protect from severe arrhythmias and it also provides information about your rhythm through its monitoring function. Should the pump function not improve, we will evaluate, if you are a suitable candidate for an implantable cardioverter defibrillator (ICD). If you require an ICD, our team will inform you in detail about its risks and benefits, as for all other procedures.