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Evaluation and monitoring of heart function

What basic examinations are there for heart diseases?

Basic examinations are an important part of the patient’s overall assessment. The doctor evaluates the need for further tests based on clinical evidence. Clinical tests draw attention to possible abnormalities in the patient’s skin, body structure and general appearance. Checking and evaluating the pulse, lungs, coronary arteries and peripheral blood circulation by listening and palpating are all important diagnostics. Using the patient’s own notes and asking them about their symptoms and other background information, the doctor evaluates the need for treatment. It is important to consider lifestyle factors such as exercise, diet, smoking and alcohol use.

What kinds of things does the doctor observe and study?

In basic examinations, the doctor checks the patient’s pulse, arteries and peripheral blood circulation by auscultation and palpating. For example, swelling of the legs or neck are signs of heart failure. Palpating the patient’s chest and abdomen enables the doctor to check for resistances, elevations and potential pain. Palpating the heart enables the left ventricular to be checked for size and function. Also, the size and possible pulse of the liver is considered.

The doctor observes the patient’s general condition. If their skin looks bluey, it may be a sign of a lack of oxygenated blood. In a patient with an acute illness, the skin temperature and dampness are significant and cold sweat may be a sign of disease.

The doctor listens to the heart and lungs with a stethoscope records the patient’s blood pressure. Auscultation for lung crackles is a basic examination of a suspected heart failure patient. Breathing sounds tend to reveal underlying asthma or bronchitis.

Electrocardiography reveals the electric function of the patient’s heart

The operation of the patient’s sinoatrial node and cardiac conduction system is investigated by means of an electrocardiogram (ECG). It is also used to investigate myocardial oxygen deficiency and damage caused by myocardial infarction. Potential arrhythmias, myocardial load and thickening, and references to heart disease can all be confirmed by an ECG.

In ECG registration, the electrodes are attached to each wrist and ankle as well as various positions on the chest. The ECG is registered whenever a heart needs to be investigated. Extra beats and abnormal heart rhythms, such as atrial fibrillation, are easily detected by ECG.

Ultrasound examination of the heart

Ultrasound examination of the heart examines the structures and function of the heart. It provides information on the function of the heart, the heart flaps and blood flow in the cardiac compartments. Ultrasound examination is a convenient and fast method of discovering the underlying disease behind cardiac symptoms.

What is ultrasound examination used for?

In the study, the computer creates a real-time image of the heart relaxing and contracting, opening and closing of the flaps, the structure of pericardial walls, and any pericardial fluid. The ultrasound also analyses the size of the heart chambers and the thickness of the cardiac muscle. It is particularly useful when examining the causes of heart murmur.

The ejection fraction, i.e. the contraction force of the heart is measured in the left ventricle throughout the rest and contraction stage. The wall contraction may seem asymmetric due to myocardial infarction. Calcium deposits can also be detected.

Functional information is obtained by measuring the blood flow rates according to the Doppler principle. This technique can be used to evaluate the severity and significance of stenosis and blood pressure in the pulmonary artery. Doppler color coding makes it possible to analyse the direction of flow at the flap opening. The red color indicates flow towards the sensor and blue away from the sensor. The Doppler colour technique provides information on the severity of flap leakage.

Is ultrasound always possible to do?

Ultrasonography is almost always possible but enlarged lungs or obesity may weaken the image quality.

If there are too many obstructions to getting an image, the examination can also be carried out through the oesophagus because it is behind the heart. In the study, the patient swallows a telescopic hose that is directed to the oesophagus. Ultrasound performed through the oesophagus provides detailed information on the structure and function of the heart.

Clinical stress test

The stress test, or stress ECG, increases the oxygen consumption of the heart by physical strain and examines the potential oxygen deficiency of the myocardium. During exercise, the symptoms and overall performance, heart rate, rhythm, blood pressure, and electrocardiogram are monitored.

What is studied by a clinical stress test?

Stress can be used to determine the patient’s performance and blood pressure during exercise. The results can be used to estimate the likelihood and severity of coronary heart disease. During the test an electrocardiogram is recorded to detect any myocardial ischemia, oxygen deficiency and arrhythmia. The test should be discontinued if any of the following occurs: unexpected cardiac symptoms (chest pain, shortness of breath), significant change in the electrocardiogram, sudden increase in blood pressure, sudden drop in blood pressure.

How is clinical stress test performed?

Usually, the exercise is done on an exercise bike or treadmill. In the test, exercise most frequently lasts for 5 to 15 minutes. To ensure the accuracy of the test results, a sufficient heart rate should be achieved, considering each patient’s age.

Before the stress test, the doctor gives the patient clear instructions. It is important to limit the use of coffee and other stimulants before the test. A light breakfast is recommended a few hours before the test. The stress test should not be carried out immediately after eating. A decision must also be made whether the test should take place during the patient’s normal course of treatment, or whether they should discontinue any medications during the test.

In the stress test, the electrodes are attached to the chest like in a normal ECG registration. The difference is that the limb electrodes are attached to the body to ensure that the limb movement does not interfere with the test results. The stress level is raised gradually and stopped when the patient can no longer function, i.e. has reached their peak.

ECG daily recording

ECG daily recording, the 24-hour Holter study, is used to detect arrhythmias. From the recording, it is possible to evaluate the heart rate and pulse in different situations, possible extra strokes and irregular heart rhythms, palpitations and references to myocardial oxygen deficiency during recording.

What is studied with 24-hour ECG?

The test helps to confirm the origin, severity and significance of a patient’s arrhythmia. The recording will also help discover if the arrhythmia originates in the front or back chamber. It may also explain the reason for the patient’s unexplained spells of unconsciousness (syncope) and receive information on myocardial lack of oxygen.

Patients presenting with night-time cardiac symptoms may also benefit from 24-hour ECG to determine if there may be an underlying cardiac problem behind those symptoms.

How is ECG registration performed?

The 24-hour ECG registration is like a regular ECG registration. Five or seven ECG electrodes are attached to the patient’s chest, through which the heart can be monitored for 24 hours or 48 hours. In the test, the patient reports arrhythmia and other cardiac symptoms in a diary, and after the recording is completed, the doctor compares the ECG recording with the patient’s own diary notes.

The patient is encouraged to live a normal life during the test and to carry out activities that may trigger arrhythmias. The heartbeats (approximately 100,000 days) during the test are recorded in the device’s memory and downloaded for subsequent interpretation and analysis.

For some people, arrhythmia is only rarely seen. In symptomatic recording, the patient is monitored for several weeks and the patient activates the ECG recording when their symptoms appear.