Treatment of coronary heart disease

Along with the medical history and clinical examination, the exercise ECG on a bicycle ergometer in particular can detect disorders of cardiac circulation in the form of ST segment elevation or depression and/or arrhythmias. Typical changes tend not to be detected with certainty in an ordinary ECG (only about 50%), and likewise on echocardiography due to movement disorders (hypokine­sia or akinesia in the area of the inadequately perfused heart muscle).

The most important investigation when CHD is highly suspected is coronary angiography (left heart catheter investigation) in which the cardiologist can discover the coronary arteries affected by stenoses and their exact location using a contrast agent, and can measure the stenoses. The left ventricular pump function can also be determined by contrast agent in the left ventricle (ventriculography). This continues to the gold standard in diagnosis (access usually through the right femoral artery). In life-threatening circumstances or after a myocardial infarction has occurred, the procedure can also be used therapeutically at the same time to reopen the artery (dilatation/PTCA) with implantation of a stabilising mesh known as a stent.

Radiological and nuclear medicine investigations such as myocardial scintigraphy with exercise ergometry also provide concrete evidence of the location and severity of the circulatory disorder in the heart muscle (evidence of ischaemia). Positron emission tomography (PET) and magnetic resonance imaging (MRI) are also used to distinguish live from already dead heart muscle.

A major innovation in the Grosshadern clinic, but also in other hospitals with 64-section CT scanners, is that the coronary arteries and in particular their level of calcification (coronary calcium quantification) can be imaged today in high resolution with the most modern CT scanners (dual-source CT), (nearly as well today as with coronary angiography). CHD can thus be identified or ruled out beforehand.