ECG is a tool used to assess the heart’s electrical activity. It can help detect heart rate, rhythm abnormalities, or other issues that may indicate the need for treatment.

The process of obtaining an ECG is quick and straightforward. A nurse places electrodes on your chest, arms, and legs, and within a few seconds, the ECG device records the necessary measurements.

In some cases, it is necessary to monitor the ECG for an extended period, typically 24 or 48 hours. During this time, the ECG continuously records your heart rhythm, allowing us to identify rhythm issues that may occur only occasionally, such as once a day or every other day.

The 24- or 48-hour ECG uses a compact, wearable device that is easy to carry. You are encouraged to continue your normal daily activities while wearing it. The goal is to determine whether you experience any rhythm abnormalities during your everyday life. In rare cases, a 7-day monitoring device may be used.

An external event recorder is a compact device that you can carry in your pocket for up to three months. Each time you sense potential rhythm problems, you can activate the device to record your heart rhythm.

This tool is particularly useful for patients who experience rhythm issues infrequently, such as episodes of a racing heart or palpitations (extra beats or pauses in the heartbeat). By capturing these episodes, we can carefully review the recordings to determine whether specific treatment is needed.

An implantable event recorder is a small device placed under the skin of your upper chest in a minimally invasive procedure.

This device is specifically used for patients who are asymptomatic but suspected of having rhythm problems. Unlike an external event recorder, which requires activation during symptoms, an implantable event recorder is ideal for patients who cannot feel when their rhythm is abnormal, allowing continuous monitoring and detection of irregularities.

To gain a comprehensive understanding of your blood pressure throughout the day, we use a device designed for 24-hour monitoring. The device is compact and can be worn on your hip.

It connects to a blood pressure cuff that measures your blood pressure every 15 minutes during the day and every 30 minutes at night. This continuous monitoring helps identify periods when your blood pressure is too high or too low, allowing us to optimize your blood pressure medication accordingly.

The exercise-stress test is an effective way to objectively assess your physical fitness. It also helps identify whether you are at risk of developing arrhythmias specifically triggered by exercise.

Additionally, the test can reveal if your blood pressure rises excessively during exercise, which is often a cause of limited exercise tolerance. Changes in the ECG or symptoms like chest pain during the test may indicate narrowed heart vessels, potentially requiring further evaluation.

Echocardiography is an ultrasound examination of the heart that provides detailed images of the size, wall motion, and function of your heart chambers, as well as the function of your heart valves. It also allows us to estimate pressures within the heart and detect any valve leakage or narrowing.

During the procedure, an ultrasound probe sends sound waves to your heart, which are reflected by its structures. These reflected waves are used to create an image of your heart. The information obtained is highly valuable for diagnosis and treatment.

Echocardiography is a safe procedure with no known relevant side effects.

Dobutamine stress echocardiography is a test used to determine whether the vessels in your heart are partially or completely blocked. This test helps assess the risk of heart attack in patients suspected of having diseased heart vessels. It evaluates both wall motion and heart valve dysfunction.

During the procedure, you receive a medication called Dobutamine, which makes your heart beat faster and harder. This allows us to evaluate how your heart performs under stress and to measure the reserve capacity of your heart vessels.

If the ultrasound (echocardiography) shows areas of the heart that do not pump well during stress, we may recommend cardiac catheterization or coronary angiography to check for narrowed vessels that might require stenting. Conversely, if the test is negative and all heart walls contract well, further diagnostic workup is typically unnecessary.

In specific clinical situations, we may need to evaluate the health of your carotid arteries or other arteries in your body to determine if there are any narrowings that might require intervention. This test allows us to examine both arteries and veins.

Cardiac magnetic resonance imaging (CMR) helps us identify structural abnormalities, inflammation, storage diseases, or insufficient blood supply to the heart. It also provides valuable insights into your potential risk for cardiovascular events. These findings are essential for tailoring your therapy to your specific needs.

PET is a diagnostic technology particularly useful for patients with sarcoidosis, an inflammatory disease of the heart that is considered a subtype of myocarditis and inflammatory cardiomyopathies.

PET CT is especially valuable for monitoring treatment response in sarcoidosis. It is an ideal method for detecting metabolic activity in sarcoid granulomas, which indicates active disease. Before undergoing PET CT, patients follow a special diet for two days that is high in fat and low in carbohydrates. On the third day, they receive a glucose solution to help identify areas in the body with active sarcoidosis lesions.

If there is a strong suspicion of narrowed or obstructed heart vessels, or if you are diagnosed with significant valve disease or another type of structural heart disease, we may recommend coronary angiography or cardiac catheterization.

During this procedure, you receive local anesthesia (a numbing medication similar to what is used at the dentist). A small catheter, about the diameter of a spaghetti strand, is inserted into an artery in your wrist or groin. Contrast fluid is injected into your heart vessels while X-ray imaging (fluoroscopy) is used to check for any narrowings or blockages in the arteries.

If obstructions are found, we try to open the affected arteries during the same procedure using a stent. A stent is a metal mesh attached to a deflated balloon on the catheter. Once the balloon inflates, the stent expands to fit the artery and remains in place when the balloon and catheter are removed. After the procedure, the vessel is fully open in the stented area. If stenting is not technically feasible, we will discuss other therapy options after the procedure.

In patients whose heart condition cannot be diagnosed using standard methods, we may recommend an endomyocardial or heart biopsy.

This procedure is performed under local anesthesia and, similar to cardiac catheterization, is minimally invasive. A small catheter is used to obtain the biopsy samples. Typically, we obtain 4 to 6 small samples, each about 1mm in size. The procedure is generally painless because pain medication is used. You may feel a few extra beats while the samples are taken.

If the pump function of your heart is severely decreased, we can offer a protective device capable of terminating severe arrhythmias if they occur. The risk of severe arrhythmias is higher when heart function is significantly reduced.

If the pump function of your left chamber (left ventricular ejection fraction) is 35% or less, we typically recommend wearing this wearable cardioverter defibrillator device for at least 3 months. During the first 3 months after a diagnosis of severely decreased heart function (not caused by vessel issues), medical therapy offers the highest chance for improvement. Therefore, the LifeVest serves as a temporary solution to protect against severe arrhythmias, which also provides monitoring to track your heart rhythm.

If heart function does not improve, we will evaluate whether you are a suitable candidate for an implantable cardioverter defibrillator (ICD). If an ICD is necessary, our team will thoroughly explain its risks and benefits, as we do with all other procedures.