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Cardiology Examination

Electrocardiography (ECG): It is the recording of the electrical activities occurring in the heart to
examine the functioning of the heart muscle and the nervous conduction system. ECG
helps in the diagnosis of heart diseases when evaluated together with the signs
and symptoms found by the physician in the examination, and when other tests
and films are taken into consideration. It has an indispensable importance
especially in the diagnosis of cardiovascular occlusions, rhythm disorders,
heart valve diseases and heart failure.

EFFORT (Treadmill) Test: Exertion test, investigating the presence of cardiovascular disease,
determining the effectiveness of treatment in known cardiovascular disease,
determining whether irregularity in heartbeat, ie arrhythmia, occurs with
effort, investigating the patient’s capacity to make effort in various heart
diseases, examining the effects of effort on blood pressure in patients with
hypertension, and It is a test used to determine the time of surgery in heart
valve diseases. During the exercise test, the patient walks on a
treadmill. The speed and incline of the gait are adjusted by the doctor to
increase the heart rate. The treadmill test is a test performed by
serially taking ECGs and measuring blood pressure while the person walks at
certain speeds on the treadmill. It enables the detection of abnormal
findings that cannot be detected on the ECG at rest, after exertion. The
effort test requires a specialist doctor’s accompaniment from beginning to end. The
exercise test provides great convenience in the early diagnosis and diagnosis
of heart diseases. The result is given immediately after the examination.

While coming to the effort (Treadmill) test appointment;
• Eat a light meal 3 hours before the test, after which you can drink a small
amount of water if you need, but do not eat food.

• Bring your previously taken EKG with you.

• Male patients should have a chest shave.

• It is more appropriate for female patients to wear 2-piece clothing.

• Before the exercise test, your doctor may ask you to stop some medications.
Consult your doctor who follows this issue.

Transthoracic Echocardiography (ECHO)
Echocardiography is the examination of heart structure and performance by means
of sound waves (ultrasound). It can be applied to everyone, including
pregnant women and newborn babies, without any risk and pain, as it is not a
method that includes radiation and no medication is used during the procedure. During
the procedure, the patient is asked to lie on a stretcher. The device,
which has an insulating feature, is applied a water-based gel and sends a sound
wave called a probe, is held by the doctor in various positions in the chest
area, allowing the heart to be visualized. Very detailed measurements and
analyzes are made on these images. Diagnosis of all structural diseases of
the heart (heart enlargement, heart muscle diseases, heart valve diseases,
hypertensive heart diseases, heart failures, pericardial diseases, intracardiac
masses, clots, heart tumors, congenital heart abnormalities, even diseases
of the largest vessel in the body called the aorta) are diagnosed by
echocardiography. No preliminary preparation is required for
echocardiography. However, it is appropriate to wear comfortable clothes
when coming to your echocardiography appointment. In addition, a request
sheet containing the patient’s medical information and the purpose of the
procedure should be obtained from the doctor of the patient who is decided to
have an echocardiography procedure, and it should be conveyed to the doctor who
will perform the echocardiography. Echocardiography is the method used
routinely. You do not need to make any special preparations when coming to
the appointment. The result is given immediately after the examination. However,
it is appropriate to wear comfortable clothes when coming to your
echocardiography appointment. In addition, a request sheet containing the
patient’s medical information and the purpose of the procedure should be
obtained from the doctor of the patient who is decided to have the
echocardiography procedure, and it should be conveyed to the doctor who will
perform the echocardiography. Echocardiography is the method used
routinely. You do not need to make any special preparations when coming to
the appointment. The result is given immediately after the examination. However,
it is appropriate to wear comfortable clothes when coming to your
echocardiography appointment. In addition, a request sheet containing the
patient’s medical information and the purpose of the procedure should be
obtained from the doctor of the patient who is decided to have the
echocardiography procedure, and it should be conveyed to the doctor who will
perform the echocardiography. Echocardiography is the method used
routinely. You do not need to make any special preparations when coming to
the appointment. The result is given immediately after the examination. You
do not need to make any special preparations when coming to the appointment. The
result is given immediately after the examination. You do not need to make
any special preparations when coming to the appointment. The result is
given immediately after the examination.

Three-Dimensional Transthoracic Echocardiography
Medipol Mega Hospitals Complex has the most advanced echocardiography devices
in the world. Three-dimensional echocardiography is used in heart valve
diseases and heart failure, when two-dimensional echocardiography is
insufficient and provides very valuable information. The result is given
immediately after the examination.

Stress Echocardiography Stress echocardiography is used to investigate whether there is an obstruction
or narrowing in the vessels feeding the heart (coronary vessels), to determine
whether a treatment other than medication is needed in patients who have had a
heart attack (myocardial infarction), and to grade the severity of the disease
in heart valve diseases. It is a safe and easy-to-apply technique that
provides crucial information.

Stress echocardiography is performed simply by examining the
heart with sound waves before and after the “stress to be created”. No
pain is felt during this procedure. The stress method to be used is to
make effort on the treadmill device, that is, to increase the workload of the
heart by running it in a brisk manner. Stress echocardiography is also
performed with medication to be administered through the arm vein. The
result is given immediately after the examination.

Before the stress echocardiography procedure;
• Come to your appointment hungry for 4 hours • Ask

your doctor whether we will stop the medications you use before the procedure

• Bring comfortable shoes and comfortable clothes to the

procedure • Bring other heart-related tests with you before the procedure.

Transesophageal Echocardiography (TEE) Test
TEE measurement is a method used when the patient’s chest structure (due to
lung disease, deformity, etc.) does not provide an adequate quality
echocardiographic image or when it is necessary to evaluate intracardiac
formations more closely. TEE is an endoscopic examination. With a
thin tube (probe) lowered into the esophagus through the mouth, the posterior
neighborhood of the heart is accessed and a very clear and detailed image is
obtained. It takes 30 minutes with the preparation before the procedure. The
result is given immediately after the examination.

3D Transesophageal Echocardiography (TEE) Test With
this method, which is only available in a few centers in our country, it is
possible to detect congenital heart holes, valve leaks in patients with
prosthetic heart valves, and other diseases that are difficult to detect with
2D TEE. What to do before and after the examination is the same as
described above. The result is given immediately after the examination.

Event Recorder These devices are similar to the EKG holter device and are used for the
detection of rhythm disorders that are not frequently repeated. The device
can remain in the patient for 14 days. It has the feature of recording
only when the patient has a complaint (the recording time can be adjusted as
desired).

Blood Pressure Holter It is the measurement of the blood pressure of the patients at frequent
intervals throughout the day and recording the blood pressure and pulse. Early
diagnosis can be achieved in patients without pre-existing hypertension with
measurements made between 24-72 hours. With the blood pressure holter, the
blood pressure of the patients is measured at frequent intervals throughout the
day, and their blood pressure and pulse rate are recorded during their
activities during the day, during sleep, during rest. Thus, patients with
long-term hypertension can be treated by determining at what time of the day
their blood pressure values increase. It
helps in early diagnosis and treatment in patients who do not have hypertension
before.

Tilt Table Test (Tilt Table Test) It is a test applied in the diagnosis of fainting (syncope)
caused by a sudden drop in blood pressure and/or heart rate after standing
still for a long time or after sitting for a long time. It is used in the
differential diagnosis of fainting. The Tilt Table test is performed in
the outpatient clinic on a tiltable table. The patient is placed on the
table, then the table is brought to an upright position. Excessive blood
pressure drop and/or low heart rate indicate an abnormal response.

Temporary Pacemakers If the heartbeat slows down excessively due to the inability of the heart’s warning
center to generate a stimulus at a sufficient rate or the inability to transmit
the stimulus to the lower centers, pacemakers placed in the body are needed to
maintain the heart rate in order for the patient to maintain a normal life. The
procedure is usually performed under local anesthesia by placing thin wires
called electrodes through the large veins going to the heart in the neck, chest
or groin into the heart and connecting it to a generator outside the body. This
procedure can be done at the bedside or under the X-ray machine. The
procedure usually takes 20-30 minutes. When the need for a temporary
battery is eliminated, the wire placed inside the heart is removed.

Pacemakers Millions of people around the world have a pacemaker. These
high-tech small devices are used for many purposes, from slowing down the heart
rate to treating heart failure, from acting as a heart pump to preventing
sudden death. The device, which eliminates the complaints experienced
after it is inserted, helps the patient to return to normal life by increasing
the quality of life. Basically, there are 3 types of pacemakers:
Single-cable and 2-wire batteries that prevent heart rate slowdown, 3-wire
batteries used for the treatment of heart failure, and defibrillators that save
lives by giving electroshock in case the heart cannot function as a pump due to
high rhythm. Pacemakers are placed in people who have heart rhythm
disorders and cannot lead a normal life. These patients can return to
their normal life patterns with the help of a pacemaker. These people can
go back to work, do household chores, drive, travel, swim, continue their
hobbies and sex lives. People with pacemakers should carry their pacemaker
identification card with them at all times. While traveling, they should
learn about the nearest clinics in their destination. After the pacemaker
is inserted, its performance must be monitored. In fact, the pacemaker,
which is a small computer itself, can be read from the outside with the help of
another computer, using a method called telemetric method. In this way,
information such as how the patient’s heart rate progressed, how long the
pacemaker worked, whether his own rhythm appeared from time to time, whether he
was always connected to the pacemaker, or whether there were other rhythm
disorders. In addition, it is possible to program the number of volts the
battery should work at or the values that
should keep the heart rate externally to the pacemaker. The patient has to
come for a check-up every 6 months for 7 years, which is the average duration
of the battery. These checks are very important as it can be predicted
before the battery will run out.

Electrophysiological Study Electrophysiological study is an interventional diagnosis and
treatment method performed by placing thin cables called electrode catheters
into the heart by passing thin sheaths placed in the inguinal veins in the
electrophysiology/angiography laboratory. Electrical signals received
directly from the heart are evaluated by advanced computers and deviations from
normal are investigated. In this way, it can be understood whether the
heart’s main center warning system works well and whether the system that
transmits the warnings can safely function. In patients with palpitations,
which are often in the form of rapid beating, rapid beats, which are the cause
of the patient’s complaint, are created with the stimuli given from these
cables placed inside the heart with special methods, and the reasons for their
occurrence are investigated. When short circuits are detected, tachycardia
can be completely cured by applying a special current point energy consisting
of radio waves. In this way, permanent treatment of most palpitations in
the form of rapid heartbeat (tachycardia) has become possible today. Electrophysiological
examinations for diagnostic purposes take 30-60 minutes. If a therapeutic
intervention is required, this is a procedure that can take up to 1-4 hours.

Catheter Ablation Catheter ablation is a rhythm disorder treatment by giving radio
waves. This method is applied in rhythm disorders that cannot be
controlled with drugs or if patients do not want to take drugs for life. In
some cases, the rhythm disturbance can be so significant that it can be
life-threatening. In such cases, direct catheter ablation may be required. The
procedure is basically performed under local anesthesia by numbing the needle
entry points, and in some cases under general anesthesia. During the
procedure, sedative medication can be administered to make the patient feel
comfortable. The probability of success in the treatment of rhythm
disorders in the form of rapid beating of the heart with catheter ablation
varies between 70-100%, depending on the type of palpitation targeted for
treatment and the location of the short circuit. Success is understood as
the treatment of palpitations never to happen again. The probability of
recurrence of palpitations after successful administration varies with the type
of arrhythmia. For example, this probability is between 3-5% in
palpitations due to short circuits in the heart. In Medipol Mega Hospitals
Complex, besides the radiofrequency ablation method called “burning”
method, arrhythmia treatment can also be performed with the
“freezing” method called cryablation.

Mitral Balloon (Valvuloplasty) Mitral stenosis; ‘Acute Rheumatic Fever’, which is a
childhood disease, is a disease that gives symptoms in the future due to
involvement of the heart valves. Mitral stenosis is narrowing of the blood
in the heart, making it difficult to pass from one chamber to another. Therefore,
blood accumulates in the lungs in the form of water. This causes the
person to feel short of breath. In mild stenosis, drug treatment is
sufficient, but in moderate and severe stenosis, Mitral Valvuloplasty or open
heart surgery is performed. Mitral valvuloplasty is an interventional
procedure performed through the groin with a catheter. With a special
needle sent through a sheath, the curtain is pierced from the right atrium of
the heart to the left atrium. The needle is removed from the sheath and
the guide wire is advanced to the left atrium through the same sheath. The
movements of the wire are monitored on the screen. After the wire is
placed in the right place, the balloon is advanced over the wire and placed
inside the narrowed cap. The balloon is inflated where the cap is narrow. Thus,
the cover is expanded as much as possible. When applied to appropriate
patients, the results of mitral balloon treatment are as successful as in
patients undergoing cardiac surgery.

Advantages of Mitral Valvuloplasty:

• Since it is performed with local anesthesia, the patient
remains conscious during the procedure. The right or left inguinal region
is anesthetized and the balloon is advanced to the heart through a small hole
opened there.

• Thus, the need to open the thorax, stop the heart and use a heart-lung machine is eliminated

• After the procedure, patients are kept under observation in the intensive care unit instead of the intensive care unit

• Patients can stand up the next day

• Most of the patients can be discharged the next day

• The valve is opened with a mitral balloon and the rhythm There is no need for
continuous use of blood thinners after the procedure in patients who do not
have irregularity.

• With balloon mitral valvuloplasty, 90% of the patients have a regression in
their complaints. This improvement can last up to 20 years. Most
patients experience relief for at least 5 to 10 years.

Coronary Angiography Coronary Angiography is a method used to detect the disease of the arteries
feeding the heart. It is caused by cardiovascular disease. Coronary
angiography also detects how narrowed or blocked which part of the arteries
feeding the heart is. It determines the stenosis or occlusions in the
heart vessels and ensures that the treatment is directed as needed. Inguinal
or arm arteries are used as the intervention site in coronary angiography. First,
the sheath is placed on the artery at the intervention site, and the vascular
structure is visualized with the opaque substance (painted substance) given to
the beginning of the heart vessels by using different catheters through this
sheath. Coronary angiography is performed in specially deployed
angiography rooms. After the procedure is completed, the sheath placed on
the artery at the intervention site is removed, By applying pressure to
that area, the bleeding is stopped. After the tight bandage is applied,
the patient is taken to the bed. Coronary angiography is completed 20 to
30 minutes after the patient is taken to the angio room. In some cases
(bypass patients, patients who have had different heart surgeries before,
patients with occlusion in the inguinal or arm veins, etc.), this period may be
extended. Hospitalization of the patient is required for coronary
angiography. After the procedure is completed, the patient is rested for 6
hours and then he is allowed to stand up. If his general condition is
suitable and his doctor approves, he is discharged. In some cases, the
suture system can be used after the sheath has been removed. These
patients can be discharged by standing up earlier. A few days before
coming to angiography, you should definitely contact the angio scattering and
get information about what needs to be done.

Percutaneous Transluminal Coronary Angioplasty (PTCA) – Stent:
PTCA and/or stent are the methods used in the treatment of narrowing or
complete occlusion of the vessels feeding the heart detected after coronary
angiography. Like PTCA and/or stent coronary angiography, it is performed
in the angiography laboratory using local anesthesia at the entrance site,
without making the patient sleepy. Processing time is variable. At
the end of the procedure, the patient is taken to the appropriate service
according to the doctor’s recommendation. Coronary balloon angioplasty is
performed using specially designed materials. First, the catheter is
placed through the sheath placed on the intervention site, and the vessel is
passed through the stenosis area with a very thin guide wire advanced through
this catheter. The balloon is slid over this guide wire and the patient is
brought to the area. Then, this balloon is inflated by giving external
fluid and the stenosis is opened.

It is rare to assure smooth opening. In addition, stents
are preferred in 95% of patients to reduce the risk of re-narrowing in the
future. At first, only bare, special, stainless metal stents were used,
but nowadays, new and different drug-eluting stents are used, depending on the
technological progress. Deciding which stent will be used in which
situation by talking to the patient is a preferred way for the right treatment. PTCA
stent is an application that requires the patient to stay in the hospital for
one day. Patient; discharged if the doctor deems it appropriate. It
is very important to stay away from stressful environments and sexual
intercourse for 15 days, along with 2 days of rest at home and 15 days of work
rest. It is also possible for the patient to travel by plane and long land
journeys after resting, determined according to the recommendation of your
doctor. While coronary angiography is routinely performed from the artery
called the femoral artery in the groin, coronary angiography can also be
performed from the artery in the wrist called the radial artery in our clinic. In
addition, in our clinic, the occlusion of not only the heart vessels, but also
the peripheral vessels, such as kidney and leg vessels, can be treated with
balloon and stent methods.

Heart Catheterization Cardiac catheterization is a method similar to coronary angiography, which is
performed using the inguinal and arm arteries, but often requires simultaneous
venous intervention. Cardiac catheterization is a diagnostic method used
in the diagnosis of congenital or acquired heart diseases, anomalies,
congenital or acquired heart holes, and whether a different treatment is
required. Cardiac catheterization takes approximately 30 minutes. After
the procedure, the sheaths placed on the artery and vein are removed and
bleeding is stopped by external pressure. A tight bandage is applied to
that area and the patient is taken to the bed. After the procedure, 6
hours of rest is usually sufficient. At the end of the rest, the patient
can be discharged if the doctor deems it appropriate. Life risk is
extremely low in cardiac catheterization and coronary angiography. A few
days before coming to the cardiac catheterization procedure, you should
definitely contact the angio secretariat and get information about what to do.

Opening Chronic Completely Occluded Veins In
patients who have had a heart attack, some veins remain 100%
occluded and usually patients need surgery to open their veins. The
procedure of opening 100% occluded coronary heart vessels with balloon and stent
procedure without the need for surgery, which is applied only in certain heart
centers in Turkey, can be performed by Medipol Mega Hospitals Complex
Cardiology Department physicians. Our clinic consists of physicians who
have the most experience and number of patients in this field.

Non-surgical Treatment of Aortic Stenosis (TAVI)

Briefly, the method called TAVI (Transcatheter Aortic Valve
Implantation); In fact, he describes the procedure of inserting the aortic
valve into the heart using the catheter method, without performing open heart
surgery. Biological heart valves that are inserted during this procedure
and are still used in valve replacement surgeries all over the world and in our
country. In the TAVI method, this biological valve is placed in a stent
sheath and when the stent is opened, it is firmly attached to the area where
the valve is inserted. Two different techniques can be used during this method:
In the first technique, the valve is advanced from the groin to the heart with
the help of a catheter, as in angiography applications, and the stent mechanism
is opened and placed there. If there is a blockage in the veins in the
groin area or in the abdomen to be used to reach the heart, the other technique
is applied. In this technique, a small incision of approximately 4-5 cm is
made on the anterior chest wall, and the end of the heart is reached, and the
valve is placed with a catheter advanced to the heart. In both methods,
there is no need to stop the heart and open surgery. The procedure can be
performed under local anesthesia without putting the patient to sleep. The
patients are taken to coronary intensive care unit after TAVI procedure. Meanwhile,
a blood thinner is given to the patient and the patient is followed up in the
hospital for 4-5 days under normal patient conditions. He is discharged
after this period. The patient, who goes home, comes to the hospital for
control after a few days of rest and continues his normal life from where he
left off. In both methods, there is no need to stop the heart and open
surgery. The procedure can be performed under local anesthesia without the
patient being put to sleep. After the TAVI procedure, the patients are
taken to the coronary intensive care unit. Meanwhile, a blood thinner is
given to the patient and the patient is followed up in the hospital for 4-5
days under normal patient conditions. He is discharged after this period. The
patient, who goes home, comes to the hospital for control after a few days of
rest and continues his normal life from where he left off. In both
methods, there is no need to stop the heart and open surgery. The
procedure can be performed under local anesthesia without putting the patient
to sleep. The patients are taken to coronary intensive care unit after
TAVI procedure. Meanwhile, a blood thinner is given to the patient and the
patient is followed up in the hospital for 4-5 days under normal patient
conditions. He is discharged after this period. The patient, who goes
home, comes to the hospital for control after a few days of rest and continues
his normal life from where he left off.

The TAVI method is primarily recommended for patients who are
too high-risk to undergo open surgery for valve insertion. Apart from
this, this method can also be applied to patients with any disability for open
surgery. In this regard, especially the very elderly, patients with lung,
liver or kidney dysfunction, or patients who have had other open heart surgery
before are considered to be at high risk for open surgery. It is known
that the TAVI method is effective in prolonging the life span and improving the
clinical condition of the patients in these patients for whom open surgery is
not suitable.

Non-surgical treatment of heart holes

In the past, intracardiac holes were mostly closed with
surgery, but nowadays, non-surgical closure methods are preferred. In
patients with a congenital hole in the heart, the heart cannot continue its
normal functioning, and dirty blood and clean blood mix with each other. In
our clinic, the holes in the majority of these patients are closed with a
device, after entering the artery in the groin without surgery and passing
through the heart hole with the help of a catheter. Our patients are discharged
within 48 hours after the procedure.

Non- Surgical Vascular Repair The endovascular method is primarily
suitable for high-risk patients for open surgery. However, this method cannot
be applied to every patient. Because in order to treat aneurysm with
endovascular method, the patient’s vascular structure must be suitable. It
is also frequently used in ruptured aneurysms where emergency surgery is
required in terms of its fast and practical applicability. The procedure
is performed with local anesthesia. However, it should be done in
environments where catheter techniques can be applied and operating room
conditions are available. For this reason, it is a great advantage to
provide an environment called hybrid operating room where both operating room
conditions are provided and catheter treatments can be performed and these
advanced imaging methods can be applied.

EVAR: In the endovascular treatment method, the aortic region
where there is an aneurysm (bubble) in the vessels formed in the abdomen is
repaired with a stent that is advanced with a catheter from the groin.

TEVAR: In the endovascular treatment method, the aortic
region where the aneurysm (bubble) formed in the vessels in the chest area is
repaired with a stent that is advanced with a catheter from the groin.

A new treatment method in resistant hypertension: Renal
Denervation There are nerves called ‘sympathetic’ around the kidney vessels that cause
blood pressure to rise. This sympathetic system is burned through the vein
with a special material, with a method similar to angio, without anesthetizing. This
method, which is based on the burning of the sympathetic nerves that cause
hypertension, is called “renal sympathetic denervation”. With
this method, persistent blood pressure, which does not fall or rises again
after a while, which seriously affects the patient’s quality of life, can be
effectively treated. The 80-90% success achieved by the renal denervation
method used in the treatment of stubborn blood pressure ensures that the number
of blood pressure medications used by patients is reduced and blood pressure is
controlled.

Myocardial Perfusion Scintigraphy (Thalium Test):
This test examines the blood supply (or nutrition) of the heart muscle during
rest and during stress. It is investigated whether there is any stenosis
in the vessels feeding the heart, and if there is stenosis, whether the
existing stenosis causes a disorder in the nutrition of the heart. It is a
more sensitive method than the effort test. First, the patient is given
intravenous radioactive and resting images are taken with a device called a
gamma camera, then a stress test is performed by walking on the tape or with
medication, and the radioactive substance is injected again. Again, the
image is taken on the gamma camera. The radioactive material goes up to
the heart and reaches the heart muscle. In places with vascular occlusion,
this substance is less retained. Gamma camera is the name of the device
that allows us to obtain images. It rotates around the heart at regular
intervals and transmits the radioactive signals from the heart to a computer.

In which cases myocardial perfusion scintigraphy is
requested; In the determination of the relationship between chest pain and
heart disease, in the diagnosis of cardiovascular diseases, in the
determination of vitality after myocardial infarction of the heart muscle, in
the determination of the benefit and necessity of the application before and
after coronary balloon angioplasty As a disease screening test in patients with
risk factors for cardiovascular disease. To determine the efficacy of treatment
after coronary bypass surgery or drug therapy To determine whether patients
have had an infarction, to determine the extent and severity of the infarction

Procedures performed in the Radiology Department of Medipol Mega Hospitals Complex Heart Health Center:

Coronary CT Angiography Computed tomography (CT) Coronary angiography can be performed with the
multi-detector “Multi Detector-multislice-multi-slice CT” device without
any prior preparation, without a catheter, and in only one breath hold time. CT
Coronary Angiography is a new groundbreaking method in the field of imaging, as
it can be performed more easily and faster than classical angiography and can
be performed bloodless and painless. It eliminates the need for
hospitalization. The patient continues his daily life after the procedure. Thanks
to this system, coronary angiography of people with risk factors can be easily
performed. It has been observed that especially patients who have
undergone classical coronary angiography prefer this method, and many patients
are treated and treated early thanks to CT angiography.

Cardiac MRI

It is an imaging method that reveals the structure of the
heart membrane, heart chambers, valves, heart muscle, great arteries coming out
of the heart and some coronary artery diseases (for now only the main branches)
very easily and without the need for any medication or procedure. The
processing time is around 45 minutes and does not require any preliminary
preparation.

Tag: Cardiology Examination