We provide professional support in Cardiology Examination.
Electrocardiography (ECG): It is the recording of the electrical activities occurring in the heart toexamine the functioning of the heart muscle and the nervous conduction system. ECGhelps in the diagnosis of heart diseases when evaluated together with the signsand symptoms found by the physician in the examination, and when other testsand films are taken into consideration. It has an indispensable importanceespecially 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 witheffort, investigating the patient’s capacity to make effort in various heartdiseases, examining the effects of effort on blood pressure in patients withhypertension, and It is a test used to determine the time of surgery in heartvalve diseases. During the exercise test, the patient walks on atreadmill. The speed and incline of the gait are adjusted by the doctor toincrease the heart rate. The treadmill test is a test performed byserially taking ECGs and measuring blood pressure while the person walks atcertain speeds on the treadmill. It enables the detection of abnormalfindings that cannot be detected on the ECG at rest, after exertion. Theeffort test requires a specialist doctor’s accompaniment from beginning to end. Theexercise test provides great convenience in the early diagnosis and diagnosisof 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 smallamount 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 meansof sound waves (ultrasound). It can be applied to everyone, includingpregnant women and newborn babies, without any risk and pain, as it is not amethod that includes radiation and no medication is used during the procedure. Duringthe 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 soundwave called a probe, is held by the doctor in various positions in the chestarea, allowing the heart to be visualized. Very detailed measurements andanalyzes are made on these images. Diagnosis of all structural diseases ofthe heart (heart enlargement, heart muscle diseases, heart valve diseases,hypertensive heart diseases, heart failures, pericardial diseases, intracardiacmasses, clots, heart tumors, congenital heart abnormalities, even diseasesof the largest vessel in the body called the aorta) are diagnosed byechocardiography. No preliminary preparation is required forechocardiography. However, it is appropriate to wear comfortable clotheswhen coming to your echocardiography appointment. In addition, a requestsheet containing the patient’s medical information and the purpose of theprocedure should be obtained from the doctor of the patient who is decided tohave an echocardiography procedure, and it should be conveyed to the doctor whowill perform the echocardiography. Echocardiography is the method usedroutinely. You do not need to make any special preparations when coming tothe appointment. The result is given immediately after the examination. However,it is appropriate to wear comfortable clothes when coming to yourechocardiography appointment. In addition, a request sheet containing thepatient’s medical information and the purpose of the procedure should beobtained from the doctor of the patient who is decided to have theechocardiography procedure, and it should be conveyed to the doctor who willperform the echocardiography. Echocardiography is the method usedroutinely. You do not need to make any special preparations when coming tothe appointment. The result is given immediately after the examination. However,it is appropriate to wear comfortable clothes when coming to yourechocardiography appointment. In addition, a request sheet containing thepatient’s medical information and the purpose of the procedure should beobtained from the doctor of the patient who is decided to have theechocardiography procedure, and it should be conveyed to the doctor who willperform the echocardiography. Echocardiography is the method usedroutinely. You do not need to make any special preparations when coming tothe appointment. The result is given immediately after the examination. Youdo not need to make any special preparations when coming to the appointment. Theresult is given immediately after the examination. You do not need to makeany special preparations when coming to the appointment. The result isgiven immediately after the examination.
Three-Dimensional Transthoracic EchocardiographyMedipol Mega Hospitals Complex has the most advanced echocardiography devicesin the world. Three-dimensional echocardiography is used in heart valvediseases and heart failure, when two-dimensional echocardiography isinsufficient and provides very valuable information. The result is givenimmediately after the examination.
Stress Echocardiography Stress echocardiography is used to investigate whether there is an obstructionor narrowing in the vessels feeding the heart (coronary vessels), to determinewhether a treatment other than medication is needed in patients who have had aheart attack (myocardial infarction), and to grade the severity of the diseasein heart valve diseases. It is a safe and easy-to-apply technique thatprovides crucial information.
Stress echocardiography is performed simply by examining theheart with sound waves before and after the “stress to be created”. Nopain is felt during this procedure. The stress method to be used is tomake effort on the treadmill device, that is, to increase the workload of theheart by running it in a brisk manner. Stress echocardiography is alsoperformed with medication to be administered through the arm vein. Theresult 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) TestTEE measurement is a method used when the patient’s chest structure (due tolung disease, deformity, etc.) does not provide an adequate qualityechocardiographic image or when it is necessary to evaluate intracardiacformations more closely. TEE is an endoscopic examination. With athin tube (probe) lowered into the esophagus through the mouth, the posteriorneighborhood of the heart is accessed and a very clear and detailed image isobtained. It takes 30 minutes with the preparation before the procedure. Theresult is given immediately after the examination.
3D Transesophageal Echocardiography (TEE) Test Withthis method, which is only available in a few centers in our country, it ispossible to detect congenital heart holes, valve leaks in patients withprosthetic heart valves, and other diseases that are difficult to detect with2D TEE. What to do before and after the examination is the same asdescribed above. The result is given immediately after the examination.
Event Recorder These devices are similar to the EKG holter device and are used for thedetection of rhythm disorders that are not frequently repeated. The devicecan remain in the patient for 14 days. It has the feature of recordingonly when the patient has a complaint (the recording time can be adjusted asdesired).
Blood Pressure Holter It is the measurement of the blood pressure of the patients at frequentintervals throughout the day and recording the blood pressure and pulse. Earlydiagnosis can be achieved in patients without pre-existing hypertension withmeasurements made between 24-72 hours. With the blood pressure holter, theblood pressure of the patients is measured at frequent intervals throughout theday, and their blood pressure and pulse rate are recorded during theiractivities during the day, during sleep, during rest. Thus, patients withlong-term hypertension can be treated by determining at what time of the daytheir blood pressure values increase. Ithelps in early diagnosis and treatment in patients who do not have hypertensionbefore.
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 standingstill for a long time or after sitting for a long time. It is used in thedifferential diagnosis of fainting. The Tilt Table test is performed inthe outpatient clinic on a tiltable table. The patient is placed on thetable, then the table is brought to an upright position. Excessive bloodpressure 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 warningcenter to generate a stimulus at a sufficient rate or the inability to transmitthe stimulus to the lower centers, pacemakers placed in the body are needed tomaintain the heart rate in order for the patient to maintain a normal life. Theprocedure is usually performed under local anesthesia by placing thin wirescalled electrodes through the large veins going to the heart in the neck, chestor groin into the heart and connecting it to a generator outside the body. Thisprocedure can be done at the bedside or under the X-ray machine. Theprocedure usually takes 20-30 minutes. When the need for a temporarybattery is eliminated, the wire placed inside the heart is removed.
Pacemakers Millions of people around the world have a pacemaker. Thesehigh-tech small devices are used for many purposes, from slowing down the heartrate to treating heart failure, from acting as a heart pump to preventingsudden death. The device, which eliminates the complaints experiencedafter it is inserted, helps the patient to return to normal life by increasingthe quality of life. Basically, there are 3 types of pacemakers:Single-cable and 2-wire batteries that prevent heart rate slowdown, 3-wirebatteries used for the treatment of heart failure, and defibrillators that savelives by giving electroshock in case the heart cannot function as a pump due tohigh rhythm. Pacemakers are placed in people who have heart rhythmdisorders and cannot lead a normal life. These patients can return totheir normal life patterns with the help of a pacemaker. These people cango back to work, do household chores, drive, travel, swim, continue theirhobbies and sex lives. People with pacemakers should carry their pacemakeridentification card with them at all times. While traveling, they shouldlearn about the nearest clinics in their destination. After the pacemakeris 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 ofanother computer, using a method called telemetric method. In this way,information such as how the patient’s heart rate progressed, how long thepacemaker worked, whether his own rhythm appeared from time to time, whether hewas always connected to the pacemaker, or whether there were other rhythmdisorders. In addition, it is possible to program the number of volts thebattery should work at or the values thatshould keep the heart rate externally to the pacemaker. The patient has tocome for a check-up every 6 months for 7 years, which is the average durationof the battery. These checks are very important as it can be predictedbefore the battery will run out.
Electrophysiological Study Electrophysiological study is an interventional diagnosis andtreatment method performed by placing thin cables called electrode cathetersinto the heart by passing thin sheaths placed in the inguinal veins in theelectrophysiology/angiography laboratory. Electrical signals receiveddirectly from the heart are evaluated by advanced computers and deviations fromnormal are investigated. In this way, it can be understood whether theheart’s main center warning system works well and whether the system thattransmits the warnings can safely function. In patients with palpitations,which are often in the form of rapid beating, rapid beats, which are the causeof the patient’s complaint, are created with the stimuli given from thesecables placed inside the heart with special methods, and the reasons for theiroccurrence are investigated. When short circuits are detected, tachycardiacan be completely cured by applying a special current point energy consistingof radio waves. In this way, permanent treatment of most palpitations inthe form of rapid heartbeat (tachycardia) has become possible today. Electrophysiologicalexaminations for diagnostic purposes take 30-60 minutes. If a therapeuticintervention 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 radiowaves. This method is applied in rhythm disorders that cannot becontrolled with drugs or if patients do not want to take drugs for life. Insome cases, the rhythm disturbance can be so significant that it can belife-threatening. In such cases, direct catheter ablation may be required. Theprocedure is basically performed under local anesthesia by numbing the needleentry points, and in some cases under general anesthesia. During theprocedure, sedative medication can be administered to make the patient feelcomfortable. The probability of success in the treatment of rhythmdisorders in the form of rapid beating of the heart with catheter ablationvaries between 70-100%, depending on the type of palpitation targeted fortreatment and the location of the short circuit. Success is understood asthe treatment of palpitations never to happen again. The probability ofrecurrence of palpitations after successful administration varies with the typeof arrhythmia. For example, this probability is between 3-5% inpalpitations due to short circuits in the heart. In Medipol Mega HospitalsComplex, 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 achildhood disease, is a disease that gives symptoms in the future due toinvolvement of the heart valves. Mitral stenosis is narrowing of the bloodin 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 theperson to feel short of breath. In mild stenosis, drug treatment issufficient, but in moderate and severe stenosis, Mitral Valvuloplasty or openheart surgery is performed. Mitral valvuloplasty is an interventionalprocedure performed through the groin with a catheter. With a specialneedle sent through a sheath, the curtain is pierced from the right atrium ofthe heart to the left atrium. The needle is removed from the sheath andthe guide wire is advanced to the left atrium through the same sheath. Themovements of the wire are monitored on the screen. After the wire isplaced in the right place, the balloon is advanced over the wire and placedinside the narrowed cap. The balloon is inflated where the cap is narrow. Thus,the cover is expanded as much as possible. When applied to appropriatepatients, the results of mitral balloon treatment are as successful as inpatients undergoing cardiac surgery.
Advantages of Mitral Valvuloplasty:
• Since it is performed with local anesthesia, the patientremains conscious during the procedure. The right or left inguinal regionis anesthetized and the balloon is advanced to the heart through a small holeopened 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 forcontinuous use of blood thinners after the procedure in patients who do nothave irregularity.
• With balloon mitral valvuloplasty, 90% of the patients have a regression intheir complaints. This improvement can last up to 20 years. Mostpatients experience relief for at least 5 to 10 years.
Coronary Angiography Coronary Angiography is a method used to detect the disease of the arteriesfeeding the heart. It is caused by cardiovascular disease. Coronaryangiography also detects how narrowed or blocked which part of the arteriesfeeding the heart is. It determines the stenosis or occlusions in theheart vessels and ensures that the treatment is directed as needed. Inguinalor 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 vascularstructure is visualized with the opaque substance (painted substance) given tothe beginning of the heart vessels by using different catheters through thissheath. Coronary angiography is performed in specially deployedangiography rooms. After the procedure is completed, the sheath placed onthe artery at the intervention site is removed, By applying pressure tothat area, the bleeding is stopped. After the tight bandage is applied,the patient is taken to the bed. Coronary angiography is completed 20 to30 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 beextended. Hospitalization of the patient is required for coronaryangiography. After the procedure is completed, the patient is rested for 6hours and then he is allowed to stand up. If his general condition issuitable and his doctor approves, he is discharged. In some cases, thesuture system can be used after the sheath has been removed. Thesepatients can be discharged by standing up earlier. A few days beforecoming to angiography, you should definitely contact the angio scattering andget 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 orcomplete occlusion of the vessels feeding the heart detected after coronaryangiography. Like PTCA and/or stent coronary angiography, it is performedin the angiography laboratory using local anesthesia at the entrance site,without making the patient sleepy. Processing time is variable. Atthe end of the procedure, the patient is taken to the appropriate serviceaccording to the doctor’s recommendation. Coronary balloon angioplasty isperformed using specially designed materials. First, the catheter isplaced through the sheath placed on the intervention site, and the vessel ispassed through the stenosis area with a very thin guide wire advanced throughthis catheter. The balloon is slid over this guide wire and the patient isbrought to the area. Then, this balloon is inflated by giving externalfluid and the stenosis is opened.
It is rare to assure smooth opening. In addition, stentsare preferred in 95% of patients to reduce the risk of re-narrowing in thefuture. At first, only bare, special, stainless metal stents were used,but nowadays, new and different drug-eluting stents are used, depending on thetechnological progress. Deciding which stent will be used in whichsituation by talking to the patient is a preferred way for the right treatment. PTCAstent is an application that requires the patient to stay in the hospital forone day. Patient; discharged if the doctor deems it appropriate. Itis very important to stay away from stressful environments and sexualintercourse for 15 days, along with 2 days of rest at home and 15 days of workrest. It is also possible for the patient to travel by plane and long landjourneys after resting, determined according to the recommendation of yourdoctor. While coronary angiography is routinely performed from the arterycalled the femoral artery in the groin, coronary angiography can also beperformed from the artery in the wrist called the radial artery in our clinic. Inaddition, in our clinic, the occlusion of not only the heart vessels, but alsothe peripheral vessels, such as kidney and leg vessels, can be treated withballoon and stent methods.
Heart Catheterization Cardiac catheterization is a method similar to coronary angiography, which isperformed using the inguinal and arm arteries, but often requires simultaneousvenous intervention. Cardiac catheterization is a diagnostic method usedin the diagnosis of congenital or acquired heart diseases, anomalies,congenital or acquired heart holes, and whether a different treatment isrequired. Cardiac catheterization takes approximately 30 minutes. Afterthe procedure, the sheaths placed on the artery and vein are removed andbleeding is stopped by external pressure. A tight bandage is applied tothat area and the patient is taken to the bed. After the procedure, 6hours of rest is usually sufficient. At the end of the rest, the patientcan be discharged if the doctor deems it appropriate. Life risk isextremely low in cardiac catheterization and coronary angiography. A fewdays before coming to the cardiac catheterization procedure, you shoulddefinitely contact the angio secretariat and get information about what to do.
Opening Chronic Completely Occluded Veins Inpatients who have had a heart attack, some veins remain 100%occluded and usually patients need surgery to open their veins. Theprocedure of opening 100% occluded coronary heart vessels with balloon and stentprocedure without the need for surgery, which is applied only in certain heartcenters in Turkey, can be performed by Medipol Mega Hospitals ComplexCardiology Department physicians. Our clinic consists of physicians whohave the most experience and number of patients in this field.
Briefly, the method called TAVI (Transcatheter Aortic ValveImplantation); In fact, he describes the procedure of inserting the aorticvalve into the heart using the catheter method, without performing open heartsurgery. Biological heart valves that are inserted during this procedureand are still used in valve replacement surgeries all over the world and in ourcountry. In the TAVI method, this biological valve is placed in a stentsheath and when the stent is opened, it is firmly attached to the area wherethe 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 withthe help of a catheter, as in angiography applications, and the stent mechanismis opened and placed there. If there is a blockage in the veins in thegroin area or in the abdomen to be used to reach the heart, the other techniqueis applied. In this technique, a small incision of approximately 4-5 cm ismade on the anterior chest wall, and the end of the heart is reached, and thevalve 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 beperformed under local anesthesia without putting the patient to sleep. Thepatients 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 thehospital for 4-5 days under normal patient conditions. He is dischargedafter this period. The patient, who goes home, comes to the hospital forcontrol after a few days of rest and continues his normal life from where heleft off. In both methods, there is no need to stop the heart and opensurgery. The procedure can be performed under local anesthesia without thepatient being put to sleep. After the TAVI procedure, the patients aretaken to the coronary intensive care unit. Meanwhile, a blood thinner isgiven to the patient and the patient is followed up in the hospital for 4-5days under normal patient conditions. He is discharged after this period. Thepatient, who goes home, comes to the hospital for control after a few days ofrest and continues his normal life from where he left off. In bothmethods, there is no need to stop the heart and open surgery. Theprocedure can be performed under local anesthesia without putting the patientto sleep. The patients are taken to coronary intensive care unit afterTAVI procedure. Meanwhile, a blood thinner is given to the patient and thepatient is followed up in the hospital for 4-5 days under normal patientconditions. He is discharged after this period. The patient, who goeshome, comes to the hospital for control after a few days of rest and continueshis normal life from where he left off.
The TAVI method is primarily recommended for patients who aretoo high-risk to undergo open surgery for valve insertion. Apart fromthis, this method can also be applied to patients with any disability for opensurgery. In this regard, especially the very elderly, patients with lung,liver or kidney dysfunction, or patients who have had other open heart surgerybefore are considered to be at high risk for open surgery. It is knownthat the TAVI method is effective in prolonging the life span and improving theclinical condition of the patients in these patients for whom open surgery isnot suitable.
In the past, intracardiac holes were mostly closed withsurgery, but nowadays, non-surgical closure methods are preferred. Inpatients with a congenital hole in the heart, the heart cannot continue itsnormal functioning, and dirty blood and clean blood mix with each other. Inour clinic, the holes in the majority of these patients are closed with adevice, after entering the artery in the groin without surgery and passingthrough the heart hole with the help of a catheter. Our patients are dischargedwithin 48 hours after the procedure.
Non- Surgical Vascular Repair The endovascular method is primarilysuitable for high-risk patients for open surgery. However, this method cannotbe applied to every patient. Because in order to treat aneurysm withendovascular method, the patient’s vascular structure must be suitable. Itis also frequently used in ruptured aneurysms where emergency surgery isrequired in terms of its fast and practical applicability. The procedureis performed with local anesthesia. However, it should be done inenvironments where catheter techniques can be applied and operating roomconditions are available. For this reason, it is a great advantage toprovide an environment called hybrid operating room where both operating roomconditions are provided and catheter treatments can be performed and theseadvanced imaging methods can be applied.
EVAR: In the endovascular treatment method, the aortic regionwhere there is an aneurysm (bubble) in the vessels formed in the abdomen isrepaired with a stent that is advanced with a catheter from the groin.
TEVAR: In the endovascular treatment method, the aorticregion where the aneurysm (bubble) formed in the vessels in the chest area isrepaired with a stent that is advanced with a catheter from the groin.
A new treatment method in resistant hypertension: RenalDenervation There are nerves called ‘sympathetic’ around the kidney vessels that causeblood pressure to rise. This sympathetic system is burned through the veinwith a special material, with a method similar to angio, without anesthetizing. Thismethod, which is based on the burning of the sympathetic nerves that causehypertension, is called “renal sympathetic denervation”. Withthis method, persistent blood pressure, which does not fall or rises againafter a while, which seriously affects the patient’s quality of life, can beeffectively treated. The 80-90% success achieved by the renal denervationmethod used in the treatment of stubborn blood pressure ensures that the numberof blood pressure medications used by patients is reduced and blood pressure iscontrolled.
Myocardial Perfusion Scintigraphy (Thalium Test):This test examines the blood supply (or nutrition) of the heart muscle duringrest and during stress. It is investigated whether there is any stenosisin the vessels feeding the heart, and if there is stenosis, whether theexisting stenosis causes a disorder in the nutrition of the heart. It is amore sensitive method than the effort test. First, the patient is givenintravenous radioactive and resting images are taken with a device called agamma camera, then a stress test is performed by walking on the tape or withmedication, and the radioactive substance is injected again. Again, theimage is taken on the gamma camera. The radioactive material goes up tothe heart and reaches the heart muscle. In places with vascular occlusion,this substance is less retained. Gamma camera is the name of the devicethat allows us to obtain images. It rotates around the heart at regularintervals and transmits the radioactive signals from the heart to a computer.
In which cases myocardial perfusion scintigraphy isrequested; In the determination of the relationship between chest pain andheart disease, in the diagnosis of cardiovascular diseases, in thedetermination of vitality after myocardial infarction of the heart muscle, inthe determination of the benefit and necessity of the application before andafter coronary balloon angioplasty As a disease screening test in patients withrisk factors for cardiovascular disease. To determine the efficacy of treatmentafter coronary bypass surgery or drug therapy To determine whether patientshave had an infarction, to determine the extent and severity of the infarction
Coronary CT Angiography Computed tomography (CT) Coronary angiography can be performed with themulti-detector “Multi Detector-multislice-multi-slice CT” device withoutany prior preparation, without a catheter, and in only one breath hold time. CTCoronary Angiography is a new groundbreaking method in the field of imaging, asit can be performed more easily and faster than classical angiography and canbe performed bloodless and painless. It eliminates the need forhospitalization. The patient continues his daily life after the procedure. Thanksto this system, coronary angiography of people with risk factors can be easilyperformed. It has been observed that especially patients who haveundergone classical coronary angiography prefer this method, and many patientsare treated and treated early thanks to CT angiography.
It is an imaging method that reveals the structure of theheart membrane, heart chambers, valves, heart muscle, great arteries coming outof the heart and some coronary artery diseases (for now only the main branches)very easily and without the need for any medication or procedure. Theprocessing time is around 45 minutes and does not require any preliminarypreparation.
Blood Pressure Holter
Myocardial Perfusion Scintigraphy (MPS)
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