Very frequently hospitals require an “Operation Clearance” by a specialist for internal medicine prior to any planned surgical procedure. The Clearance involves an ECG, a blood test as well as a lung check-up. The consultant will also decide whether any medication routinely taken by the patient has to be stopped prior to the operation.
Clearance should be obtained 14 days before the surgical procedure, therefore we kindly request our patients to provide dates of any planned operations when making an appointment with us to ensure timely clearance.
The ECG provides an indication of acute circulatory disorder, recent heart attacks, cardiac arrhythmia and conditions of the myocardial muscle
The echocardiograph provides a relatively precise image of the heart by means of ultrasound. Heart function and valves become immediately visible on the monitor. This way, disturbances in the function of the heart and valvular malfunctions can be diagnosed. Evaluation of lung pressure is also possibly through echocardiographic investigation. For this transthoracic echocardiography, the head of the ultrasound is placed at the posterior thorax wall while the patient is lying on the examination table. The examiner positions the head of the ultrasound against the various parts of the heart to obtain an image as precise as possible of the heart structures to be depicted on the screen.
Stress ECG is used as routine examination for early recognition of circulatory disorders caused by stenosis of the coronary vessels. Under physical stress oxygen deficiency of the heart becomes visible on the ECG. Stress ECG shows:
Many forms of arrhythmia cannot be seen on a regular ECG, as they occur infrequently and usually at home, partly even at night. To monitor for such arrhythmia, the patient is given a monitoring device to take home. These 24-hour-ECGs monitor the heart rate for a period of 20 – 24 hours. This recording can be evaluated later in the doctor’s office, to give information on the type of arrhythmia, and thus enables the physician to treat it accordingly.
Blood pressure underlies heavy fluctuation in most humans and equally much depends on the psychological state. Some patients exhibit elevated blood pressure while at the doctor’s surgery (white coat syndrome). Home blood pressure measurement gives precise information on the blood pressure situation of a patient, as blood pressure is read several times each hour over the course of 20 – 24 hours. The cuff is worn for this period at home, blood pressure reading is automatic. Evaluation by the physician will indicate if treatment is needed.
A thyroid ultrasound is performed to explore the thyroid gland and its surrounding areas. The exam is free of pain and radiation. It involves measuring the size of the thyroid gland and any nodules if present. Furthermore, an ultrasound of the thyroid allows the doctor to analyze the structure of the thyroid for potential autoimmune diseases (such as chronic thyroiditis, Morbus Basedow, Morbus Hashimoto).
An abdominal ultrasound is a pain-free procedure to assess liver, gall bladder, biliary tract, spleen, abdominal aorta and kidneys. It is applied as a preventive measure for an early detection of cancerous changes, as well as in case of cirrhosis of the liver, diseases of the biliary tract, renal diseases, or kidney and gall stones.
It is important for the patient to have fasted for at least 4 hours prior to the examination. # Otherwise, gasses may impair visibility of the abdominal organs.
such as blood count, electrolyte, metabolic parameters, parameters for heart-/circulatory system-/vascular diseases (e.g. Lp-a), cholesterol/triglycides, blood sugar level, liver function test, kidney function test, thyroid values, and hormone analysis, tumor markers if needed.
The blood examination is performed at our practice (best time in the morning for a fasting blood collection, though fasting may not be necessary for some tests). The parameters are then evaluated either at our practice or at a partner laboratory.
Conditions of the lung and the bronchi usually lead to breathing problems. By measuring the tidal volume with special devices, the physician gains an insight on the type of lung condition the patient is suffering from.
This exam is used to diagnose problems with the blood flow of the leg vessels (peripheral arterial disease, intermittent claudication) and arm vessels. It can also be applied to monitor progression of known vascular diseases. The exam is completely pain- and risk free. Similar to blood pressure readings, pressure sleeves are attached to legs and arms to record pulse rates. The readings are evaluated to check for any circulatory disturbances. Since this exam does not allow for locating the exact point of the vascular change, an ultrasound exam may be needed consequently in case of suspected circulatory problems. This will then assess exact location and length of the vascular constriction.
The venous photoplethysmography is an exam used to detect venous diseases of the legs in patients presenting swollen legs (chronic venous insufficiency – venous weakness). Small electrodes are placed on the lower leg to measure blood flow while resting and after stress. The exam is completely pain- as well as risk free. Since this exam does not allow for locating the exact point of the vascular weakness, a subsequent ultrasound exam may be used to assess exact location and length.
This painfree ultrasound test depicts blood flow in the carotid arteries (arterial carotis and arteria vertebralis) following their course from the main artery (aorta) to the brain. This exam is used in case of
The carotid artery serves as the ‚indicator vessel for early detection of diseases related to the vessel system of the human body. Measuring thickness of the vessel wall (Intima-media-thickness) of the carotid artery provides information on the patient’s cardiovascular risk.
This duplex ultrasound is a painfree exam to assess the arteries of the legs and pelvis. It is performed
An abdominal aortic aneurysm is a life-threatening condition as rupture of the vessel may occur. The diameter of the abdominal artery is measured by means of duplexsonography to detect aneurysms early and start treatment as necessary.
Drivers whit certain medical conditions (like high blood pressure, diabetes or cornary artery disease) are sometimes required to undergo a medical check-up to validate their driving licences. The driving licence health check is intended to establish that you are fit to drive.
Myocardscintigraphy combined with a pharmacological (drug) stress test is a highly sensitive, non-invasive method to assess and localize circulatory disorders (ischemia) of the myocardial muscle. A low radiation substance is injected into a vein and gets distributed through the body, where it primarily collects in the myocardial muscle. The special camera of this nuclear medicine examination shows the radioactivity in the heart muscle, which is measured and depicted graphically to provide an image of the current circulatory situation. Frequent indications for myocardscintigraphy are:
Suspected coronary condition with a high clinical probability
The cardiac computer tomography (CT) images the coronary arteries and enables a measurement of the coronary calcium deposit. This is also referred to as minimal invasive virtual intracardiac catheter. The cardiac CT provides a three dimensional image of the heart and shows any alterations of the vessel wall in its early stages. The physician can so judge whether the plaque is composed of fibrous tissue, fat cells or calcium and also whether the deposit is causing stenosis of the vessel. The patient is placed in the CT tube for a few minutes; the examination itself only takes a couple of seconds. Beforehand, a contrast agent is injected into an arm vessel, which is used to depict any stenosed areas in the heart.
A transesophageal echocardiogram allows a high-resolution image of the heart valves and the atria. This way even tiny blood clots can be seen. A TEE is performed to obtain clear images of details and structures.
The TEE is performed via an endoscopic probe inserted into the oesophagus (food pipe). Due to the position of the oesophagus, the probe can be placed in close proximity of the heart. In comparison to a transthoracic echocardiogram this limits disturbances or weakening of the signal caused by the body structures (skin, ribs, muscles as well as air in the lungs). This is important when searching for clots in the heart, especially in case of arrhythmia, after a stroke or when suspecting inflammation of the valves. Modern 3D-TEE probes allow for assessing function of the valves in real time. Cardiologist and cardiac surgeons can obtain very clear and realistic images, which assists in choosing the best treatment early on. Mild sedation is induced in the patient during the procedure.
A cardiac magnetic resonance imaging scan is a non-invasive method used to check for heart problems. The MRI is optimal for viewing the heart muscle’s function (cardiomyopathy) and the heart valves. Cardiac MRI scans have a significant value in checking inflammatory problems of the heart (myocarditis) as well as in congenital heart and vessel diseases. They are useful for recognizing circulatory disturbances and damages to the heart muscle. Cardiac MRIs offer the advantage of excellent image quality without having to apply radiation.
A coronary catheterization is a way of examining the heart’s arteries, called coronary arteries. It involves taking an x-ray to see the course of the coronary arteries as well any pathological narrowings frequently caused by vascular calcification. Such kind of stenosis is often typical for angina pectoris and heart attacks.
For the procedure, a catheter is inserted into a blood vessel at the arm or the groin. The catheter is a thin tube, which will be passed up through the main arteries towards the heart via a guide wire. Various instruments can be attached to the tip of the catheter depending on the presenting complaints of the patient. This allows different investigations as well as therapeutic interventions. A contrast medium is applied to obtain clear images for detecting the cause of angina pectoris or heart attacks. The contrast medium is a type of dye which becomes visible on the x-ray images and depicts the body structures under investigation. During a coronary angiography the coronary arteries are filled with the contrast medium and simultaneous x-rays are taken of the heart to make the blood flow and the interior of the vessels visible.
Coronary angiography is especially useful if surgery is being considered for opening a constricted or clogged up coronary vessel. In this case, it is possible to inflate a balloon at the tip of the catheter at the end of the angiography to widen the vessel at the point of calcification. In order to keep the widened part free from further calcification a supporting device called stent is placed at the problematic area. Following the procedure, anti-clotting medication is administered to lower the risk of the vessel becoming blocked again.
A coronary angiography is also performed to assess the necessity of bypass surgery, which is one option of re-establishing function of the coronary arteries in case of extended stenosis. A blood vessel from another body part, most commonly the leg, is used to restore blood flow.
During the procedure it is possible to determine function of the left ventricle and heart valves, which provides information on the extent of the damage to the heart muscle and the function of the valves. That way, prognostic information becomes available and simultaneously risk for any operations can be assessed.
A coronary angiography is performed in a specialized department in a hospital setting by experienced specialists and their teams. Complications are rare. For control purposes, ECG and x-ray images are taken during the procedure. The teams have been trained to recognize any complications such has arrhythmia immediately and start treatment on the spot.
Angiography is an image producing test that depicts the blood vessels of the human body in order to diagnose diseases of the veins and arteries. It is performed to detect narrowings or blockages amongst other conditions in the blood vessels but also to check for thrombosis. A CT angiography works just like any other CT test. A contrasting agent containing iodine is administered through an arm vein. The computer creates a 3D-image consisting of all the cross-sections and slices.
Similarly, MR angiography works like any other MRI scan. An iodine-free contrasting agent is injected into an arm vein. The computer then assembles an image from all the slices.
Chest radiography depicts the internal organs of the thoracic cavity, i.e. lungs, heart and artery. Radiation dose is very low and gives important information on lung conditions, abnormal heart enlargement, abnormal dilation of the arteria etc.