Services

Operation Clearance

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.

Resting ECG

The ECG provides an indication of acute circulatory disorder, recent heart attacks, cardiac arrhythmia and conditions of the myocardial muscle

Colour duplex heart sonography (Echocardiography)

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.

Ergometry (Stress ECG)

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:

• Maximum heart rate (to asses exercise frequency)
• Increase of heart rate and blood pressure (is the pressure too high?)
• Stress arrhythmia
• Circulatory disorders (for example in case of chest pain or after stents or myocardial infarction)

24 Hour –ECG

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.

24 Hour-Blood Pressure Monitoring

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.

Gastroscopy

A gastroscopy is an examination to assess the upper digestive tract. lt allows the physician to assess the inside of esophagus, stomach and duodenum. lf necessary, tissue samples (biopsies) can also be taken during the examination.

A special endoscope, called gastroscope, is used for the examination. The device features flexible tubes and its images are transmitted to a monitor via video optics.

A gastroscopy is recommended to clarify persistent nausea, upper abdominal discomfort, heartburn and unclear diarrhea. Diseases such as gastroesophageal reflux, gastritis, gastric or duodenal ulcers and stomach cancer, amongst others, can be diagnosed via gastroscopy.

For the examination, the patient must be fasting, i.e. not have eaten or drunk for at least 6 hours.

lmmediately before starting the examination, the throat is anesthetized to reduce gagging. A mouthpiece between the teeth prevents the patient from biting the endoscope when it is finally advanced over the tongue and throat, looking into the esophagus.

At the request of the patient, the examination can be carried out under sedation which is free of charge in our group-practice.

Colonoscopy

A colonoscopy is an examination of the lower digestive tract. Du ring the examination, a flexible endoscope, called colonoscope, is advailced slowly guided via images transmitted to a monitor through the anus and colon up until the last few inches of the small intestine. lf necessary, tissue samples (biopsies) can be taken during the examination.

A colonoscopy is recommended for the clarification of unclear middle and lower abdominal pain, changes in bowel movements such as constipation and diarrhea, as well as rectal bleeding or blood in the stool (“positive hemoccult”) or tarry stool.

lt is mainly used to diagnose inflammation (Crohn’s disease or ulcerative colitis), diverticula (protrusions), stenosis (narrowing) or colorectal cancer.

Colonoscopies are also important as part of screening procedures to prevent colon cancer. During the screening colonoscopy the intestine is examined for polyps, which frequently are a precursor of colon cancer. lf a polyp is found, it will be removed immediately during the examination.

The screening colonoscopy is recommended for all patients from the age of 50 at the latest, and should be performed earlier in familial forms of colon cancer.

Before the examination, the intestine must be emptied, which is ensured by taking a streng laxative the day before.

In our group-practice, the colonoscopy is performed using medical gas C02 (carbon dioxide) instead of normal room air, which is to the advantage of the patient, as. C02 is exhaled quickly and passes through the lungs completely unnoticed. This almest completely prevents flatulence and abdominal pain, which might occur when using room air for a colonoscopy. C02 colonoscopy is clearly superior to conventional room air colonoscopy in terms of patient satisfaction.

At the request of the patient, the examination can be carried out under sedation which is administered free of charge in our group-practice.

Abdominal ultrasound

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.

Thyroid ultrasound

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).

Laboratory diagnostics and Urine analysis

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.

Pulmonary Function Test

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.

Ankle-Brachial-Index (ABI) and oscillography

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.

Venous photoplethysmography

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.

Vascular ultrasound of the carotid artery (carotid and vertebral arteries – duplex sonography)

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

• suspected circulatory disorders or deposits (risk of stroke)
• narrowing or blockages in the arteries
• monitoring progression of known narrowings (deposits)
• monitoring progression after any surgery to the vessels or after stent placement
• measuring thickness of the vessel wall („cardiovascular risk“)

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.

Duplexsonography of the abdominal artery

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.

Driving Licence medical check-up

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.

Mother-Child-Booklet Screenings

The Austrian Mother-Child-Booklet contains medical screenings during pregnancy and up until the child’s fifth year of life. These compulsory examinations are a precaution to ensure mother and infants stay healthy.

In order to be eligible for childcare allowance, all 10 mandatory examinations have to be done.

The Mother-Child-Booklet also lists an internal assessment of the expectant mother during the 17th to 20th week of pregnancy. Amongst others, heart, lung and blood pressure of the mother are checked. If needed, a heart ultrasound can be done at our facility. Should it be necessary, we can see a patient again for reevaluation between the 30^th and 32^nd week of pregnancy or even after giving birth.

Preventive medical examination

„Prevention is better than cure“– As part of a preventive medical examination, the health check reveals important information regarding your general health. It allows for chronic disorders to be detected early. Consequently, risk factors can be minimized as the appropriate measures are taken and chance of recovery is higher. We mainly focus on cardiovascular diseases and cancer, as these are the nation’s leading causes of death.

Why do I need a preventive medical examination?

A preventive medical examination gives you your health’s status quo. The check-up is beneficial in recognizing certain disorders and deficiencies to be recognized early. It also helps to stop minor ailments developing into serious issues. Taking regular preventative examination means you don’t need to worry about your health.

What happens during the examination?

A blood test and urine test will be done during your first appointment, therefore please come fasting. It is important to only consume water or unsweetened tea before the appointment to obtain correct blood values. Amongst others, we will look at blood count, blood fat, blood sugar, liver and renal values, pancreatic or thyroid values. For patients over the age of 50, we will ask for stool sample and/or colonoscopy.

Depending on your results, pre-existing conditions and risk factors, further examinations can be scheduled at our office (e.g. cardiac ultrasound, ultrasound of vessels, thyroid gland as well as gastroscopy and colonoscopy etc.)

Food Intolerances

There are many reasons for digestive disorders such as stomachache, flatulence and/or diarrhoea. Frequently these disorders are due to irritable bowel syndrome or functional dyspepsia, which are conditions without organic problems detectable by current routine investigation means. These diseases are not life threatening.

Occasionally these conditions may improve by simple changes to your diet. Hydrogen (H2) Breath Tests are a means to detect such food intolerances.

H2-Breath Tests

The H2 Breath Test is performed in order to detect either sugar intolerances (for example lactose intolerance, fructose intolerance, sorbitol intolerance) or bacterial miscolonisation of the small intestine.
Abnormal Bacterial Colonisation of the small intestine, which may result in food intolerances, is also diagnosed using a glucose H2 Breath. Should you be tested positive for abnormal bacterial colonisation, antibiotic treatment will be administered.

The procedure

For an H2 Breath Test you will asked to drink a sugary solution containing for example lactose (milk sugar). At regular intervals, you will be requested to blow into a measuring device similar to the breathalysers used by police forces for alcohol tests. Every time you blow into the device, it measures the hydrogen content of your breath.

This works because sugar is metabolised into hydrogen in the early parts of the intestinal tract in case of bacterial overgrowth and in deeper parts in case of malabsorption.

The H2 values are charted together with any discomfort experienced by the patient. This way, it can easily be assessed whether the sugary substance tested for is tolerated or not.

The cost for the Breath Test to detect food intolerances is not covered under the Austrian Insurance Scheme and has to be paid for privately.

Download: Preparation procedures for H2-Breath Test

Nutritional Consultation

Individual nutritional counselling allows you to discuss your personal nutritional goals. Together with your therapist, you will work out a personalized therapeutic plan to achieve your goals.

Please bring along the following documents for your consultation:

• Any former medical reports
• Your current blood results
• Findings of any tests for intolerances
• In case of Diabetes mellitus or hypertension, your blood sugar chart and/or blood pressure chart
• Your completed 5 day food protocol, which you will receive when requesting the appointment, alternatively it can be downloaded here

Main areas:

Healthy eating habits and prevention

Age-appropriate diets

Weight management

• Obesity and excess weight
• Underweight/desire to gain weight
• malnutrition

Diabetes mellitus

High blood pressure

Lipid Metabolism Disorders (Cholesterol, Triglycerides,…)

Liver diseases (Steatosis hepatis,…)

Food intolerances (Lactose, fructose,…)

Gastrointestinal diseases (Gastritis, constipation, diarrhoea, heartburn,…)

Elevated levels of uric acid and Gout

Osteoporosis

…further issues on request.

Ms. Carina Müller BSc, our dietician, will be advising you on nutritional issues. Since completing her education in 2015, Ms. Müller has obtained several additional certificates:

Additional certifications:
Diabetes counselling
Nutritional expert for bariatric surgery
IGM-health coach
Specialist consultant for intestinal health
Sports and nutrition coach
Certified health and fitness trainer in training.

Costs for nutritional coaching are not covered under the Austrian Insurance scheme and are thus to be paid for privately.

Please take the completed 5-day food protocol with you to the nutritional consultation appointment (Download: food protocol)!

If needed further external diagnostic examinations can be arranged at specialized centres for:

Myocardscintigraphy

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

• • • Questions related to the relevance of stenosis in patients with known coronary conditions
    • Differentiating between scar tissue and reversible ischemia of the myocardial muscle after revascularization interventions (PTCA, bypass surgery).
    • Rarely to assess left ventricular pumping function of the heart.

Measurement of Coronary Calcium Deposit/Coronary Computer Tomography

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.

Transesophageal echocardiogram – TEE

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.

Cardiac MRI

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.

Cardiac catheter (Coronary angiography)

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 of the blood vessels (CT-angiography or MR-angiography)

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 X-Ray

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.