Cardiovascular diseases


Cardiology deals with the treatment of cardiovascular diseases. The Internal Medicine Center, Srce offers modern tests and check-ups that help diagnose and treat cardiovascular diseases. Cardiovascular investigations and services:

  • Cardiovascular subspecialist check-up
  • Color dopplerechocardiography
  • Stress test
  • Blood vessels Doppler (carotides)
  • 24-hour ECG monitoring -Holter
  • 24-hour ABP - blood pressure Holter
  • Consultations, advising, therapy, preventive check-ups, second opinion

Some facts about the cardiovascular diseases

Cardiovascular diseases are the leading cause of death in the world: more people die annualy of cardiovascular diseases (CVD) than of any other illness. It is estimated that 17.5 million people died of CVD in 2005, which is 30% of the death rate in the world. 7.6 million lost their lives as a result of a coronary artery disease and 5.7 million as a result of stroke. Over 80% of the cases are in the underdeveloped and developing countries, man and women equally rated. Until 2015, nearly 20 million people lost their lives as a result of cardiovascular diseases, mainly heart diseases and stroke. This is the World Health Organization evidence, which leads to the conclusion that CVD will become the leading cause of death in the world.

The reasons for cardiovascular diseases are well known. The most relevant reasons for CVD are the unhealthy diet, inactivity and smoking. These are the so called “modifying factors” i.e. factors that can be modified. The effects of the unhealthy diet and physical inactivity can result in hypertension,increased blood sugar level, increased fat levels and overweight.

The main “modifying” factors are responsible for 80% of the coronary artery diseases and cerebrovascular diseases. Furthermore, equally important components that determine the onset of cardiovascular diseases, are the social, economic and cultural changes in the world: the globalization, urbanization and aging of the population, poverty and stress.

Having in mind the statistics about the cardiovascular diseases being the leading cause of death in the world, and the fact that the reasons for the diseases are in close connection to the lifestyle, the least you can do for yourself is to have a cardiovascular check-up in order to prevent or spot the disease as early as possible, when there are no symptoms for the illness.

The cardiovascular check-up comprises of trials for the assessment of your heart and blood vessels, as well as detection of possible risk factors for cardiovascular diseases. Detailed laboratory test analyses, ECG – electrocardiography, measuring the blood pressure, color Doppler-ultrasound, stress test (ergometry) and other trials give a possibility for a thorough assessment of the situation and the capacity of the heart and blood system of each individual.

Electrocardiography or ECG is the initial, routine diagnostic tool for assessment of heart electrical activity and allows the doctor an insight in the heart rhythm, the size and the function of the heart muscle and the ventricles and atrium. It can also help detect the presence of arrhythmia (irregular heart activity), insufficient amount of blood in the heart (angina pectoris), heart damage after a heart attack, increased heart dimensions etc.

The investigation is performed by applying 12 electrodes (little stickers) on the chest, arms, and legs while the patient is  lying. The testing is performed by a nurse, technician or doctor, it lasts for 1 minute, and the patient does not feel anything.

enables examination inside the heart and the blood vessels. The doctor can spot the atherosclerotic changes, asses the degree of obstruction of the blood vessels, and possible irregularities in the size and function of the heart muscle. The test results help assess the degree of risk for various diseases of the heart blood vessels, the brain and the limbs.

The doctor, together with the patient, elaborates strategy for prevention of appearance and/or progression of cardiovascular diseases.

Each individual is assessed the possibility for a change in the lifestyle. We try to remove the risk factors that come from the patient’s unhealthy habits or lifestyle. When necessary, we recommend medicaments to prevent or treat cardiovascular diseases. If the investigations imply greater damage of the heart coronary arteries, which means a possible stroke in near future, we try to ensure immediate hospital investigations, that would lead towards an ultimate solution for the constricted coronary vessels.

Echocardiography is an ultrasound check-up of the heart. It is a standard method in the diagnostics of heart diseases. It is a visual presentation of the heart structure and function. The special piezoelectric probes of the ultrasound machine emit ultrasound waves in the body. The prones receive the waves and they are transformed into an ultrasound image of the heart that is visible on the screen. The image can be one-dimensional, two-dimensional or Doppler. The latter further images the specific structures and the blood flow in the heart and the valves. The blood stream can be heard and is visible in color on the screen.

It helps the doctor get an insight in: the structure of the heart walls and the valves, the width of the heart walls, the size of the heart space, the ability and the strength of the heart muscle. All of these help discover and follow various diseases like:

  • Valve diseases
  • Presence of a thrombus in the heart
  • Assessment of the artificial heart valves
  • Heart muscle diseases
  • Irregularities of the heart walls or the aorta
  • Presence of fluid in the heart

The ultrasound probe is used in the chest area, to which jelly has been applied to improve the wave transmission. The chest is slightly lifted up and the left hand is above the head. During the procedure the doctor directs the probe towards various regions of the heart in order to get a better image of the heart structures.

This implies monitoring the electrocardiogram during physical stress. The electrocardiogram (ECG) is a record of the electrical activity of the heartbeat, represented as a curve, and results from the flow of the electric impulses in the heart muscle.

The stress test ECG record is obtained in the same way as the basic ECG while resting. The only difference is that the former implies physical activity on the part of the patient and therefore an ergo bike (or treadmill) is used. During the procedure, the intensity is gradually increased. The stress test helps the doctor asses the physical condition of the patients and have an insight in the kind of changes that happen in the cardiovascular system while working under stress. It can help discover and monitor the following diseases:

  • artery coronary disease
  • increased blood pressure under stress
  • heart arrhythmias under stress
  • assessment of a successful treatment of blood pressure or coronary disease treatment
  • assessment of the possible stress level after heart attack or heart surgery

An ECG when resting is made before the stress test. After that, the patient approaches to ride a bike that increases the resistance (in the pedals) every two minutes, during which the blood pressure is constantly measured, whereas the ECG record is permanently monitored. After this, there is a 3-5 minute recovery phase, during which the patient is observed. The aim of the test is to achieve maximum heart frequency (which is individual and depends on each patient’s health individually) so that a precise diagnosis can be made.

Carotids are the two big arteria in the neck that supply the greatest part of the blood for the brain. Fatty deposits that obstruct the normal blood supply for the brain can occur on their walls. Tiny bits of the deposits can be drained away by the blood stream into the brain, thus causing obstruction or interruption in the blood supply of certain parts of the brain, which further results in stroke or TIA (Transient Ischemic Attack) – a series of minor strokes. Carotid Doppler Test is a non-invasive method for evaluation of the possible fatty deposits in the artery. The test is performed with a probe applied on the neck and the ultrasound waves create an image of the artery walls, which shows whether they have fatty deposits, and to which extend.

Kidney diseases may be a reason for increased blood pressure or can result from increased blood pressure. Kidney artery ultrasound helps detect the presence or absence of stenosis or narrowing of the kidney blood vessels, which might be a reason for high blood pressure.

Holter monitor is a small, portable ECG device which records the heart activity over a 24-hour period. 7 small electrodes, connected to a portable ECG (the size of a mobile phone), are attached to the body. The device is attached to a belt, and the patient can do the usual activities, except for shower, swimming, bathing or other activities that cause excessive sweating.

It is used to detect irregularities in the heart activity (arrythmias) that cannot be recorded with the regular ECG, because arrhythmias are sometimes transitory and can be recorded only during a longer period of monitoring the heart activity.

The blood pressure measured in the office is generally taken as your “real” blood pressure level, or the average level within a period of time. But, this is not always the case: many people become tense and upset when visiting the doctor, so their blood pressure increases. This is the so called “doctor induced” hypertension. The 24-hour (ambulatory blood pressure) monitoring is a method that allows measuring the blood pressure outside the doctor’s office, within a period of 24 hours, while the patient is doing his/her regular daily activities.

Holter- monitor is as big as a Walkman and is warn on the belt. It is connected to the cuff, on the arm, with a tiny rubber hose. It can be programmed to measure blood pressure in various intervals, usually at 30-minute interval during day time, and 45-60 minute interval at night. It is completely automatic, so it pumps the cuff, measures the blood pressure and memorizes it automatically. During the measuring procedure, the patient should hold the arm still, for better measurement. After the 24- hour period, the device is taken off and the data are transferred on the computer for further analyses.