Cardiology

Cardiology Services at Da Medika Polyclinic

A unique approach to blood pressure disorders that includes a comprehensive check-up of the heart and blood vessels, as well as an examination of other organs and systems if necessary. The Hypertension Center is led by Prof. Dr. Vesna Stojanov, a leading expert in the field of hypertension treatment both domestically and internationally.

Why should you be regularly examined by a cardiologist?

Our folks say, ‘Prevention is better than cure!’  The good news you should be aware of is that a heart attack and/or a brain infarction can be prevented in 80% of cases. And how can you do that?  By being examined by a cardiologist regularly!  Thus high arterial blood pressure and other risk factors which lead to a heart attack and/or brain infarction can be discovered in time and then the treatment, which is always more efficient when it is received in the early stages of a disease, can be started immediately and thus the progress of the disease and complications can be prevented.

Do you know that almost a half of the population which have elevated or high arterial blood pressure are not aware of that  and that they do not take any medications because they do not feel any symptoms? It is for that reason that hypertension (high blood pressure) is called a silent killer.  An examination by a cardiologist will help that it is discovered and its consequences as well as the consequences of other heart conditions the symptoms of which are not displayed in the early stages are prevented in time.  

Symptoms which may indicate heart problems

The symptoms for which it is necessary that you should address a cardiologist are as follows: 

  • Difficulty breathing, pain and tightness in the chest
  • Shortness of breath (especially during physical exertion)
  • Head pressure, headache and ear buzzing
  • Heart palpitations
  • Dizziness, syncope or a complete loss of consciousness
  • Weakness
  • Dry cough and leg swelling

Who is recommended regular cardiology examinations?

The persons who already suffer from cardiovascular diseases have to be given regular check-ups considering the fact that their condition changes depending on the time of the year, outdoor temperature, air humidity and atmospheric pressure as well as on the diet, physical activity and some other factors. For that reason, it is necessary that the cardiologist occasionally adjusts the drug dosage or changes the treatment and its administration. Changing the treatment on you own can be life-threatening.

All persons over forty are recommended regular annual cardiology examinations even if they do not feel any symptoms.

In case your parent has suffered a heart attack or a stroke, suffered from a coronary heart disease, heart failure and arrhythmia or had any cardiac interventions (stent placement, pacemaker insertion, bypass grafting, heart valve replacement), you are at higher risk from cardiovascular diseases and thus you are recommended regular cardiology examinations as early as of the age of 25 on.

If you are a smoker and are overweight, consume alcohol regularly, are not physically active, and if you have diabetes in addition to that,  you are at higher risk from cardiovascular diseases. 

Regular cardiology examinations are necessary for women in menopause. Why? A great majority of women develops high blood pressure after entering menopause due to the drop of oestrogen  levels, and hot flashes that appear then lead to sudden rises and drops of blood pressure and thus the function of the heart is burdened.

Regular cardiology examinations are also necessary for professional athletes and recreationists  because their cardiovascular system is exposed to greater strain and hence to risks from cardiovascular complications.

Types of cardiology examinations performed at Da Medika Polyclinic

  • An examination by a cardiologist involves an interview with the patient on the present complaints, taking data on other previous and present diseases and diseases in the family, clinical examination of the patient, interpreting the results of laboratory and other tests, establishing the diagnosis and prescribing treatment.
  • ECG is a painless cardiological diagnostic method by which the electrical activity, i.e. the heart rate and heart rhythm are recorded on a paper roll, while the patient is reclining and resting with the electrodes vacuum-attached to the skin of the chest. The recording lasts several minutes and it can reveal: slower or faster than normal heart rate (bradycardia and tachycardia), irregular heartbeat (arrhythmia), a coronary disease,  scar tissue as a result of a suffered heart attack or  evidence that a heart attack is taking place at that moment, the place and the level of heart damage, dilation of heart chambers,  thickening of the heart muscle etc.
  • Cardiac and abdominal ultrasound are diagnostic methods which give important data on the condition of the heart and the cardiovascular system.

Cardiac ultrasound (echocardiography) is a painless diagnostic method by which the structures of the heart are recorded and seen on the monitor of the device with the help of ultrasonic waves. It lasts around 30 minutes. Gels is applied to the skin in the area around the heart and the doctor then slides the ultrasonic probe across that area. Cardiac ultrasound enables a cardiologist to see the structure and the function of heart muscle, heart  valves, the dimensions of heart atria and ventricles, the velocity of blood flow through the heart and the great vessels,  but also to discover blood clots (thrombi).

Cardiac ultrasound measures ejection fraction (EF) and the heart volume and reveals:  the dilation of the heart chamber, thickening of the heart muscle, cardiomyopathy, atherosclerosis, irregular functioning of the heart valves, arrhythmia, infective endocarditis,  pericarditis, pericardial effusion, the consequences of suffered pericarditis or viral myocarditis, congenital heart defect, cardiac insufficiency, cardiac tumour. 

Abdominal ultrasound may reveal abdominal aortic aneurysm, i.e. the widening of abdominal aorta  the rupturing of which may cause death.

  • Doppler of carotid and of renal arteries are ultrasonic diagnostic methods which are used to discover the narrowing, blockage or bulging of the arteries in the neck and the main renal arteries.

Carotid arteries  are the  arteries (blood vessels) in the neck which deliver blood and oxygen from the heart to the brain. Doppler of carotid arteries is recommended when the following symptoms are present: weakness and numbness in the arms and legs, facial numbness, blurred vision, difficulty speaking, loss of consciousness, dizziness and difficulty concentrating. If you parent has suffered a stroke, if you have tendency to thrombosis, if you have been a smoker for years or you suffer from diabetes, you should undergo this examination preventively.

The colour image is shown on the screen of the ultrasound machine while the doctor slides the probe across the carotid arteries by the change of frequency of ultrasonic waves, i.e. by using Doppler effect.  Gel is applied to the skin of neck in the area of carotid arteries beforehand so that the ultrasonic waves would travel through the tissue. The patient is lying still all the time during the examination. Doppler of carotid arteries may reveal the narrowing, clogging or bulging of blood vessels in the neck (aneurysm), blood clots (thrombi), which may cause a stroke. Doppler of carotid arteries also reveals the irregular shape of  internal carotid arteries (kinking and coiling), which may lead to transient ischemic attack (TIA) when the neck is bent. 

  • Doppler of renal arteries is a painless diagnostic method which produces a colour image on the screen of the ultrasound machine by the change of the frequency of the ultrasound, i.d. by the Doopler effect, and in that way it enables the monitoring of the flow of blood through arteries which supply the kidney with blood. It enables the detection of narrowing (stenosis), clogging (as a result of  atherosclerosis) or bulging (aneurysm) in the main renal arteries, which may cause hypertension (elevated blood pressure) and the problems with the functioning of the kidneys.
  • Ergometry is a diagnostic method the other name of which is a cardiac stress test. It evaluates heart function and blood circulation in the conditions of physical straining until 85% of maximum heart rate for the person of the corresponding age is reached. It is achieved by having a patient ride a stationary bicycle or walk on a treadmill, while the speed, the incline and the resistance are increased every three minutes. The test takes between 15 and 30 minutes. During the test, the following is measured: blood pressure, pulse, oxygen saturation level, ECG. Ergometry is used to detect: weakened heart muscle,  coronary heart disease, arrhythmia, effects of prescribed treatment. Based on the results, the cardiologist determines whether any additional diagnostics are required. 
  • 24-hour, 48-hour, 72-hour or 7-day ECG holter monitor test is a diagnostic procedure by which the heart rate is monitored constantly over the period of 24 hours, 48 hours, 72 hours or 7 days, and thus the irregular rhythm of the heartbeat (arrhythmia) may be detected, which cannot be done by a regular ECG due to the short recording period. An ECG holter monitor test may provide better evaluation of the cardiovascular risk, but it can also discover the cause of occasional loss of consciousness, symptomatic and asymptomatic coronary diseases. It is necessary that the patient should keep a diary of daily activities, i.e. describe when and how he or she performs a physical activity, rest and record the problems that appear during that time. An ECG holter monitor test also help in monitoring the effectiveness of the prescribed treatment.
  • 24-hour ambulatory blood pressure monitoring is a diagnostic method which is performed with the help of a mobile device which measures blood pressure automatically every 15-20 minutes during the day and every 30-60 minutes during the night over the period of 24 hours. It is recommended to persons with the white coat syndrome, diabetics and persons who have suffered a stroke, in cases of hypertension which does not respond to prescribed treatment, sudden morning rises of blood pressure, hypertension during pregnancy, suspected syncope (dysfunction of autonomic nervous system) etc.
  • Thoracic bioelectrical impendance (cardiac output, peripheral resistance and cardiac index) is a quick non-evasive method for the estimation of the hemodynamic status of a patient by the emission of the safe level of an electrical current through the body of the patient. It helps indirectly in the estimation of the strength of the cardiac muscle, the age of the majority of blood vessels, the level of the body fluid and the resistance of peripheral blood vessels. Cardiac output is the amount of blood the heart pumps out through one chamber in a minute. Peripheral resistance is the resistance which the arteries offer to the blood flow. Cardiac index is the relation between the amount of blood pumped out from the left ventricle of the heart in one minute and the patient’s body surface area. Based on these parameters, the adequate treatment for elevated blood pressure is prescribed more easily. 
  • Ankle-brachial index is a simple test the result of which is a number (index) which is obtained when the measured value of the arterial blood pressure in the ankle is divided by the arterial blood pressure in the upper arm. The patient is in the reclining position while the blood pressure is taken. If the result is lower than 0.9, that means that the patient has a disease of the peripheral arteries of the legs. This procedure is used to prevent the progress and the complications of the disease and to assess the risk from the onset of a coronary disease.
  • Measurement of blood vessel stiffness using Arterial Stiffness, SphygmoCor and Mobil-O-graph methods are diagnostic methods which show how much the elasticity of the arteries, i.e. their ability to expand and contract is reduced depending on the change of the blood pressure. Arterial stiffness is measured on the basis of the pulse pressure. SphygmoCor measures the balance between blood supply and demand in the inner heart muscle, which gives a better insight into cardiac function under stress. It is used for measuring central aortic pressure. Mobil-O-Graph is a 24-hour ambulatory monitoring of the arterial blood pressure.
  • Laboratory analyses of blood and urine provide a cardiologist with important data on the condition of the patient’s organism on the whole and they help in prescribing the treatment. Depending on the disease a patient suffers and/or is suspected to suffer from, a cardiologist determines which analyses are to be conducted for each individual patient.  
  • Diet and lifestyle counselling. Depending on the diagnosis established, other associated chronic diseases, patient’s discomforts and risks from complications, a cardiologist provides advice on a diet and lifestyle. The Mediterranean diet and everyday physical activity (walking for at least 30 minutes and even more strenuous physical activity if the disease and the condition of the organism allow that) is most often recommended.

Cardiology examination

A clinical examination by a cardiologist does not require any particular preparation.

A cardiology examination commences by personal and family medical history being taken and the previous medical records, the results of cardiology diagnostic methods and laboratory tests (if a patient possess them) being reviewed. Following that, a cardiologist will inquire about the patient’s discomforts for which the appointment has been made, will take the patient’s blood pressure and listen to his or her heart and lungs with a stethoscope. An examination by a cardiologist also includes the examination of the head (hairiness, yellowing of sclera), the neck (the pulsation of the blood vessels in the neck – carotid arteries), the abdomen (mild pressing and examination of the abdominal aorta bruits), the legs (checks for the presence of swellings of ankles and feet). Depending on the symptoms and a suspected cardiovascular disease, a cardiologist will conduct additional cardiology examinations and order the necessary laboratory tests.

Diseases which may be discovered by some of the cardiovascular examinations:

  • Hypertension and hypotension (high or low arterial blood pressure)
  • Tachycardia and bradycardia (increased or decreased heart rate)
  • Arrhythmia (irregular heartbeat)
  • Narrowing (stenosis), clogging or bulging (aneurysm) of blood vessels
  • Atherosclerosis (build-up of cholesterol and calcium in the inner lining of blood vessels which leads to narrowing or clogging)
  • Ischemic heart diseases (coronary heart diseases) – the consequence of atherosclerosis of the great arteries, which deliver blood to the heart, which may manifest as the variants of angina pectoris,  heart attack, arrhythmia, heart failure, sudden cardiac death.
  • Angina pectoris (tightness and pressure in the chest accompanied by difficulty breathing for reduced oxygen flow to the heart muscle)
  • Heart failure (cardiac insufficiency – weakening of the heart muscle and reduced blood flow)
  • Congenital heart defects (septal defects, the dilation and thickening of the left ventricle, constriction of the ascending aorta or the pulmonary aorta, the aortopulmonary  window,  cardiac malposition)
  • Inflammatory heart diseases – diseases caused by bacterial, fungal or viral infections (myocarditis – viral inflammation of the heart muscle, pericarditis – bacterial, fungal or viral inflammation of the pericardium, infective endocarditis – bacterial or fungal inflammation of the heart valves).

Cardiologist performing examinations at Da Medika Polyclinic are:

Prof. Vesna Stojanov, MD, PhD, a specialist in internal medicine – cardiologist, and Dr. Nenad Radivojević, a specialist in internal medicine – cardiologist.

Experts Conducting Cardiology Examinations at Da Medika Polyclinic

Expert for blood pressure disorders
Specialist in Internal Medicine

Impressions of our patients

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