Cardiology

Current Diagnostic and Treatment Algorithm for Coronary Artery Disease 

Coronary Artery Disease (CAD) is the most common type of heart disease and the leading cause of mortality and morbidity for both men and womenworldwide. This is a pathological condition in which a coronary artery is narrowed or blocked, usually as a result of atherosclerosis. Over the last decades, there has been a revolution in the treatment of coronary artery disease, and medical specialists and scientists are making new discoveries every day.  

Germany is one of the leading countries, who could establish a really good working algorithm, which combines different preventive, diagnostic and treatment options for the patients with Coronary Artery Disease. For every patient, an individual therapy concept is modelled and implemented. Such a plan prevents the heart diseases of the patients from worsening, even reversing some of the plaque build-up and consequently significantly reducing the risk for a heart attack. Due to well established system, manyoverseas patients choose to come to Germany for treatment.  

Diagnostic Approach to CoronaryArtery Disease 

Both for getting a second opinion and organizing the treatment in Germany, we need detailed information about the patient. The diagnostic evaluation for overseas patients is usually not complete when they contact us for a second opinion and subsequent treatment recommendations. The system employed by German Health Advisors, however, allows for the completion of this stage while the patient is in his homeland. It is not necessary to come to Germany for diagnostic (for more detail, visit our homepage). You will be informed if there are any obstacles in the diagnostic processes. 

For the diagnostic of CAD, please bear in mind the following:

  • Medical history, comorbidities, risk factors, physical examination, blood count and differential, liver and renal function tests (see the request form for German Health Advisors). This will usually be carried out by our local colleagues and documented in the form of a doctor’s letter.
  • Electrocardiogram (ECG) is stillone of the basic tools employed and important in the diagnostic of CoronaryArtery Disease.  
  • Echocardiographyis a non-invasive diagnostic technique which provides information regarding cardiacfunction and hemodynamics.
  • Stress testing is an important modality to evaluate patients with known or suspected coronary heart disease and provides information aboutheart's ability to deal with an increased need for blood and oxygen. 
  • Cardiac catheterization is gold standard to assess the status of coronary arteries, and this is nowadays a safe examination.  
  • Computerized tomography (CT) scan of the heart (also called a calcium-score screening heart scan) and CT coronary angiogram can also be used to evaluate patients with known or suspected coronary heart disease.

If you want a second opinion or you want to come to Germany for the treatment, please obtain your digital radiology images from the facility and send the DICOM filesusing German Health Advisors’secure data transfer system.

Treatment of CoronaryArtery Disease 

The goals of the current treatment strategies are to maximize quality of life and minimize the risk of death through the modification of risk factors (diabetes, hypertension, and hyperlipidemia), lifestyle changes and, if necessary, medical treatment and certain procedures.After a careful assessment, angioplasty and stent placement (also known as percutaneous coronary intervention) may be performed to open the narrowed or blocked arteries with stents (small tubular support devices). Some patients with coronary artery disease have widespread plaque in several arteries, or a severe narrowing in the main artery that transports blood from the aorta to the heart. In this situation, coronary artery bypass graft (CABG) surgerywould be recommended which would be a safer and more effective treatment than angioplasty and stenting.  Our telemedicine platform will enable you to find out the best treatment option for your individual case. 

Follow-Up after the Treatment 

Most patients can return to their everyday routine a few days after a successful percutaneous coronary intervention. After this procedure, patients should be followed up both by the family doctor and by the cardiologist one week after the procedure, and then every three to six months for the first year. In these regular follow-up visits, the family doctor will take a clinical history focusing particularly on current symptoms (specific cardiac symptoms, but also fatigue or diminished performance), endurance level, and functional status, including effects on family life, occupation, everyday activities, sports, and sexual activity.

Patients, who received treatments in Germany, usually do not need to return to Germany for the follow-up visits. German Health Advisors will provide you with follow-up care through its Telemedicine platform. For more detail, visit our homepage. 

References: 

  1. ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Task Force Members, et al. European heart journal34.38 (2013): 2949-3003
  2. German nationwide data on current trends and management of acute myocardial infarction: discrepancies between trials and real-life. European Heart Journal, Volume 35, Issue 15, 14 April 2014, Pages 979–988