Alongside the ECG, echocardiography (cardiac ultrasound) is the most important non-invasive diagnostic procedure in cardiology. The examination can be used to visualise heart structures in temporal and spatial resolution. This provides information about the size, function and wall thickness of the individual heart chambers as well as the condition of the pericardium and heart valves.

Echocardiography is used to assess: 

• Pump performance of the heart muscle or quantification of heart muscle weakness (heart failure) 
• Wall movement disorders of the heart muscle as an indication of potential circulatory disorders of the coronary vessels (coronary heart disease) 
• Follow-up checks after heart attacks or heart surgery such as balloon dilatation (PTCA), stent implantation or bypass surgery 
• Heart valve defects and follow-up after heart valve surgery 
• Increased pressure in the right heart/pulmonary circulation (e.g. pulmonary embolism, chronic respiratory disease) or in the left ventricle (hypertensive heart) 
• Exclusion of blood clots in the heart after a stroke 
• Inflammation of the heart muscle (peri-/myocarditis)

The ECG is the classic method of cardiac diagnostics. Every heartbeat or contraction of the heart muscle is preceded by an electrical excitation, which normally originates in the sinus node (in the right atrium of the heart) and spreads via a conduction system of specialised heart muscle cells. In order to record the electrical activity of the heart muscle, electrodes are placed on the chest and extremities. The examination is harmless and painless. 

The ECG provides indications of

• Circulatory disorders of the heart or a previous heart attack 
• Cardiac arrhythmia 
• Inflammation of the heart muscle (myocarditis) or pericardium (pericarditis)
• Thickening of the heart wall (hypertrophy)

Ergometry is used to test the heart during controlled physical exertion with continuous ECG recording and simultaneous blood pressure measurement. The intensity of the exercise is computerised and increased continuously or gradually. The exercise phase usually lasts 8-12 minutes. The test is terminated when the individually calculated target work capacity is reached or prematurely in the event of physical exhaustion, chest pain, shortness of breath, dizziness, serious ECG changes or blood pressure abnormalities.

The exercise ECG provides indications of

• Circulatory disorders of the heart 
• Exercise-induced cardiac arrhythmia
• Blood pressure misbehaviour under stress
• Individual resilience 

Ergometry as a performance test:

Performance diagnostics are not only suitable for ambitious competitive athletes. A precise performance analysis is also particularly useful for patients with manifest pre-existing conditions (e.g. diabetes mellitus, arterial hypertension, coronary heart disease), for whom a supervised exercise programme is an important therapeutic measure. 

Ergometry can be used to evaluate the individual physical performance level and serves as the basis for recommendations for the sensible design of a goal-oriented training programme.

The examination is primarily used to diagnose cardiac arrhythmias.

As arrhythmias often only occur for a few minutes during the day or in resting phases/at night, the long-term ECG is used as an examination method. As with a normal ECG, three or more electrodes are attached to the chest wall. Using a small portable recording device, the ECG can be recorded continuously over a period of 24 hours to 7 days while the patient goes about their usual activities and notes any symptoms. 

Blood pressure measurement is used to detect high blood pressure (arterial hypertension). 

Blood pressure is not always the same. It is subject to natural fluctuations throughout the day, and other influencing factors include physical and emotional stress.

The 24-hour blood pressure measurement is considered the gold standard for assessing the patient's individual blood pressure situation in everyday life. An automatic blood pressure monitor, which is placed on the upper arm, records the blood pressure over 24 hours at pre-programmed intervals; additional measurements can be triggered by the patient themselves. By storing the data in a recorder, corresponding daily activities or subjectively perceived disorders can be assigned, which the patient documents in a log.

The 24-hour blood pressure measurement provides the following information: 

• Due to nervousness, many patients' blood pressure is measured incorrectly high in the doctor's surgery. The examination makes it possible to differentiate between white coat hypertension and hypertension requiring treatment. 
• Detection of nocturnal and stress-induced blood pressure regulation disorders that otherwise escape diagnosis. 
• Checking the success of therapy with blood pressure medication.