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With the heart there is rarely “a little bit” of a problem: people who start thinking about treatment abroad are usually already anxious — breathlessness, chest pain, an irregular pulse, or a report that does not say whether to operate or to watch and wait. Heart treatment in Germany starts not with choosing a method but with answering whether an intervention is needed at all: first the diagnosis, then the decision.
This page covers the order of the tests, who decides between drugs, a catheter and surgery, where the major heart centres are and why a second opinion helps. Heart surgery, stenting, valves and rhythm disorders have their own pages, collected below this text.
Why cardiology in Germany runs deep
Cardiology in Germany runs deep because cardiovascular disease remains the most common cause of death in Germany, accounting for about a third of all cases. According to the World Health Organization, it is the leading cause of death worldwide as well. Hence the investment in a network of specialised heart centres, settled protocols and early diagnosis: quality rests on a system with nationwide clinical guidelines, not on a few famous names.
The system is also consolidating. On 1 August 2024 the German Heart Centre in Munich (Deutsches Herzzentrum München) and the university hospital Rechts der Isar merged into a single structure, TUM Klinikum of the Technical University of Munich, after almost thirty years of close cooperation. Day to day the two remain independent, but together they are meant to form one centre of cardiovascular medicine, where the cardiologist, the cardiac surgeon and the interventional specialist discuss a case together rather than in turn.
This way of working is known as the Heart Team. The decision to stent, to operate or to treat with drugs is taken jointly and must be justified, which reduces the chance that surgery is ordered out of habit where a gentler option would have been enough. The decision is recorded in the medical file, and under German law patients may read their file and receive a copy.
Diagnosis first: what is examined and in what order
The work-up starts with a basic set of tests, and more are added depending on the results. The ECG shows the rhythm, echocardiography (an ultrasound scan of the heart) shows the valves and the heart muscle, and 24-hour monitoring catches disturbances that hide from a short examination. Almost every echo report gives the ejection fraction — the share of blood the left ventricle pumps out per beat, a measure of pumping strength that guides both drug choice and decisions on intervention.
If coronary artery disease is suspected, the key test is coronary angiography: a contrast image of the heart’s arteries that shows directly where and how badly a vessel is narrowed. It is often combined with treatment: if a critical narrowing is found, the stent goes in straight away. While the diagnosis is still open, non-invasive methods often come first: CT coronary angiography or stress tests that examine the heart under exertion. Tests are matched to the case, and nothing is ordered for its own sake.
With suspected valve disease, cardiomyopathy (disease of the heart muscle itself) or inflammation, doctors add cardiac MRI, blood markers of heart muscle damage and, if needed, right heart catheterisation to measure pressures in the heart and the pulmonary artery. Recent results are required because heart disease changes: a report a year old is almost always repeated. That is protocol, not greed — decisions on an intervention rest on current findings.
Drugs, catheter or surgery: how the tactic is chosen
The tactic follows the diagnosis, the state of the vessels and valves, age and other illnesses; there is no single scheme “for the heart”. Some problems are kept under control for years with drugs and check-ups, and that is full treatment, not a refusal to treat. Even after a stent or a bypass, tablets remain the basis of therapy: they protect the vessels and lower the risk of another heart attack.
Catheter procedures go through a puncture in the groin or wrist, without opening the chest: arteries are widened and held open with stents, holes between heart chambers are closed, valves are repaired or replaced. The clearest example is TAVI, aortic valve replacement by catheter: the new valve travels to the heart along a blood vessel, with no large incision. In Germany a narrowed aortic valve is now replaced by catheter far more often than by open surgery, and the method is no longer reserved for high-risk patients.
Open surgery remains the right choice for disease in several coronary arteries, complex valve problems and combined procedures, such as a valve replacement with bypass grafts. Bypass versus stent is decided by the Heart Team under protocol, not by one doctor’s preference. How heart surgery in Germany is organised is explained on a separate page.
Rhythm disorders are a large field of their own. Some are treated by catheter ablation: an electrode guided through a vessel cauterises or freezes the small patch of tissue that drives the rhythm off course. Others need a pacemaker, which stops the heart beating too slowly, or a defibrillator, which ends a dangerous arrhythmia with a shock. Selection matters most here, because not every arrhythmia needs an intervention; the options are covered under arrhythmia treatment.
German heart centres and the doctors who run them
A large heart centre brings cardiology, cardiac surgery and interventional work under one roof, often with paediatric cardiology too, plus its own intensive care and operating theatres. The German Heart Centre in Munich is an example: its medical head, Prof. Markus Krane, directs cardiovascular surgery, while Prof. Peter Ewert leads the clinic for congenital heart disease and paediatric cardiology. Adult cardiology, including catheter procedures, belongs to the clinic for heart and circulatory diseases.
Strong centres exist elsewhere too. In Berlin, the German Heart Centre of the Charité has the cardiac surgeon Prof. Volkmar Falk as medical director; his deputy, the cardiologist Prof. Ulf Landmesser, heads cardiology, angiology and intensive care medicine. At the Heart and Diabetes Centre NRW in Bad Oeynhausen, medical director Prof. Jan Gummert heads thoracic and cardiovascular surgery, and Prof. Philipp Sommer directs electrophysiology and rhythmology. At Essen University Hospital, Prof. Tienush Rassaf heads cardiology and angiology.
When choosing, look not at how famous the name is but at whether the clinic regularly performs the intervention you need and has cardiac surgery on site if valves are involved. How the heart centres in Germany differ is set out in an overview. How to choose among cardiologists in Germany, and whether a doctor who speaks your language can be expected, has its own page: such a doctor cannot be promised, but a medical interpreter attends the appointment.
Rehabilitation and a second opinion
After a heart attack or heart surgery, cardiac rehabilitation usually follows in Germany; after a planned stent procedure it is prescribed when there is a specific reason. It is part of the treatment, not a holiday: supervised graded exercise, training in taking the medication, work on blood pressure, cholesterol, smoking and weight, and psychological support where needed. Details are on the page on cardiac rehabilitation.
A second opinion makes sense when the diagnosis was made at home but doubts about an operation remain. A German cardiologist reviews the images, angiography recordings and reports and says whether the indication for an intervention is confirmed, guided by clinical guidelines such as the German national guideline on chronic coronary heart disease. Honestly: sometimes this spares an unnecessary operation, sometimes it opens an option not offered at home, and sometimes it confirms the original plan.
Step by step: you send documents and images, the clinic replies with a written estimate, and you arrive for an in-person work-up that usually repeats some tests. The doctors, in complex cases the Heart Team, then decide, the intervention follows, and you leave with a follow-up plan and a medication schedule, written out before discharge, to hand to your doctor at home. The cost is set by the clinic’s written estimate; the page on heart surgery costs in Germany explains how the bill is built up.
Frequently asked questions
Do tests done at home have to be repeated in Germany?
Partly, yes. German doctors study the discharge letters, images and recordings you send, but before an intervention they repeat key tests such as echocardiography, blood tests and sometimes CT or angiography, because the heart changes and decisions rest on current findings. Earlier results still matter: they show how the disease has developed and help decide which tests really need repeating.
Can a heart problem be managed without an operation?
Often it can, but this becomes clear only after the work-up. Many heart conditions are controlled with drugs for years, and a narrowed artery or a worn valve can often be treated by catheter without opening the chest. With disease in several arteries or complex valve problems, open surgery may remain the right choice. The cardiologist and the cardiac surgeon decide together and explain why.
What is a Heart Team, and can the patient read its decision?
A Heart Team is a meeting at which a cardiologist, a cardiac surgeon and a catheter specialist review the case together and choose the tactic — for example, stent or bypass, catheter valve or open surgery. The decision is recorded in the medical file. Under German law, patients may inspect their file and receive a copy, so the reasoning can be read; your companion helps with the translation.
Which documents should be sent for a heart centre to assess the case?
Send recent discharge letters and cardiology reports, ECGs, the echocardiography report with the ejection fraction and blood results. After coronary angiography, CT or cardiac MRI, the recordings on disc matter as much as the written reports. A 24-hour ECG and a list of current medication with doses also help. The fuller the set, the more precisely the clinic can say what to repeat and which treatment to discuss.
How AlenMed arranges treatment in Germany
AlenMed organises everything from the first documents to discharge: it collects and translates discharge letters and the results of echocardiography, angiography and 24-hour monitoring, sends them to the relevant heart centre and obtains the written estimate on the clinic’s letterhead. It prepares the visa papers, meets the patient, accompanies them at appointments and on the ward, and arranges an urgent arrival if needed. The company’s office is in Munich; its partner clinics are across Germany.
This material is for information only and does not replace a consultation with a doctor. Whether treatment is possible, what it will involve and what it will achieve can be determined only after an examination at the clinic in person.
Individual procedures
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