Treadmill test - Causes , Symptoms and Treatment .MF .
Indications for the treadmill test
Preparation for the procedure
treadmill test results Explanation
heart muscle (myocardium) - the most powerful and enduring muscle in the human body.Due to the myocardium are made continuous blood flow to all organs and tissues and providing oxygen and nutrients to the body's cells.But myocardial cells also need oxygen, so that they fully implement its contractile function.To do this, twist around the heart of a network of blood vessels, which are called coronary or coronary.If these arteries fully or partially clogged thrombi or atherosclerotic plaques, they become impassable for blood, and then there is a mismatch between blood flow and myocardial oxygen demand.This is especially true if you exercise when there is an increase in heart rate (HR), and myocardium need more oxygen than at rest.This condition leads to the development of coronary heart disease (CHD) and myocardial infarction.
Typically, these diseases manif
Treadmill - is instrumental diagnostic method based on the use of the dosage of exercise under medical supervision (walking on a treadmill) to increase heart rate, which is used to assess the response to increased myocardial oxygen demand.Thus, treadmill test can detect the presence of certain diseases of the heart, as well as to confirm or refute the diagnosis in the case of ECG data uninformative or differences of clinical symptoms with an ECG.
equipment for treadmill
test Besides the routine method of investigation, there are modifications treadmill test - treadmill with gas analysis (evaluation of functional lung condition to study the concentration of oxygen and carbon dioxide in the inhalation and exhalation), stress - echocardiography(holding ultrasound of the heart before and after exercise), carrying out the test with Doppler study (study of blood flow in the heart before and after exercise).
Indications for treadmill test
1. Examination of patients had no complaints on the part of the cardio - vascular system:
- persons older than 40 years working in the field of socially significant profession (public transport drivers, pilots, pilots, machinists andetc.), as well as those involved in sports,
- men over 40 and women over 50 years old with a history of two or more factors of heart disease risk - diabetes, hypertension, the presence of sudden cardiac death in the immediate family under the age of sixty years,increase blood cholesterol and related lipid disorders, obesity, smoking,
- patients older than 40 years prior to elective surgery in gynecology, general surgery, urology, oncology and other surgical profile (if necessary)
2. Examination of patientscomplaints from the heart:
- CHD diagnosis, refinement of functional class (FC - the classification criteria, allowing to differentiate the degree of clinical and instrumental data, depending on the degree of physical activity),
- assessment of ongoing drug therapy, or conducted cardiac surgery treatment,
- diagnosis of "silent" myocardial ischemia (asymptomatic ischemia, revealed on an electrocardiogram),
- diagnosis of arterial hypertension, cardiac arrhythmias (paroxysmal atrial fibrillation, atrial tachyarrhythmias), insufficient arterial blood flow in the lower extremities,
- examination of disability in patients with CHD orafter myocardial infarction.
Contraindications for research
Despite the ease of use, availability, security and accurate diagnosis for the patient, yet there are contraindications for treadmill test.These include:
- acute vascular disease - acute myocardial infarction, stroke, aneurysm of the aorta, systemic thromboembolism (pulmonary, mesenteric, femoral arteries), thrombosis of the lower extremities,
- acute infectious and feverish conditions,
- acute rheumatic feveracute pericarditis, acute myocarditis,
- chronic heart disease in the stage of decompensation - heart disease, severe heart failure, pulmonary edema, complex arrhythmias,
- respiratory diseases, digestive and endocrine systems in the stage of decompensation (asthma, cirrhosis, diabetesdiabetes, etc.),
- acute surgical pathology (acute pancreatitis complicated by gastric ulcer, etc.).
Preparing for the patient to test
patient may be referred for treadmill test in the department of functional diagnostics of polyclinic or the profile of the hospital (cardiac, surgical or other profile in the case of a survey before the planned surgery).Direction carried therapist, cardiologist, or physician.Before the examination the patient should undergo other diagnostic methods - ECG, Holter (daily) monitoring of ECG, ultrasound of the heart.
One day before the study the patient in consultation with a physician is necessary to cancel the drugs affecting the heart rate and improve coronary blood flow (beta - blockers, nitroglycerin and its analogues).It is also necessary to eliminate or reduce the number of cigarettes smoked and to limit the consumption of coffee, as the substances contained in them have a direct impact on the frequency of contractions and may distort the results of the survey.
For three - four hours before the study, patients were allowed to take a light breakfast, but just before the test food is better not to take.Water regime is permitted in the usual volume.
How is the treadmill test
As already stated, the patient is sent to the treadmill test in a planned manner from the clinic or the profile of the hospital in which he was hospitalized at the time of the study.After receiving the results of the ECG, echocardiography and inspection physician or cardiologist nurse accompanies the patient in the study of functional separation methods.Then he was invited to the office and asked to lie down on the couch for the measurement of blood pressure (BP) and ECG at rest (before exercise).To do this, the patient superimposed electrodes on the chest with the help of adhesive tape and fixed on the cuff sphygmomanometer (blood pressure measuring apparatus) on his shoulder.
After the registration of patient data are asked to take a comfortable position on the treadmill and start walking in a familiar rhythm to it.This is a continuous registration of the ECG and blood pressure monitor medical computer.Every three minutes, change the angle of incline of the treadmill and the accelerated pace of movement, that is, there is an increase in dosage of exercise.This continues for as long as the patient starts to experience unpleasant subjective sensations or discomfort (headache, dizziness, shortness of breath characteristic of CHD pressing chest pain or other pain in the heart).The study also may be terminated if there was a significant increase in blood pressure, there are signs of cardiac arrhythmias or myocardial ischemia on ECG.
After walking registration of blood pressure and ECG lasts for about ten minutes, then the doctor interprets the results and gives its opinion.After that, the patient was escorted to the office or in the case of the direction of the clinic, he can go home, if a satisfactory feeling, and in the course of the survey revealed no life-threatening conditions.Duration of treatment is about forty minutes (including 9 - 12 minutes directly assigned to a physical load) are not in most cases causing significant impairment of health, as the slightest discomfort study on the patient's request may be terminated.
test results How and when carrying out any medical examination, an independent analysis of the test results is unacceptable.Issues conclusions on a mandatory basis should be evaluated by the attending physician.Nevertheless, the patient is important to know that the main purpose of treadmill test is to determine whether there had coronary heart disease or other heart and vascular diseases, as well as to determine the individual threshold of tolerance (tolerance) to the physical stress that plays a rolein the subsequent treatment strategy (for example, if the patient has pain or ECG changes at the slightest load, it must be doobsledovat using coronary angiography and to determine the appropriateness of the surgical method of treatment of coronary heart disease).
dwell on the data analysis.Finally, be sure to indicate speed recovery and the level of the track, the level of exercise tolerance (ET) - high, medium or low, changes in blood pressure and ECG (heart rate, raise or decrease (depression) segment ST, arrhythmias), as well as time,through which normalizes blood pressure and heart rate after the termination of the test.
test results are evaluated by the level of submaximal has been achieved (75% of the maximum), heart rate (140 - 160 beats per minute, depending on the age and sex).If achieved, and the patient in this case did not have pain, shortness of breath, a significant increase in blood pressure, disruption of the heart, the ECG recorded, and no myocardial ischemia, the sample is considered negative, that is, the data in favor of the presumptive diagnosis is not enough.
sample is considered positive in case if the patient began to complain of pain in the heart and / or objective evidence of myocardial ischemia on ECG.
sample is considered doubtful , if the patient does not disturb characteristic of coronary artery disease complaints, and an electrocardiogram revealed no diagnostically significant changes.
test may be uninformative, if the study was terminated at the request of the patient in other circumstances not related to the occurrence of complaints from the heart and blood vessels.
In addition to these results, the conclusion stated in response to the load type BP - normotensive (maximum blood pressure increased to 190/100 mm Hg), moderately gipertonicheskky (BP within the 190/100 - 210/100 mm Hg), hypertensive (blood pressuremore than 210/100 mm Hg), hypotonic (BP 140/80 - 150/90 mm Hg), sympathetic - asthenia (gradual increase in blood pressure during the loading process, followed by a sharp fall at the height of his load or in the first minute of recovery period after discontinuation ofwalk).
Can there be complications during the test?
Complications during the treadmill test occur in very rare cases.These include - syncope (fainting, collapse with a sharp drop in blood pressure), stroke, acute myocardial infarction, ventricular fibrillation, atrial fibrillation and other arrhythmias, sudden cardiac death, asthma attack in asthmatic patients.
prevent complications are a thorough examination of the patient before the study, identifying possible contraindications, as well as increased medical supervision, conducting a survey of the condition and state of health of the subject.
therapists Sazykina OJ