Veloergometry - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | In The Cardiology

In the event a person of any diseases of the cardiovascular system is not always based on symptoms and routine techniques (measurement of pressure (BP), ECG) can immediately establish an accurate diagnosis and prescribe treatment.In controversial cases, doctors prescribe diagnostic patient samples to conduct exercise.Their use is based on the increase in heart rate at a load that causes an increase in myocardial oxygen demand.A healthy heart is able to adequately respond to the load, but in violation of the blood supply to the myocardium (coronary heart disease), there are changes that are recorded on an electrocardiogram.

One of these samples is veloergometry.The method consists in the ECG at rest before the study, patients receiving a dosage of physical activity on the device, resembling a bicycle, and further recording of ECG with the assessment of any changes in the heart.

advantages veloergometry are the ability to detect hidden, asymptomatic forms of disease that are not registered in the proc

ess of recording a single ECG at rest, ease research, accessibility (modern hospitals are well equipped with the necessary equipment), non-invasive ( "bloodless" diagnostics), the possibility of multiple studies.The disadvantage is the presence of contraindications, because many patients can not experience the physical load.

Indications for research

Veloergometry apply in the following situations:

1. Coronary heart disease:
- with the aim of qualifying in asymptomatic, when there are no complaints, and ECG recording episodes of myocardial ischemia
previously recorded - in the presence of complaintson pressing pain in the heart, not accompanied by characteristic changes in the ECG
- ported previously silent myocardial infarction
- in patients with established coronary artery disease and / or myocardial infarction transferred to assess exercise tolerance
2. hypertension
3. heart failure:
- allows you to diagnose the degree of impairment of myocardial contractility under various heart diseases in the degree of dyspnea, occurring under load
4. cardiac arrhythmias:
- not previously recorded ECG changes when there are complaints from the relevant nature of the patient
5. risk factors for coronarypathology (two or more):
- diabetes
- age over forty and fifty years old for men and women respectively
- hypertension
- smoking
- obesity
- lipid
exchange - an increase in cholesterol
blood - family history ofheart disease, especially in the presence among the close relatives of those who died from sudden cardiac death under the age of 60 years old ti
6. Monitoring the effectiveness of medication or cardiac surgery treatment of these diseases

Veloergometry required when any of the following complaints:

- crushing chest pain or burningnature, smack in the left arm, shoulder, jaw
- nonspecific pain (raking, stabbing, cutting) on ​​the left side of the chest, worse on exertion
- shortness of breath under load
- disruptions in heart palpitations at rest or under load
- nausea, dizziness, headache in the occipital region, accompanied by a rise in blood pressure during stress

Contraindications veloergometry

Conducting tests are contraindicated in the following diseases:
- acute myocardial
infarction - unstable angina
- acute arrhythmias (frequent ventricular premature beats, for the first timeby having atrial fibrillation, paroxysms of atrial fibrillation, ventricular tachycardia, complete atrioventricular block, first emerged complete blockade of the left leg bundle branch block and other)
- suspected dissecting aortic aneurysm
- systemic thromboembolism
- acute stroke
- heart disease decompensated
-acute and severe chronic heart failure
- hypertensive crisis
- a persistent increase in blood pressure to high numbers, not treatable
- acute rheumatic fever, and repeated attacks of rheumatic fever in the acute phase
- pericarditis, myocarditis and endocarditis in the acute stage
- fevers
- acute surgical condition
- diabetes, asthma and other chronic diseases in the stage of decompensation

preparing for a patient

special training in conducting veloergometry not required.On the eve of the liquid can be taken and the food in the usual quantities, but on the day of the study allowed only a light breakfast not later than two - three hours before the procedure.In two - three days before the study in consultation with the doctor canceled drugs affecting the myocardial blood flow and blood pressure, unless otherwise lead to the development of life-threatening conditions.These drugs include nitroglycerin and its derivatives, beta - blockers, ACE inhibitors, and others.

eve should avoid significant physical and psycho-emotional stress, as well as eliminate the use of alcohol, nicotine and coffee, as all this may affect the functioning of the heart in the study day.On the procedure is better to come loose clothing, not hamper movement and allows you to freely move on the cycle ergometer.

How is veloergometry?

Chimes at study day the patient comes to the department of functional diagnostics, where he was invited to the office to carry out tests with physical activity.The patient is asked to sit or lie down on the couch to stretch cuff tonometer on the shoulder and the electrodes on the chest.After that, the measurement of blood pressure and ECG at rest.Next, the patient is conveniently arranged on a bicycle ergometer, and he is asked to start pedaling at a normal pace.Continuously (every three minutes), the load increases by a solenoid mechanism or a belt, which leads to an increase in heart rate.In case of pain in the chest, severe shortness of breath and other unpleasant symptoms, significant increase in blood pressure or severe ischemia on ECG test can be stopped.If these signs not test ends when the submaximal heart rate (75 - 80% of the maximum, this value is calculated according to the tables depending on gender and age).

BP measurement carried out at the end of each minute of study, ECG recording is continuous.The whole procedure takes about ten minutes and then for another 15 minutes, the doctor evaluates the restoration of blood pressure and heart rate.The study does not cause discomfort to the patient.

After the procedure, the patient expects a conclusion, and having received it, can go home.The results are to be transmitted to the attending physician, right at the sample.

Decoding results veloergometry

received the medical report in his hands, the patient will see in the following figures it:

1. Work done in joules (J) or kilogram-meters per minute (kg * m / min) and the threshold power in watts (W).
2. Reasons for termination of the sample (symptoms, ECG changes, or to achieve the maximum load).
3. The level of physical performance (low, medium, high).
4. Changes in blood pressure and heart rate, as well as their product (double work).
5. Time during which there was a BP recovery, heart rate and ECG changes (normally by the end of the fifth minute).
6. BP reaction to the load (the value of "peak" BP - registered at the peak load).If this value was more than 190/100 mm.Hg.Art., the diagnosed hypertensive type of reaction, which requires a destination or correction of antihypertensive treatment.
7. Arrhythmias - registered or not, if so, what.Normally to be in sinus rhythm, sinus tachycardia allowed (50 - 60% of the initial heart rate at rest).Dysrhythmia normally should not be.
8. Coronary disorders.Normally, there should be no changes in the ECG (depression, ST segment elevation, and others).If yes, describe in detail, which, on a minute rest vanished changes.
9. Functional Class CHD is estimated depending on the power level of the load at which any change (in watts).

10. Conclusion of the sample:
- positive - in a patient having bouts of pain behind the breastbone or in the heart, accompanied by signs of myocardial ischemia on ECG or without (if not, then diagnosed painless form of CHD)
- negative - complaints and changesECG is not registered, a high level of
performance - doubtful - patient concerned about pain in the chest, but without evidence of ECG ischemia, or the sample is suspended at the request of the patient in connection with other complaints (headache, dizziness, pain or cramps in the calf muscles and other).

11. Additional recommendations.This might include the doctor wishes, carried out the sample, for example, the need to adjust the treatment of coronary artery disease and hypertension, refer the patient if necessary to CAG (coronary angiography) in the presence of pain in the heart, without signs of ECG ischemia, conduct further examination in case of a sample of - for dizziness orpain in the thighs and legs (duplex scanning of neck vessels, head, legs).

Complications veloergometry

Since this study involves the implementation of a patient a certain amount of physical work, it can cause serious disturbances in the activity of his heart and blood vessels.These include the development of hypertensive crisis, myocardial infarction, paroxysmal arrhythmias (atrial fibrillation, ventricular tachycardia), extremely dangerous arrhythmias - atrial and ventricular fibrillation.Also, the patient may lose consciousness, especially if he already has a carotid and cerebral arteries (as a result of atherosclerosis, hypertension).These complications occur very rarely, because the conductive sample doctor carefully monitors the condition of the patient, and in the case of the slightest suspicion of the risk of complications of the study will be terminated.In addition, the survey is planned, that is, the doctor did not prescribe this procedure, if he has the slightest doubt as to the stability of the cardio - vascular system of the patient.

therapists Sazykina OJ