Stress tests in cardiology practice in the conditions of the Lipetsk Regional Clinical Hospital. Treadmill test

What is a treadmill test?

A treadmill is a track that can move at an increasing speed. A treadmill test is a stress test during which the patient walks and then runs on a treadmill with a changing angle of inclination, an ECG is recorded at the same time, blood pressure and pulse readings are recorded. The protocol of the study is chosen by the doctor conducting the study.

Walking is a simple and familiar type of exercise that any mobile person can perform. That is why the treadmill test is more physiological and has a higher reproducibility, which is especially important in the dynamic observation of patients. During the test, walking on flat terrain or uphill is simulated, while the speed of the track and the angle of inclination are set to the patient automatically, depending on the selected protocol.

Preparation for the study, indications and contraindications, evaluation of the sample are similar to bicycle ergometry, since in both cases the factor provoking ischemia is physical activity.

The difference between a treadmill test and a bicycle ergometry is in the form of a load and the ability to perform a treadmill test by patients with diseased joints who cannot pedal a bicycle ergometer.

Preparation:

1. A light meal 1.5-2 hours before the test.
2. Do not drink strong tea, coffee, alcohol; smoking is prohibited for an hour before the test.
3. Cancellation of beta-blockers in 48 hours, nitrates in 24 hours (on the recommendation of a cardiologist).
4. For a high-quality ECG recording, it is necessary to shave the hair from the chest.
5. It is mandatory to have with you the results of ECG, echocardiography (echocardiography, ultrasound of the heart), if available - daily ECG monitoring, outpatient card, towel.
6. Comfortable clothing that does not restrict movement is recommended.

Indications:

1. Differential diagnosis of chest pain.
2. Diagnosis of the risk of developing clinical outcomes of coronary heart disease, assessment of the functional class of angina pectoris, clarification of the prognosis of the disease in patients with coronary heart disease.
3. Assessment of the condition of patients with an established diagnosis of coronary heart disease with a significant change in the clinical picture of the disease.
4. Assessment of prognosis in patients who have suffered acute myocardial infarction, determination of permissible physical activity and adequacy of therapy.
5. Clinical assessment of the condition of patients who underwent revascularization surgery (restoration of blood flow), with the resumption of symptoms.

Absolute contraindications to the stress test:

1. Acute conditions: acute myocarditis, pericarditis, endocarditis, venous thrombosis, pulmonary embolism, fever, dissecting aortic aneurysm.
2. Aneurysm of the left ventricle, aorta and other vessels.
3. Intracardiac thrombosis.
4. Severe heart failure with clinical manifestations.
5. Severe aortic stenosis with clinical manifestations.

After conducting the test in conclusion, the doctor indicates the data obtained:

1. Presence or absence of ischemia:

• the sample is evaluated as negative in the absence of ischemic changes;
• a positive test in the presence of ischemic changes on the ECG;
• a test with the presence of changes on the ECG is considered doubtful, but not exactly related to ischemic;
• uninformative - a test during which the required heart rate is not reached).

2. Tolerance (tolerance) to physical activity (low, medium, high).

3. Blood pressure reaction to the load (adequate blood pressure reaction, blood pressure reaction according to the hypertensive or hypotonic type).

Prepared:

• Head of the Department of Functional Diagnostics Natalia Viktorovna Zaikina;
• Doctor of the Department of functional diagnostics Litvinenko Svetlana Aleksandrovna.