Stress tests in cardiology practice in the conditions of the Lipetsk Regional Clinical Hospital. Bicycle ergometry

Electrocardiography (ECG) is the main and most common method of diagnosing coronary heart disease (CHD). Changes in the ST segment on the ECG (depression of the ST segment - a decrease below the isoline or elevation of the ST segment - a rise above the isoline), changes in the T wave, especially associated with physical or psychoemotional stress, may indicate pathology of coronary vessels.

The variety of clinical manifestations of coronary artery disease, the prevalence and localization of coronary artery lesions, combined with the low specificity of changes in the ST segment and the T wave of the ECG cause difficulties in diagnosing coronary pathology. The connection of an anginal attack in coronary heart disease with physical stress allows the use of stress tests, characteristic ECG changes during physical exertion are almost unambiguously associated with the pathology of the coronary arteries.

The whole range of stress tests is carried out in the Lipetsk Regional Clinical Hospital:

1. Bicycle ergometry (VEM).
2. Treadmill test.
3. Stress echocardiography (stress echocardiography).
4. Dynamic myocardial scintigraphy with load.
5. Transesophageal electrical stimulation (ischemic test).

The first and most common of these load tests is bicycle ergometry.

Bicycle ergometry is a stress test during which the patient pedals a bicycle ergometer, an ECG is simultaneously recorded, blood pressure and pulse readings are recorded. The load is set by the doctor conducting the study, according to a pre-selected protocol.

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 the test with physical activity, the doctor indicates the data obtained:

1. Presence or absence of ischemia:
   - negative test - in the absence of ischemic changes;
   - positive test - in the presence of ischemic changes on the ECG;
   - questionable test - the presence of changes on the ECG, but not exactly related to ischemic;
   - an uninformative test - during which the required heart rate is not reached.
2. Tolerance (tolerance) to physical activity (low, medium, high).
3. The reaction of blood pressure to the load (adequate reaction of blood pressure, reaction of blood pressure 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