Bicycle ergometry - Causes, symptoms and treatment. MF.

When a person develops a disease of the cardiovascular system, it is not always possible to establish an accurate diagnosis and prescribe a treatment on the basis of symptoms and routine research methods( pressure measurement( BP), ECG).In disputable diagnostic cases, physicians prescribe to the patient the carrying out of samples with physical exertion. Their use is based on an increase in heart rate with exercise, which leads to an increase in myocardial oxygen demand. A healthy heart can adequately respond to the load, but with a violation of blood supply to the myocardium( coronary heart disease), there are changes that are recorded on the ECG.

One of such samples is bicycle ergometry. The essence of the method consists in recording the ECG at rest before the study, getting the patient dosage physical load on a device resembling a bicycle, and further recording the ECG with an assessment of the changes in the heart.

The advantages of bicycle ergometry are the ability to detect hidden, asymptomatic forms of diseases not recorded during the recording of a single ECG at rest, ease of research, accessibility( modern medical facilities have good equipment with the necessary equipment), non-invasiveness( "bloodless" diagnostics), the possibility of multiple studies. The disadvantages include the presence of contraindications, as many patients can not experience physical stress.

Indications for the

study The bicycle ergometry is used in the following situations:

1. Coronary heart disease:
- with a clarifying purpose in the asymptomatic course when complaints are absent, and when ECG recording was previously recorded episodes of myocardial ischemia
- if there were complaints of pressing painin the heart area, not accompanied by characteristic changes on the ECG
- a previous painless myocardial infarction
- in individuals with an established diagnosis of ischemic heart disease and / or myocardial infarctionexercise tolerance
2. Arterial hypertension
3. Heart failure:
- allows to diagnose the degree of violation of myocardial contractility in various heart diseases in terms of the degree of dyspnea that occurs with the
load 4. Heart rate disturbances:
- unchanged changes onECG in the presence of complaints in a patient of the appropriate nature
5. Risk factors for coronary pathology( two or more):
- diabetes
- age over forty and fiveten years for men and women respectively
- hypertension
- smoking
- obesity
- lipid metabolism disorders
- increase in cholesterol in blood
is an aggravated heredity for cardiac pathology, especially when close relatives of people who die from sudden cardiac death are younger60 years
6. Monitoring the effectiveness of medical or cardiac surgery for listed diseases

Bicycle ergometry is necessary if the following complaints occur:

- boWhether behind the breast of a pressing or burning nature, giving to the left arm, shovel, jaw
- nonspecific pains( shooting, stabbing, cutting) in the left half of the chest, intensifying with physical activity
- dyspnea at the load
- heart discomfort, palpitationsat rest or under load
- nausea, dizziness, headache in the occipital region, accompanied by a rise in blood pressure under the load

Contraindications for bicycle ergonomics

The sample is contraindicated in the following diseases:
- acute myocardial infarction
- unstable angina
- acute rhythm disturbances( frequent ventricular extrasystole, atrial fibrillation, atrial fibrillation, ventricular tachycardia, complete atrioventricular blockade, first complete blockage of left bundleGisa and others)
- suspected of a dissecting aortic aneurysm
- systemic thromboembolism
- acute stroke
- heart defects in deco stage
- acute and severe chronic heart failure
- hypertensive crisis
- persistent increase in blood pressure to high digits that can not be treated
- acute rheumatic fever, as well as repeated attacks of rheumatism in the acute phase
- pericarditis, myocarditis and endocarditis in the acute stage
- feverish conditions
- acute surgical conditions
- diabetes mellitus, bronchial asthma and other chronic diseases in the decompensation stage

Preparation for the patient

Special podgwhen the veloergometry is not required. On the eve you can take liquid and food in the usual amounts, but on the day of the study, only a light breakfast is allowed no later than two to three hours before the procedure. Two to three days before the study, in consultation with the attending physician, preparations that affect blood supply to the myocardium and blood pressure are abolished, unless otherwise leads to the development of life-threatening conditions. These drugs include nitroglycerin and its derivatives, beta-adrenoblockers, ACE inhibitors and others.

On the eve it is necessary to avoid significant physical and psychoemotional loads, as well as to exclude the intake of alcohol, nicotine and coffee, since all this can affect the work of the heart on the day of the study. On the procedure it is better to come in loose clothes, do not shackle the movement and allow to move freely on the veloergometer.

How is veloergometry conducted?

On the day of the study, the patient comes to the department of functional diagnostics, where he is invited to the office for carrying out tests with physical activity. The patient is asked to sit down or lie down on the couch to apply the cuff of the tonometer on the shoulder and the electrodes on the chest. After this, the blood pressure is measured and the ECG is recorded at rest. Further the patient is conveniently arranged on a veloergometer, and he is asked to start pedaling at the usual pace. Constantly( every three minutes) the load increases with the help of electromagnetic or belt mechanisms, which leads to an increase in heart rate. In the case of chest pain, severe shortness of breath, other unpleasant symptoms, a significant increase in blood pressure, or severe ischemia on the ECG, the sample can be stopped. If these signs do not exist, the sample ends when the submaximal heart rate is reached( 75 - 80% of the maximum, this value is calculated according to the tables, depending on sex and age).

BP measurement is carried out at the end of each minute of the study, ECG recording is continuous. In general, the procedure lasts about ten minutes, after which the doctor assesses the recovery of blood pressure and heart rate for another 15 minutes. The study does not cause unpleasant sensations in the patient.

After the procedure, the patient awaits the conclusion, and, having received it, can go home. Obtained results must be transferred to the treating doctor who sent for testing.

Interpretation of the results of bicycle ergonomics

Having received the doctor's conclusion, the patient will see the following indicators:

1. Executed work in joules( J) or kilograms per minute( kg * m / min) and threshold power in watts( W).
2. Reasons for stopping the sample( symptoms, changes in the ECG, or reaching the maximum load).
3. The level of physical performance( low, medium, high).
4. Changes in blood pressure and heart rate, and also their product( double product).
5. The time during which the recovery of blood pressure, heart rate and changes in the ECG occurred( normally at the end of the fifth minute).
6. The response of blood pressure to the load( the value of "peak" AD - the peak load recorded).If this value is more than 190/100 mm.gt;the hypertensive type of reaction is diagnosed, which requires the appointment or correction of antihypertensive treatment.
7. Violations of the rhythm - registered or not, if so, which ones. Normally, there should be a sinus rhythm, sinus tachycardia is allowed( 50-60% of the initial heart rate at rest).Violations of the rhythm should not be normal.
8. Coronary disorders. Normally there should be no changes on the ECG( depression, ST segment elevation and others).If there is, describe in detail what, at what minute of rest the changes disappeared.
9. The functional class of IHD is estimated depending on the level of load power at which changes occurred( in Watts).

10. Sample conclusion:
- positive - the patient has had chest or heart attacks accompanied by signs of myocardial ischemia on the ECG or without it( if not, then the painless form of IHD is diagnosed)
- negative - ECG complaints and changesnot registered, the high level of operability of
is reached - doubtful - the patient is concerned about chest pain, but without signs of ECG ischemia, or the sample is suspended at the request of the patient due to other complaints( headache, dizzinesspain, or cramps in the calf muscles, and others).

11. Additional recommendations. Here you can specify the wishes of the doctor who conducted the test, for example, the need to correct the treatment of IHD and hypertension, send the patient, if necessary, to CAG( coronarography), if there are pains in the heart without signs of ECG ischemia, to conduct additional examination in case of stopping the sample due to dizziness orpains in the hips and legs( duplex scanning of vessels of the neck, head, legs).

Complications of bicycle ergometry

Since this research involves the patient performing a certain amount of physical work, it can cause serious disruptions in the activity of his heart and blood vessels. These include the development of hypertensive crisis, myocardial infarction, paroxysmal rhythm disturbances( ciliary arrhythmia, ventricular tachycardia), extremely dangerous rhythm disturbances - flutter and ventricular fibrillation. Also, the patient may lose consciousness, especially if he already has a lesion of the carotid and cerebral arteries( as a result of atherosclerosis, hypertension).These complications develop extremely rarely, because the conducting doctor carefully monitors the patient's condition, and in the case of the slightest suspicion of the risk of complication, the study will be discontinued. In addition, the survey is planned, that is, the doctor will not prescribe this procedure if he has any doubts about the stability of the patient's cardiovascular system.

Doctor therapist Sazykina O.Yu.