Cardiovascular diseases take the first place both in frequency of occurrence and in mortality. Often they sneak up unnoticed, proceeding for a long time without symptoms. For the diagnosis and detection of hidden forms of cardiac pathologies, a method such as bicycle ergometry has been developed.
What is its essence
VEM is an ECG (electrocardiogram) record in minutes of physical activity. They conduct research on a bicycle ergometer – a special bike that automatically doses the load.
During the procedure, the patient pedals with different intensities (the load increases stepwise), while the pulse and blood pressure are recorded.
The choice of load is determined by the general condition of the patient, the underlying disease and history.
Similar testing is carried out on a treadmill with an incline (treadmill) or using a step test, in which the patient steps in two steps.
- identify heart failure, coronary heart disease, latent arterial hypertension, heart rhythm disturbances associated with stress;
- determine tolerance to increasing physical activity and the reaction of the cardiovascular system to it;
- find out if there is a connection between pain and blood flow disturbance, that is, whether the pain has coronary causes;
- assess the dynamics of the disease and the effectiveness of the treatment;
- track the recovery time Blood pressure and heart activity after the termination of the load;
- to evaluate the patient’s performance after suffering an ischemic heart disease.
The fact is that in patients with cardiac ischemia, characteristic changes in the electrocardiogram appear only during physical exertion, when blood pressure rises, the pulse increases, the heart works faster to provide an increased need for oxygen in the heart. In healthy individuals, vasodilation occurs during exercise, blood flow and oxygen supply to the myocardium increase. People with heart diseases do not have enough oxygen, they have chest pain, and specific changes are recorded on the electrocardiogram.
Bicycle ergometry allows you to diagnose ischemic heart disease, which cannot be determined using electrocardiography alone
- Physical and emotional stress is not allowed before VEM.
- You can’t eat for three hours before the procedure, in the morning a light breakfast is allowed (for example, kefir and a piece of bread).
- The drug is stopped for a day.
- On the eve (12 hours before the examination), you should not drink alcoholic beverages and coffee and smoke.
- It is necessary to find out if there are any contraindications to the ECG with a load.
Important! The patient needs to warn the doctor in advance if he is taking the drugs. Some medications can not be abruptly canceled, so the doctor should do this in advance. These include cardiac glycosides, diuretics, calcium antagonists, beta blockers, corticosteroids and others.
Hemoptysis and hypoglycemic agents do not cancel.
Terms and conditions
Earlier than two hours after breakfast, bicycle ergometry cannot be performed.
The test is carried out under the supervision of an experienced cardiologist who knows the patient’s medical history and the indications for the procedure. The room should be equipped with all necessary equipment in case of resuscitation. The air temperature in it is from 18 to 20 ° C.
Constant monitoring of the well-being and appearance of the subject is being conducted. An electrocardiogram is monitored with an oscilloscope. Heart rate and blood pressure are regularly recorded.
The magnitude of the load is estimated by blood pressure, heart rate, ECG, oxygen consumption. Samples with maximum load can only be performed by healthy people.
Method of conducting
Cardiovascular disease (CVD) is the leading cause of death worldwide. Often for a long time they occur without severe symptoms. People suffering from CVD or at risk of developing such diseases really need timely diagnosis and the provision of qualified care.
Modern medicine has made a breakthrough in terms of studying the work of the heart and blood vessels of man. Many effective diagnostic methods have been developed. Among them, bicycle ergometry is very informative.
This method is based on the use of a special apparatus – a bicycle ergometer. Under the control of the cardiogram of the heart and the measurement of blood pressure at moments of physical exertion, it is possible to clarify the physiological state of the cardiovascular system.
Bicycle ergometry (VEM) is a graphical display of electrical potentials that occur during contraction of the heart at times of increased physical activity. A bicycle ergometer is a special exercise bike that is able to automatically dose a load.
Such testing is carried out using a treadmill with a slope – a treadmill test. It is used to assess peripheral blood circulation: pressure drops and drops in blood flow, measurement of the ankle-brachial index, the time of restoration of blood flow after exercise.
During VEM, the test subject pedals a bicycle ergometer with varying intensity. The increase in load occurs gradually and at the same time, heart rate and blood pressure are constantly measured.
The choice of load is based on the general condition of the patient, his underlying disease and the totality of information obtained during the preliminary examination.
Using bicycle ergometry, you can achieve the following:
- To identify acute and chronic disorders in the work of the heart, damage to the coronary arteries, leading to disruption of the blood supply to the myocardium, latent hypertension, as well as heart rate disorders associated with increased load.
- Determine exercise tolerance or physical performance. The study shows the degree of physical fitness of the patient and his ability to tolerate the imposed load, as well as the reaction to this of his cardiovascular system.
- Determine the cause of the pain, whether they appear against the background of coronary disorders.
- In dynamics, evaluate the course of the disease and understand how effective the selected treatment tactics is.
- See how quickly blood pressure and heart rate are restored after lifting the load.
- Assess the physiological capabilities of the patient in the recovery period after the diagnosed coronary artery disease.
Bicycle ergometry allows you to confirm the diagnosis – IHD, which can not be determined using a standard ECG at rest
In healthy people, the expansion of blood vessels serves as a response to an increase in the load, as a result of which blood enriched in oxygen enters the myocardium more actively. In patients with severe cardiac pathologies, oxygen deficiency is observed, chest pain appears, and characteristic changes are noted on the ECG.
In patients with coronary heart disease, specific changes in the electrocardiogram can be noted only at the moment of change in the imposed load. This is due to increased blood pressure, increased heart rate and fast heart function, which is trying to make up for the increased myocardial oxygen demand.
Such a diagnostic procedure is indicated for such categories of people:
- After age 30 with chest pain with serious suspicion of coronary heart disease.
- Patients with already diagnosed ischemia in order to predict the course of the disease.
- Patients in the intermediate period between the stable course of ischemic heart disease and complications.
- Patients with insulin-dependent diabetes who want to pay serious attention to sports.
- Pediatric patients undergoing heart surgery to correct congenital abnormalities.
- Young men of draft age and athletes who experience unusual deviations in well-being during exercise.
However, this technique has serious contraindications for its implementation:
- If after acute acute extensive necrosis of the myocardial site, less than 3 weeks have passed.
- The first heart attack occurred against a background of spasm of the coronary arteries.
- Endocarditis (inflammation of the inner lining of the heart), myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the outer lining of the heart) in the acute phase.
- Acute and subacute ischemic stroke.
- If the patient has fainting conditions, and preliminary ultrasound of the heart and daily ECG monitoring were not performed.
- The patient has heart defects with significant circulatory disorders.
- Sack-like expansion of the aorta and other vessels.
- Severe ventricular extrasystole.
- Disorders of the electrical impulse from the atria to the ventricles of the II – III degree.
- Blockage of the pulmonary artery and its branches with blood clots or if less than 3 months have passed after pulmonary artery thrombosis.
- Arterial hypertension of the III degree (recurrent hypertensive crises, transient cerebral ischemia, encephalopathy with hypertension and other disorders).
- Diseases of the musculoskeletal system or other causes that are not related to the work of the heart, but interfering with the test.
AV block on an ECG
- mild heart valve defects;
- thin scar of the left ventricle, devoid of the muscle layer;
- mineral deficiency, especially Mg and K;
- persistent hypertension;
- pathology from the endocrine system;
- chronic infectious diseases;
- problems with the musculoskeletal system;
- neurological diseases;
- malignant neoplasms;
- low hemoglobin content;
- period of carrying a child.
This test is not recommended for patients under the age of 15 years and older than 70 years.
This diagnostic method does not require complex preparation, but the following should be considered:
- Your healthcare provider should be advised of any medications you are taking. Many of them will have to be canceled before the procedure, but since most often this cannot be done abruptly, it is necessary to inform all medicines in a timely and detailed manner. As a rule, anticoagulants and sugar-lowering drugs are not completely canceled, while others are canceled according to a certain scheme.
- Before carrying out bicycle ergometry, probable physical activity and stressful situations should be excluded.
- 12 hours before the study, you need to abandon the use of alcohol, coffee and smoking.
- 3 hours before the procedure, you should not eat food.
What is its essence
How is bicycle ergometry, indications and possible complications
For those who are not familiar with the concept of “bicycle ergometry”, we explain – the method of bicycle ergometry consists in the study of cardiac activity against the background of physical activity.
A bicycle ergometer is a special exercise bike that is able to accurately dose physical activity.
When asked how bicycle ergometry is performed, one can answer what it looks like like cycling with different intensities, while the cardiovascular system is automatically controlled at the same time.
As a result, specialists can evaluate its response to the proposed load. An alternative to a bicycle ergometer can be a treadmill – a treadmill.
Bicycle ergometry allows you to evaluate blood pressure, pulse parameters and record an ECG, and all this is done before the test starts, at the time of the test and a few minutes after its completion, when the subject is resting. After the cycle ergometry was performed, readings at rest are needed to study the process of restoration of cardiac activity.
It is no secret that with increased physical activity, the intensity of the heart increases sharply, which leads to an increase in oxygen consumption.
At the same time, a healthy heart reacts calmly to such loads, and even if a person is exhausted, it does not feel much discomfort, while it shows normal ergometry.
But a weak heart quickly breaks out of the norm, which is immediately noted on the recorded electrocardiogram in the form of characteristic changes.
When a treadmill test is conducted, preparation for it or for bicycle ergometry is discussed with the attending physician: the possibility of canceling medications that affect the cardiovascular system is discussed. If the drugs continued to be used, then in conclusion, their names, dosage and frequency of administration should be indicated.
It should be borne in mind that the sensitivity of the test increases significantly with the abolition of antianginal drugs. On the other hand, abrupt cancellation of β-blockers can lead to ricochet tachycardia.
To avoid this, these drugs should be gradually withdrawn – within a few days.
- In two weeks, cardiac glycosides (digoxin) are canceled, which make it difficult to clearly interpret the test results.
- For two days, sedatives and calcium antagonists are canceled.
- In 12 hours – nitrates with prolonged action.
- Within a week, you need to reduce the dose of clonidine and completely cancel it a day before the test.
- Can be used 2 hours before testing short-acting nitro drugs.
- Antidiabetic agents and anticoagulants are not canceled.
- Three hours before the test it is not recommended to eat, drink alcohol and coffee, as well as smoke.
- Physical activity should be absent on the day of the test.
- The test subject should wear clothing and shoes that are comfortable for exercise.
- At the end of the test, outpatients should be taken home by relatives.
- The patient should have a list of medications to be taken.
ECG is recorded in twelve modified leads.
On the hands, electrodes are attached closer to the shoulders or in the area of the collarbone, and usually intended for the legs electrodes are fixed in the lumbar region or in the area of the ilium, and sometimes in the area of the shoulder blades on the back (it is more convenient to mount reusable electrodes).
Before the test, a regular ECG is recorded on the subject lying on his back. The location of the electrodes is indicated in the conclusion.
Computer processing of the ECG allows dynamic express analysis of the ST area, the degree of depression of the ST segment, the slope of the ST, the ST / HR index, etc.
With automatic measurement of blood pressure, diastolic blood pressure measurement errors due to movement may occur, therefore it is recommended that they be duplicated by manual measurement of blood pressure.
If a pathological reaction of blood pressure is registered, then the second testing employee should double-check it.
The load should be reduced gradually to avoid a vagotonic reaction, in which blood pressure drops sharply, as well as bradycardia. Therefore, at the end of the test, you need to turn the pedals for about a minute, in which the resistance is disabled. Observation after exercise lasts 6-8 minutes.
If after this time, heart rate, blood pressure and ECG have not returned to their original values, then observation is carried out until they normalize.
With a pathological reaction to an almost full load when observing the patient in a supine position after 5 minutes, these deviations can return, therefore it is better for the patient to carry out a recovery period while sitting.
- If the subject coped with the task successfully, reaching the maximum level of the proposed physical activity.
- If the heart rate has reached the limit for the test parameters, calculated by the formula “220 minus age.”
- If a person complains of pain in the heart, feeling unwell or tired.
- When changes appear on the ECG.
- With a sharp drop or increase in blood pressure.
- If you experience headache, shortness of breath, dizziness, blurred vision, or nausea.
Such a simple test of physical activity allows you to find the degree of endurance of the body of the subject, to identify cases of latent attacks of myocardial ischemia, cardiac arrhythmias, which are manifested only with an intensively working heart.
Having learned how to perform bicycle ergometry, you will no longer be surprised at how popular this test has become not only among patients, but also in completely healthy people.
Using such stress tests, you can assess the response to physical activity from the cardiovascular system, the degree of endurance of the body during exercise, to identify cases of myocardial ischemia, even if it proceeds without pain, and heart rhythm disturbances associated with physical activity.
These tests help to establish a connection between pain in the chest and the state of coronary blood flow or, conversely, to refute its presence, since pain can be caused by completely different reasons.
It is valuable that the removal of the ECG under load allows you to quantitatively determine the degree of insufficiency of cardiac blood flow, as well as adaptive resources of the body, since they can be associated with clearly dosed physical activity, achieved parameters of blood pressure, heart rate, ECG picture. In addition, the time required to restore blood pressure and cardiac activity after the cessation of exercise is monitored. In other words, an opportunity opens up for an objective assessment of the dynamics of the disease and the effectiveness of the treatment.
Of course, it has bicycle ergometry and treadmill test indications and contraindications.
ECG fixation under load has been widely used for the diagnosis of coronary heart disease, determine the optimal treatment tactics and an objective assessment of its effectiveness.
If pronounced myocardial ischemia is detected, bicycle ergometry or a treadmill test can be combined with coronography, which will give grounds for surgical intervention.
So, we list what indications and contraindications bike ergometry and treadmill test can have.
- Atypical pains in the region of the heart that are not monitored by a normal electrocardiogram.
- When changes in the ECG are nonspecific, atypical angina pectoris or a negative T wave appears.
- In violation of lipid metabolism without the diagnosis of coronary heart disease.
- People over 40 years old with the professions of drivers, pilots, divers, who are at high risk of developing coronary heart disease.
- To identify cases of painless myocardial ischemia.
With all the effectiveness, nevertheless, bicycle ergometry has contraindications:
- The acute period of myocardial infarction.
- High arterial hypertension (more than 200/100).
- Unstable angina.
- Acute pericarditis or myocarditis.
- Congestive uncompensated heart failure.
- Acute infection accompanied by fever.
- Serious disturbances in conduction and rhythm.
- Active thrombophlebitis.
- Pulmonary embolism.
- Aneurysms of large vessels.
- Severe respiratory failure.
- Multivalve heart diseases.
- Severe hypotension with a transition to fainting.
- Malignant tumors.
- Diseases of the blood.
- Diseases requiring restriction of physical activity.
When bicycle ergometry is completed, the results are presented in the form of a conclusion about the absence or presence of latent myocardial ischemia, there is also a reaction of blood pressure to the load and the timely recovery of hemodynamic parameters, a recommendation is made on the level of permissible physical activity.
1. The work performed, estimated in J or kg * m / min, as well as the threshold power, expressed in watts. 2. Reasons for stopping the test (reaching maximum load, changes in the ECG or symptoms that appear). 3. Assessment of the level of physical performance (from low to high) .4. Changes in heart rate and blood pressure and their product. 5.
Sinus rhythm is considered normal, sinus tachycardia, up to 60% of the initial heart rate, is possible. Normally, there should be no rhythm disturbances. 8. When bicycle ergometry is performed, normal indicators should also not demonstrate coronary abnormalities reflected in the ECG (ST segment elevation, depression, etc.).
Upon detection, those are described in detail, as well as at what minute of rest they disappeared.
9. The functional class of coronary heart disease, determined by the load power (W), which led to the changes.
10. Treadmill test: assessment of results: a. Positive – if the subject has pains in the region of the heart or behind the sternum, which on the ECG show signs of myocardial ischemia (otherwise, the painless variant of CHD is diagnosed); b.
Negative – in the absence of ECG changes and subject’s complaints even after reaching the maximum load; c.