There are many modern methods for studying the work of the heart and blood vessels of a person. This is an electrocardiogram, and Holter daily observation, and many others. Among them, such a procedure as bicycle ergometry stands out. How this event is held, to whom it is shown and to whom bicycle ergometry is contraindicated, we will tell in this article.
Bicycle ergometry is a method of instrumental diagnostics of the state of the cardiovascular system using a special apparatus, a bicycle ergometer. The essence of the methodology is as follows: when the load on the bicycle ergometer (exercise bike with variable resistance of the pedals) pulse increases.
With an increase in heart rate, the blood supply to the heart muscle changes. If a patient has coronary heart disease, it can manifest itself in such conditions on an electrocardiogram.
An electrocardiogram during bicycle ergometry is recorded continuously and is evaluated in real time by a functional diagnostics doctor.
Bicycle ergometry reveals myocardial ischemia, that is, insufficient supply of blood and oxygen. A standardized load allows you to determine the severity of ischemia (functional class of angina pectoris).
This study allows you to determine exercise tolerance, that is, patient endurance. In this test, the response of blood pressure to exercise is evaluated.
During bicycle ergometry, rhythm disturbances can be recorded.
According to the doctor’s prescription, the following drugs can be canceled:
- cordaron the week before the test;
- prolonged beta-blockers (metoprolol, bisoprolol, concor and others) – three days before the test;
- prolonged nitrates (cardicet retard, monochinqua and others) – one day before the study.
Nitroglycerin and nitrospray can be used on the day of the test when an attack of angina pectoris occurs, but you need to warn the doctor who will perform bicycle ergometry.
Bicycle ergometry is usually performed in the morning, one to two hours after breakfast. On the day of the study, it is advisable not to smoke or donate blood from a vein (if this is not possible, you need to wait 2 hours before the test).
No need to be afraid of research. No one will force the patient to carry out a load too heavy for him. The examinee has the right at any time to refuse to continue the test. Excessive excitement and experience can adversely affect the results of bicycle ergometry.
The patient sits on a bicycle ergometer (a special exercise bike), his blood pressure is measured and equipped with electrodes. These electrodes are wired to a computer. On the monitor screen, the doctor sees the “running” electrocardiogram of the patient in real time.
After registering the recording at rest, at the command of the medical staff, the subject begins to pedal. In different systems for testing, the control of the cadence frequency is different (numbers on the display, lights, and so on), however, in any case, you need to pedal at a frequency of about 60 rpm (1 revolution per second).
After three minutes, the load will increase, the patient will have a feeling that he was riding a bicycle uphill.
Subsequent load steps will also last for three minutes. Blood pressure is regularly measured.
If the patient has complaints of pain in the heart, dizziness, severe shortness of breath, or other unpleasant sensations, he should inform the doctor about this, but not stop.
The load stops at the command of a doctor. For several minutes, the patient rests, after which blood pressure is measured, and the subject is released.
The test cannot be performed if the patient has the following conditions or problems:
- Acute myocardial infarction within one to three weeks (depending on severity).
- Unstable angina pectoris (progressive, first occurring).
- Acute inflammatory heart disease.
- Disturbance of cerebral circulation (stroke) in the acute and subacute phase.
- Fainting without preliminary ultrasound of the heart and daily monitoring of ECG.
- Severe aortic stenosis and other heart defects with a significant violation of intracardiac blood flow.
- Aneurysm of the heart, aorta and other vessels.
- Intracardiac thrombus.
- Severe arterial hypertension.
- Severe ventricular arrhythmias.
- Atrioventricular block II – III Art.
- Heart failure III – IV FC.
- Pulmonary thromboembolism or pulmonary infarction with a duration of less than 3 months.
- Severe pain in the joints or other extracardiac causes that impede the load.
- Bad contact of the doctor with the patient.
The doctor may cancel or postpone the study in the following situations:
- A documented angina attack on the day of the study.
- A history of stroke with resting blood pressure above 120/80 mm Hg. Art.
- Heart defects.
- Severe supraventricular arrhythmias.
- Heart failure II – III FC.
- Pulse at rest is higher than 110 / min, blood pressure is higher than 140/90 mm Hg. Art.
- Beta-blocker withdrawal syndrome (high blood pressure, high heart rate).
- The patient was not examined (examination, history, electrocardiogram at rest, preferably echocardiography and daily monitoring of the ECG).
- Exacerbation of joint diseases.
- Anemia with a hemoglobin level below 110 g / l.
- Decompensation of diabetes.
- Fever, acute respiratory infection.
- People over 30 years old with chest pain, taking into account the pre-test likelihood of coronary heart disease, which is determined by the doctor using special tables. The study is shown with an average probability of coronary heart disease.
- Patients with a previously diagnosed “Coronary heart disease” in order to determine the prognosis of the disease.
- Patients with unstable angina and lack of a high risk of myocardial infarction (after stabilization).
- It will be useful to undergo bicycle ergometry for patients with type 2 diabetes who are planning to play sports.
- Children and adolescents after surgical correction of congenital heart defects, children with diseases of the valves and heart muscle.
- Young athletes who experience any deviations from normal health during exercise.
When patients are prescribed bicycle ergometry (VEM), thanks to the prefix “bicycle”, many immediately guess what it is and are right. The study is carried out on a bicycle simulating a bicycle.
During dosed physical activity, latent coronary insufficiency can be detected, because in patients suffering from coronary heart disease (CHD), physical activity causes a decrease in myocardial blood supply and this is reflected by certain changes in the ECG.
Over the course of several days before exercise, drugs that affect the cardiovascular system are gradually discontinued:
- For 2 hours, you can take nitroglycerin short-acting for the last time;
- For 12 hours, stop taking long-acting nitroglycerin;
- For 24 hours, clonidine is no longer taken, the dose of which was previously gradually reduced over the course of a week;
- For 48 hours, stop taking L-type calcium channel blockers, diuretics, ACE inhibitors, sedative (sedative) drugs;
- For several days, stop taking antianginal drugs;
- For 14 days, stop taking cardiac glycosides.
The patient should make sure in advance that, after bicycle ergometry, he should be accompanied by loved ones on the way home, and during the test he should change into comfortable shoes and clothes.
In addition, preparation for the examination includes several more simple conditions:
- On the day of testing, avoid physical activity;
- 3 hours before bicycle ergometry do not drink coffee, do not smoke or eat;
- Prepare and take with you a list of medications to be taken.
Before starting the load, the patient is placed on the couch and lying on his back, in a state of complete rest, the electrocardiogram is removed and blood pressure is checked.
Then the patient is placed on a bicycle ergometer and kneads for a couple of minutes, and only then does the main load begin, before which electrodes are attached to the subject in two areas:
- In the area of the collarbone or on the hands closer to the shoulders;
- On the lower back or around the ilium, or on the shoulder blades.
The patient should not pedal for more than a quarter of an hour. At the end of the test, the load is reduced gradually. For at least a minute, the patient should pedal the bicycle ergometer idle, without load, and then specialists should observe it for 5-8 minutes.
Most often, this time is enough for all pre-test indicators to return to normal. If this does not happen, the patient is monitored for as long as his body needs to achieve normal levels.
Lying at this time is not recommended, it is better to spend this period of time sitting.
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- : Bicycle ergometry
- Bicycle ergometry: how is it carried out, preparation, indications, contraindications, results, complications
- VEM. Principle of the technique
- Tips for passing (to patients)
- Bicycle ergometry: how is it carried out, preparation, indications, contraindications, results, complications
- Decoding VEM results
: Bicycle ergometry
From this article you will learn about such a valuable research method as bicycle ergometry or bicycle ergometry test. This test is widely used in cardiology and has great prognostic value in heart diseases.
Bourguta Alexandra, obstetrician-gynecologist, higher medical education with a degree in General Medicine.
Bicycle ergometry (VEM) or a bicycle ergometry test is a specialized test for a person’s endurance to physical activity and for revealing latent forms of coronary insufficiency and coronary heart disease (conditions in which the heart muscle experiences oxygen starvation).
This test is carried out using a special simulator – a bicycle ergometer – which patients and doctors themselves call “a bicycle”. The bicycle ergometer really reminds an exercise bike at which load is very precisely regulated. In addition to the “bike” itself, a test system requires a continuous recording of an electrocardiogram, measuring pressure and heart rate.
The process of bicycle ergometry
Analogs of endurance testing are also a step – a step of a certain height, to which the patient alternately steps with each foot, and treadmill – an analogue of a treadmill with an ever-increasing incline.
The essence of the bicycle ergometry method is as follows: during physical activity, the heart rate increases, and the heart requires more oxygen and nutrients.
In the presence of hidden problems with the myocardial vessels – coronary arteries, the presence of congenital and acquired heart defects, as well as cicatricial changes in the heart after heart attacks – the heart can not cope with the load, there is ischemia or oxygen starvation of the heart muscle.
Bicycle ergometry: how is it carried out, preparation, indications, contraindications, results, complications
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.
It is doubtful – when the patient’s pains are disturbing, but there are no signs of ischemia on the ECG, as well as in cases of stopping the test at the request of a subject having other complaints (dizziness, spasms in the calves, etc.).
VEM. Principle of the technique
The patient must have the necessary medical documents with him (an outpatient card or an extract from the medical history, answers from previous ECGs), a list of constantly taken medications, a towel and a tracksuit.
Electrodes are placed on the patient’s chest area to take ECG readings, and a tonometer cuff for measuring blood pressure is placed on the shoulder. Before the procedure, ECG readings and Blood pressure at rest are taken. Then the patient is given minimal physical activity (pedaling a bicycle ergometer), and gradually increasing it every 2-3 minutes, changes in ECG, pressure and pulse are recorded. Also, the examinee is obliged to inform the doctor of all his sensations, even insignificant ones.
The appearance of certain changes on the ECG (ischemic in nature, allowing to diagnose coronary artery disease, severe arrhythmia), the occurrence of coronary pain in a patient, an increase in fatigue, or reaching a certain level in the testimony Blood pressure and heart rate are the criteria for completing the test.
After stopping the bicycle ergometer for another 5-10 minutes, the doctor monitors the pulse and pressure, thereby assessing the recovery process of the body of the subject after exercise.
As you know, physical activity causes an increase in heart rate, which means that the heart needs more oxygen and nutrients.
If the patient has problems with the coronary arteries (vessels of the heart muscle), heart defects (congenital or acquired), scars after heart attacks and other changes, the heart cannot cope with the load, there is ischemia (or oxygen starvation) of the heart muscle. This phenomenon is immediately reflected in bicycle ergometry data: the nature of the load and the time of appearance of the initial signs of oxygen starvation (ischemia) are recorded.
Visually, the apparatus used in testing resembles an exercise bike. In addition to recording an electrocardiogram, in the process of “training”, there is a continuous recording of indicators of heart rate and blood pressure (ECG, heart rate, blood pressure).
The doctor who performs bicycle ergometry also monitors the patient’s breathing and general condition. With obvious signs of intolerance to the procedure, as well as with an excessive increase in heart rate, testing is stopped.
Indications recorded during bicycle ergometry are useful not only for the diagnosis of heart disease. A VEM test helps, for example, determine a person’s readiness for sports or other vigorous activity.
This study is necessary for anyone involved in sports.
An analog of this testing is the load treadmill test.
The treadmill test is carried out on a treadmill with an ever-increasing slope. Not all patients like this type of exercise test – most of all, the treadmill test procedure resembles a constant and steady climb uphill.
Treadmill test and bicycle ergometry are methods of electrocardiographic diagnostics with stress tests, which are used to detect signs of latent coronary insufficiency and determine individual tolerance of physical activity.
The load during the treadmill test is created using a treadmill, which can change the angle of the platform, and with bicycle ergometry, an exercise bike.
The basis of these two methods of examination is the fact that with a load on the ECG curve the signs of even latent myocardial ischemia are reflected – elevation or depression of the ST segment, deviations in the T and R waves, cardiac excitability or conduction.
A treadmill is required for the treadmill test. The patient follows it, at the same time his ECG is recorded. The angle of the track is gradually increasing – the situation of walking uphill is simulated. The response of the human heart to the load is evaluated.
For the treadmill test, a treadmill is used, the speed and angle of which can vary. The examinee walks along it or runs, and during the test the speed of its movement and inclination periodically increases.
The result is the results that are observed when running or climbing uphill.
For carrying out bicycle ergometry, a special type of exercise bikes is used, which can accurately dose the load necessary for the examination. In practice, the following types of bicycle ergometers are used:
- With mechanical brake system. On such an exercise bike, the load changes due to friction created by a leather belt pressing against the wheel or the brake pad system of the exercise machine. When using this exercise bike during the examination, it is necessary to observe the speed of rotation of the pedals, and it should be 60 revolutions per minute.
- With electric brake system. This exercise bike is able to provide braking with a special device (a conductor in the form of a metal strip on a wheel). During the study, the patient can make a different number of pedal rotations, but the load force will remain constant.
In addition to the treadmill and exercise bike, for conducting the techniques considered in this article, an electrocardiograph and tonometer for measuring blood pressure are used to record the ECG in 12 leads. Equipment for the treadmill test is more complicated and more expensive than for VEM.
Treadmill test and bicycle ergometry have similar indications for the appointment:
- cardiac ischemia;
- determination of the functional class of angina pectoris;
- assessment of the results of conservative and surgical treatment of angina pectoris;
- dynamic monitoring of cardiological patients (assessment of the prognosis of the disease, analysis of the condition after stenting for myocardial revascularization, etc.);
- selection of the degree of permissible physical activity during rehabilitation of patients with cardiovascular pathologies;
- determination of exercise tolerance and response of the cardiovascular system to physical activity.
In clinical practice, the treadmill test and bicycle ergometry are usually used to examine patients with coronary heart disease and evaluate the effectiveness of the treatment.
There are absolute and relative contraindications for the purpose of the treadmill test and bicycle ergometry.
In some cases, the study may be postponed to another time or canceled. Performing a treadmill test is relatively contraindicated in the following conditions:
- arterial hypertension with systolic 170 mm RT. Art. and above or diastolic pressure of 100 mm RT. Art. and higher;
- some arrhythmias;
- pulmonary hypertension;
- moderate manifestations of heart defects;
- post-infarction aneurysm without thrombosis;
- severe cardiomegaly (enlargement of the cavities of the heart);
- concomitant pathologies of other systems and organs of moderate severity.
Performing bicycle ergometry is absolutely contraindicated in the following cases:
- condition after acute myocardial infarction in the first 1-3 weeks (depending on severity);
- acute and subacute phase of stroke;
- unstable angina;
- severe ventricular arrhythmias;
- acute inflammatory processes in the tissues of the heart: endocarditis, myocarditis, pericarditis;
- heart failure III-IV class;
- atrioventricular block II-III Art .;
- severe course of aortic stenosis;
- heart defects with pronounced deviations in intracardiac blood flow;
- fainting conditions in which Holter ECG and Echo-KG were not performed;
- aneurysms of blood vessels, aorta, or heart;
- severe arterial hypertension;
- blood clots in the heart;
- suffered less than 3 months ago pulmonary infarction;
- joint or extracardiac disease, in which the load is contraindicated;
- the impossibility of contact between the patient and the doctor with mental disorders.
Bicycle ergometry can be delayed or canceled with the following diseases:
- angina attack on the day of the study;
- heart defects;
- severe arrhythmias;
- heart failure class II-III;
- arterial hypertension above 140/90 mm RT. st .;
- heart rate above 110 beats per minute;
- resting blood pressure after a stroke of more than 120/80 mm RT. st .;
- state of beta-blockers withdrawal syndrome;
- decompensated diabetes;
- hemoglobin level less than 110 g / l;
- SARS and fever;
- exacerbation of joint diseases;
- the patient did not pass all the necessary examinations to exclude contraindications.
What drugs should be discontinued before the study, and which ones should be continued, the doctor will tell.
When prescribing a treadmill test or bicycle ergometry, the doctor acquaints the patient with the procedure for performing the procedure and the purpose of the study.
Before the appointment of a treadmill test or bicycle ergometry, the following drugs may be discontinued:
- cardiac glycosides – 14 days before the procedure;
- clonidine – the dose is reduced throughout the week, and the drug is stopped taking the day before the test;
- diuretics, calcium channel blockers and prolonged beta-blockers (Bisoprolol, Concor, Nebilet, etc.) – 2-3 days before the study;
- long-acting organic nitrates (Monochinque retard, Mono poppy depot, Efox long, etc.) – a day before the procedure.
The use of blood thinners (Cardiomagnyl, Aspirin, etc.) or sugar-lowering drugs (Insulin, Diabeton, Diaformin, etc.) can continue as usual. ACE inhibitors should be taken, especially if beta-blockers were canceled before the study.
The condition after their cancellation may be accompanied by a marked increase in blood pressure and an increase in heart rate, so a stress test will be uninformative or the doctor will cancel it altogether.
Patients with severe hypertension may need to temporarily increase the dose of other antihypertensive drugs, especially ACE inhibitors, when beta-blockers are withdrawn.
On the day of the study, with the appearance of pain in the heart, the intake of fast-acting nitrates is allowed (Nitroglycerin, Izok poppy, Izoket).
However, the patient must inform the doctor about this fact, since in the event of a heart attack, the procedure can be canceled or postponed to another day.
As a rule, a treadmill test or bicycle ergometry is prescribed in the morning. On the day of the study, the patient should observe the following rules:
- take breakfast 3-4 hours before the procedure;
- refuse to take coffee or other caffeinated drinks;
- exclude the use of alcohol;
- quit smoking or minimize the number of cigarettes smoked;
- try to postpone the delivery of blood from a vein to another day or carry out the procedure 2 hours after blood sampling;
- exclude additional physical activity;
- Wear comfortable clothing (sweatpants, flat shoes) and take a towel with you.
Tips for passing (to patients)
The need to come in special clothes for this, not restricting movement, to provide the necessary load, since an incorrectly selected wardrobe can hamper movement, reduce the degree of load, or, conversely, increase it.
Since during the procedure it is necessary to pay attention to the most vulnerable areas in the electrode system – amplifiers – recording, one of which is the place where the electrodes come into contact with human skin. From this it can be seen that preparation of the skin for bicycle ergometry is no less important.
Before starting the procedure, shaved areas are wiped with a concentrated alcohol solution and wait until they dry. After draining the treated areas, these areas are highlighted with a special pencil and gently wiped with thin sandpaper or other coarse material, such as special disposable exfoliating graters, microabrasive strips, tampons with a special gel with microparticles.
When implementing these recommendations, the resistance of the skin is reduced to optimal, namely, 5000 ohms or less. It should be remembered that the most modern, such as disposable electrodes, while observing this technology, not only does not need such preparation of skin integuments as alcohol treatment, but it is also not recommended.
In this case, this can cause an increase in skin impedance due to dehydration of its upper layer (stratum corneum). When using disposable electrodes, the skin, instead of alcohol, is wiped with a damp cloth, which contributes to its degreasing and at the same time promotes hydration (the addition of water molecules to molecules or ions).
Bicycle ergometry is a functional study in which electrocardiography is performed against a background of dosed physical activity. This makes it possible to detect latent (hidden) changes in the heart, as well as impaired blood supply to the myocardium (cardiac muscle).
A modern option for bicycle ergometry is the treadmill test, in which a special treadmill is used for dosed physical activity.
During bicycle ergometry, an ECG is performed with a load that is given in steps (gradually increases to a certain level) using a bicycle ergometer (similar to a stationary bike).
In this case, the patient rotates the pedals at a certain speed (recorded using a tachometer), and the doctor gradually adds load, due to which it becomes harder to rotate the pedals.
During the entire procedure, electrocardiography is performed, which allows you to detect the slightest changes in the work of the heart, provoked by physical exertion.
Holter monitoring can also be used to detect minor or periodic changes in heart function. The cost of such a study significantly exceeds the cost of bicycle ergometry. Also, Holter monitoring requires a long period of time for the study (at least 24 hours).
Bicycle ergometry is indicated for pathological conditions of the heart, which in a normal state do not appear on the electrocardiogram, but with increased load on the body, as well as myocardial oxygen and nutrient requirements, they can be characterized by a violation of the heart condition, these include:
- Coronary heart disease – a violation of the nutrition of the myocardial site due to atherosclerotic lesions of the coronary (arteries that feed the heart) vessels, which in a calm state does not appear.
- Minimal or latent disturbances in the rhythm and heart rate (arrhythmia).
- Compensated valve defects, without pronounced hemodynamic disturbances.
A load study is also conducted to test the compensatory capabilities of the heart after myocardial infarction (including to assess the effectiveness of rehabilitation).
Absolute contraindications are distinguished (absolute when doing veloergometry is strictly contraindicated) and relative (research is possible, but there is a high probability of complications). Absolute contraindications include:
- Myocardial infarction during the acute course.
- Unstable (independent of physical activity) angina pectoris (decreased myocardial nutrition, which is manifested by the appearance of pressing pains in the heart region and characteristic changes on the ECG).
- Severe decompensation of the heart – heart failure.
- Identified stratified aortic aneurysm or suspicion of its development.
- Thromboembolism (blockage of one of the arterial vessels by a thrombus) of the lung with or without a heart attack of its tissues.
- Myocarditis (myocardial inflammation), endocarditis (inflammation of the inner heart membrane).
- Severe aortic narrowing (stenosis).
- Severe somatic (pathology of the liver, kidneys), endocrine (bazedova disease, diabetes mellitus) or infectious diseases (viral respiratory infections, bacterial processes) of various localization.
Relative contraindications include moderate valvular heart defects, chronic infections (HIV, viral hepatitis), endocrine disorders in the stage of compensation or subcompensation, aneurysm (bag-like expansion) of the left ventricle, hypertrophic cardiomyopathy (degenerative dystrophic process in the heart muscle), ventricular extrasystole (occurrence of extraordinary contractions of the ventricles with localization of the ectopic focus of nerve impulse generation in their conducting system). In case of identification of relative contraindications, the doctor decides on the issue of performing bicycle ergometry individually.
In order to avoid unreliable results, as well as the development of complications during bicycle ergometry, you should definitely follow simple preparatory recommendations, which include:
- 3 hours before bicycle ergometry, it is necessary to exclude the intake of alcohol, coffee, smoking, the intake of fatty, fried foods.
- On the day of this functional diagnostic technique, any other physical activity is excluded.
- In the event that bicycle ergometry is performed on an outpatient basis, then after it is important to make sure that someone accompanies the patient home (sometimes the development of late complications is possible).
In the case of the systematic administration of any medications (including for the treatment of diseases not related to heart pathology), it is imperative to familiarize the doctor with the list of drugs.
Carrying out bicycle ergometry for the heart is a certain stress, therefore, with concomitant severe ischemic disease, several complications from various body systems may develop:
- Heart and blood vessels – acute coronary syndrome (sharp deterioration of blood circulation in the myocardium), rhythm and heart rate disturbances (atrial fibrillation), rupture of aortic aneurysm, arterial hypotension or hypertension, heart failure.
- Respiratory organs – spasm (pronounced narrowing of the lumen) of the bronchi, especially against the background of concomitant bronchial asthma, pneumothorax (air entering the pleural cavity), exacerbation of chronic bronchopulmonary pathology.
- Nervous system – headache, dizziness of varying degrees of intensity, stroke, fainting.
- Digestive system – nausea, which may be accompanied by vomiting, abdominal pain, which is spastic in nature.
With the development of any complications, the doctor stops carrying out bicycle ergometry and provides emergency care to the patient.
Bicycle ergometry is an informative method for the functional diagnosis of various pathologies of the heart and blood vessels. It allows the cardiologist to make a definite conclusion about the nature and severity of the pathological process, as well as functional disorders. However, the diagnosis is established only on the basis of a comprehensive study, including other diagnostic methods.
Negative consequences develop extremely rarely, mainly in those suffering from any disease.
From the cardiovascular system:
- various arrhythmias – ventricular, atrial;
- circulatory arrest;
- acute coronary syndrome (acute myocardial infarction or acute angina pectoris);
- rupture of an aortic aneurysm;
- hypertensive crisis (a sharp increase in blood pressure).
From the respiratory system:
- bronchospasm (in the presence of bronchial asthma);
- exacerbation of chronic lung diseases.
From the gastrointestinal tract:
- abdominal pain;
- dyspeptic disorders (vomiting, diarrhea).
- stroke (acute cerebrovascular accident);
- loss of consciousness.
Patients with pathology of the musculoskeletal system may develop complications due to existing diseases (exacerbation of arthritis, arthrosis, osteochondrosis, etc.).
Despite the fact that electrocardiographic studies when performing bicycle ergometry are recognized as quite effective methods for studying disorders in the work of the heart and blood vessels, it is not carried out so often and is mainly used in such a category as athletes to determine the possible acceptable load for them.
This is caused by the fact that during the study, the subject must achieve the maximum load exerted on the body, which is usually acceptable to athletes, but not to patients suffering from various diseases.
This method is used in patients only if the risk of bicycle ergometry is justified by other studies, it is not possible to identify deviations from normal heart function. Since, bicycle ergometry is carried out while providing a large physical load on the body, this can provoke an additional manifestation of disturbances in the work of the heart and blood vessels.
The most common complications after performing bicycle ergometry, it is customary to include such manifestations:
- like the formation of a hypertensive crisis,
- myocardial infarction
- paroxysmal rhythm disturbances (atrial fibrillation, ventricular tachycardia).
Also, heart rhythm disturbances such as flutter and / or ventricular fibrillation may occur.
In addition, during the study, when the load is performed, the subject can lose consciousness, especially if he has previously undetected lesions of the carotid and cerebral arteries, which are usually the consequences of atherosclerosis, hypertension.
But you should not refuse to carry out bicycle ergometry. Since it is usually prescribed to patients rarely, and only if necessary, when it was not possible to establish violations in the work of the heart by another way. If the attending physician makes a positive decision regarding the conduct of an ECG with a load, then the patient must undergo the procedure, as this means that the doctor has a sufficient number of justifications for this.
It should be noted that complications during electrocardiographic studies are very rare.
The specialist conducting the examination during bicycle ergometry carefully monitors the subject, constantly measures the pressure, monitors the ECG readings, and with the slightest complications, makes a decision to interrupt the study procedure.
In addition, the examination itself is constructed according to the method of slowly increasing load, which allows you to constantly monitor the condition of the subject and, if necessary, to terminate the study in a timely manner without harming the patient.
Decoding VEM results
Decryption of bicycle ergometry is carried out only by a qualified specialist who has a medical education of the appropriate profile, as a rule, often conducting the examination itself.
His competence includes decoding the information of the research results, and he also determines the degree of deviation of indicators from the norm. As a rule, the description of the cardiogram is compiled on a separate sheet, to which the cardiogram itself obtained during the study is also attached.
This description indicates:
- The ongoing work during the study of the measuring unit is Joules (J) or kilograms per minute (kg * m / min) and the threshold power in watts.
- Mandatory reasons are indicated for which bicycle ergometry was discontinued. These include the achievement of the maximum allowable load. As well as changes in indicators identified during the study, in which further stress test without harm to the body is impossible.
- The degree of physical performance.
- Changes in Blood Pressure and Heart Rate.
- The time period during which blood pressure, heart rate, and ECG changes completely recovered. It is considered normal if the heart regains its usual rhythm in 5 minutes.
- Reaction Blood pressure on the exercise load, that is, the achieved maximum blood pressure level is indicated. Moreover, if it is more than 190/100 mm. Hg. Art., then this means that the patient has a hypertensive type of reaction, which indicates the need for the appointment or change of antihypertensive therapy.
- Be sure to indicate the presence or absence of cardiac arrhythmias. If there are violations, their degree is described. With indicators without deviation from the norm, the sinus rhythm is normal. In this case, sinus tachycardia is allowed at a level of 50-60% of the initial heart rate at rest.
- Coronary Disorders If changes in the heart rhythm on the ECG are detected, it is mandatory to indicate what they are and how much time it took for them to return to normal.
- The functional class of IHD is taken into account based on the degree of load.
At the end, a general conclusion (conclusion) is also indicated, as a rule, there are 3 types of them:
- Positive – a person has deviations in the work of the heart organ;
- Negative – no ECG changes were detected;
- Doubtful – a person during the study became concerned about pain in the chest and / or heart, dizziness, and other health problems. In this connection, the study was terminated.
In addition, it is necessary to indicate the location on the body of the electrodes in the conclusion.
Thus, in conclusion, the presence or absence of ischemic heart disease, reactions of blood pressure to the stress test, the timeliness of normalization of indicators, as well as the degree of permissible physical load on the subject are indicated.
Hardware data includes parameters such as:
- patient performance level;
- heart rhythm, detected violations (if any);
- скорость восстановления Артериальное давление и ЧСС;
- type of reaction of blood pressure to the load;
- severity of ischemia;
- time and reason for termination of testing, etc.
After interpreting the data, the patient is issued a conclusion.
Negative VEM test – upon reaching maximum load, normal physiological parameters were preserved. IHD in most cases is excluded.
A positive result – changes on the ECG that speak of ischemia, often accompanied by an attack of angina pectoris, are recorded.
Doubtful result – the subject complained of pain, but there were no changes on the ECG.
Uninformative test – the study was not fully completed, the patient refused to continue testing because of dizziness, severe headache or seizures, although there were no signs of coronary artery disease.
With all the informational content of bicycle ergometry for most patients, the uncertainty of the results of a particular test may require the appointment of additional studies.
The interpretation of the treadmill test is practically no different from the interpretation of the VEM results. Normal indicators for the treadmill test, as well as the VEM test, are negative indicators.
Do not know where to undergo bicycle ergometry in Moscow? We invite you to do this in our multidisciplinary clinic!
The cost of the procedure is affordable and adequate. Modern high-precision equipment, experience and qualifications of our cardiologists, ultrasound diagnostics specialists and other doctors allow us to state: the examination at MedicCity is always reliable and informative!
An electrocardiographic study during bicycle ergometry is one of the most accurate and effective ways to establish indicators of the cardiovascular system. Its primary goal is to establish the presence or absence of disturbances in the activity of such a vital system as the cardiovascular system, as well as the establishment of ultimate physical capabilities while providing load on the body. This method is the most common due to its availability and accuracy of establishing the efficiency of the human heart.
Most often it is used among a category of people with complaints similar to diseases of the cardiovascular system, it is used where it was not possible to establish the causes of characteristic pain for heart dysfunction using conventional studies and techniques.
Thus, it can be reasonably concluded that, thanks to the methodology of conducting an electrocardiological study during bicycle ergometry, this study is able to most fully and fully examine the state and activity of the cardiovascular system, identify irregularities in its operation, and also establish the physical endurance system of an individual load that cannot be detected by any other studies.
But, unfortunately, it is not possible to use this research method for absolutely all people, due to the fact that it is associated with a large physical load on the body. In this connection, it is contraindicated to many patients, although it is possible and is the only sure way to investigate and determine the degree of impaired activity of their cardiovascular system.
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