Stress Echocardiography types of procedure their pros and cons preparation and conduct

Stress echocardiography, or stress echocardiography is an ultrasound scan (ultrasound) of the heart before and after loading it. The load can be given in the form of movements (for example, walking on a treadmill), medication or electrical stimuli. The purpose of this effect is to accelerate heart contractions and identify areas of the myocardium that arise with a lack of oxygen.

An early manifestation of ischemia is a decrease in contractility of the heart muscle region in response to stress, while normally this contractility remains unchanged or increases. The movement of the heart wall is clearly visible with echocardiography:

  • First, it is evaluated before the test.
  • Then the patient is either injected with a drug that increases the pulse, or they are offered to perform physical activity.

The introduction of the dobutamine medication in many cases is preferable to a load test. When walking on a treadmill, some patients cannot reach the desired heart rate, some appear to have rhythm disturbances or other obstacles to continue the test, as well as quicker breathing. All this negatively affects the accuracy of diagnosis.

Pharmacological tests cause more complications than stress tests. If a test with physical activity is used, it is preferable to do it on a “recumbent” bicycle ergometer. This device allows the patient to pedal in the supine position rather than stand on the track, and upon termination of the load very quickly move to the couch.

To determine myocardial ischemia in cardiology, ECG recording at rest, daily ECG monitoring, VEM, treadmill test, pharmacological tests, myocardial scintigraphy are used. Among these studies, stress echocardiography is distinguished by high sensitivity (74-97%) and specificity (%). The method of stress echocardiography combines two-dimensional echocardiography and a stress test, allowing you to identify the ischemic response of the myocardium to one or another type of controlled provocation. The main criterion for stress echocardiography is the pathological kinetics of the left ventricle, recorded in response to the induced load.

In the process of conducting stress echocardiography, various types of loads are used: physical (VEM vertical or horizontal, walking on the treadmill, isometric load, etc.), electrical stimulation of the atria (direct or transesophageal), pharmaceutical tests (with ATP, arbutamine, dobutamine, adenosine, ergonin, dipyridamole) and others (hyperventilation, cold).

Diagnostic benefits of stress echocardiography include the ability to visualize the heart in multiple sections and a detailed study of segments of the left ventricle; excellent spatial resolution; admissibility of the assessment of general and regional contractility of the heart. Stress echocardiography is a non-invasive safe technique that can be repeated several times and has a relatively low cost compared to coronary angiography and myocardial perfusion scintigraphy.

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In recent years, methods for examining the heart have reached unprecedented heights. In addition to the usual cardiogram, there are many ways to determine the quality of a person’s heart. What is stress echocardiography (stress echocardiography), to whom it is shown and how is it performed, you will learn from this article.

Stress echocardiography refers to inexpensive methods of non-invasive imaging of the heart, is “friendly” to the patient, as it is quickly performed. The sensitivity and specificity in the diagnosis of coronary heart disease is higher than with stress tests using electrocardiography. It is currently considered the most affordable method for diagnosing coronary insufficiency and has been used in cardiology for the past 30 years.

Currently, methods for examining the heart and other important organs have reached unprecedented heights. In addition to a simple cardiogram, in practice, a huge range of methods are used to establish how your heart works.

Stress echocardiography is an ultrasonic modern method of studying the work of the heart, which is accompanied by an increase in the frequency of its contractions. This is one of the most popular and leading methods used by cardiologists. Stress echocardiography is performed in order to record objective signs of ischemia, which can be induced by overvoltage or the use of drugs. Failures in violation of the frequency of contractions of the heart irreversibly lead to the appearance of foci of the myocardium. It is these areas that the doctor determines during the study.

The study is absolutely safe, suitable for people of any age category and even pregnant ladies. Also, this ultrasound is painless, which indicates a clear advantage.

  1. Pressure in the aorta, ventricle, and atrium;
  2. Changes in the outer heart membrane;
  3. Blood flow in the chambers of the heart;
  4. Functionality of the valve mechanism of the heart;
  5. Level of contractions of the heart muscle;
  6. The thickness of the heart walls and their integrity;
  7. Heart size
  8. Tumor;
  9. Hydropericardium

The fundamental principle justifying the use of stress echocardiography is that with the development of coronary ischemia in the myocardium of the left ventricle, there is a violation of its contractility in the area corresponding to the stenotic coronary artery basin. Disorders of local kinetics associated with ischemia appear after a violation of blood flow through the coronary arteries (but before angina pain and ECG changes!

) and have a transitory character. In a viable myocardium in a state of chronic ischemia, an inotropic reserve is maintained, and partial or complete restoration of blood flow, leading to a decrease or elimination of ischemia, is accompanied by the dynamics of local contractility. Registration of the response of individual segments of the left ventricular myocardium to the load and changes in coronary blood flow is the problem to be solved during stress echocardiography.

Stress echocardiography is a comprehensive method in which, in the process of performing a stress test, echocardiographic imaging of the heart and ECG recording are simultaneously performed.

  1. Diagnosis of coronary heart disease:
  • the presence on the initial ECG of changes making impossible an adequate interpretation of the ECG during exercise (intraventricular blockade, left ventricular hypertrophy with secondary changes in the ST segment, WPW syndrome, ventricular electrocardiostimulation, etc.);
  • painless myocardial ischemia;
  • dubious results of an ECG load test;
  • negative result of stress ECG test with clinical suspicion of angina pectoris.
  1. Assessment of the functional significance of lesions of the main coronary arteries.
  2. Assessment of myocardial viability in patients with extensive disorders of myocardial contractility:
  • after a myocardial infarction and acute coronary syndrome (diagnosis of a “sleeping” (hibernating) myocardium, identification of myocardial patches at risk of ischemic damage);
  • in chronic forms of coronary heart disease;
  • before cardiac revascularization procedures.
  1. Evaluation of the effectiveness of myocardial revascularization (bypass surgery, angioplasty, stenting of the coronary arteries).
  2. Evaluation of the effectiveness of drug therapy.
  3. Assessment of the forecast of the course of coronary heart disease.
  4. Assessment of the risk of complications:
  • with operations on the heart, aorta, lungs;
  • during heavy non-cardiac surgery.
  1. Valve defects:
  • assessment of the effect of physical exertion on asymptomatic valvular defects to establish the timing of surgery.
  1. Cardiomyopathies:
  • assessment of contractility in dilated cardiomyopathy;
  • study of the pressure gradient in the outflow tract of the left ventricle with hypertrophic cardiomyopathy with obstruction.
  1. To address the issues of the examination of disability.

The organization of stress echocardiography involves the fulfillment of a number of mandatory requirements for equipment, personnel and the place of the study.

To perform stress echocardiography, modern ultrasound systems are used that integrate special software for presenting and processing data. Workstations compatible with standard ultrasound systems of the appropriate level are offered. The images obtained in standard positions at rest and at various stages of the load test in real time are recorded with ECG (cine loop mode) simultaneously, which allows them to be analyzed by matching on the monitor screen (side-by comparisons).

Extremely important technical aspects are the ability to record all stages of stress echocardiography on a VCR and the availability of a large amount of memory for archiving images obtained during the study. Improving the information content of the method is achieved using color tissue dopplerography, a technique for automatically determining the endocardium, modulating the anatomical M-mode, colorkinesis and Strain Rate methods, and contrast echocardiography.

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What it is?

  1. Diagnosis of coronary heart disease:
  1. Valve defects:
  1. Cardiomyopathies:
  • Uninformative any other stress test
  • The inability to conduct a stress test (physical exercise test) due to non-cardiac restrictions (diseases of the joints, nervous system and others)
  • Changes in the electrocardiogram that make the stress test impossible (blockade of the left leg of the bundle of His, severe hypertrophy of the left ventricle with impaired repolarization of the resting ECG, and others);
  • Assess the effectiveness of interventions (angioplasty, stenting, CABG) on the vessels of the heart
  • Identification of areas of myocardium with impaired contractility (zones of ischemia and myocardial hibernation).
  • Diagnosis of myocardial ischemia with the inability to conduct a test with physical activity
  • Identification of problem areas of the heart muscle after myocardial infarction to determine indications for cardiac revascularization (CABG, stenting)
  • Assessment of the severity of valvular defects

Stress echocardiography: indications, contraindications, preparation, research methods

2 doctors (a diagnostician with EchoCG technique and a stress test specialist) and a nurse assistant are involved in stress echocardiography. All personnel involved in the implementation of stress echocardiography should have the skills to provide emergency cardiopulmonary resuscitation, and the office must have the necessary equipment (defibrillator) and medications.

The next stage of stress echocardiography involves provoking ischemia in a selected way (using dynamic physical activity, a pharamcological test, PE EX, etc.). During the test, all changes in the ECG, heart rate and blood pressure are monitored and recorded. When using a horizontal bicycle ergometric test, pharmacological tests, transesophageal electrical stimulation during the stage of provocation of ischemia during stress echocardiography, monitoring and storage of echocardiographic data are performed.

Основаниями для прекращения нагрузочных проб при стресс-эхокардиографии могут служить отказ пациента продолжать нагрузку, появление неприемлемых побочных эффектов (головной боли, тошноты, критического подъема Артериальное давление и др.), а также регистрация ишемических маркеров. К маркерам ишемии относятся клинические (боли за грудиной, снижение АД, признаки периферической или мозговой гипоперфузии), электрокардиографические (элевация или депрессия сегмента ST без измененного зубца Q, развитие опасных аритмий) и эхокардиографические (определение нарушений региональной сократимости ЛЖ) проявления.

In the post-stress period, stress echocardiography again recorded an echocardiogram in standard sections with the preservation of the video loop. At the final stage of stress echocardiography, all successively received video images are reproduced on a single screen, cardiac cycles are synchronized, and the nature of the mobility of the myocardial sections is compared.

Transthoracic stress echocardiography is performed with the patient lying down on his side. Thanks to this position, it is possible to achieve rapprochement of the left part of the sternum with the apex of the heart, which will provide incredibly accurate visualization of the heart muscle, and all four heart chambers will be visible on the computer monitor. This will allow the cardiologist to more meaningfully analyze the situation and make a final conclusion.

The quality of ultrasound is directly dependent on three important aspects:

  • Physical data of the subject, obesity, as well as pulmonary emphysema and curvature of the chest, creating a powerful barrier to ultrasound;
  • Quality of technology;
  • Doctor’s technical skills and ability to decrypt the image exactly

Before conducting stress echocardiography, the patient is prescribed a usual ultrasound of the heart. Special sensors during the test will allow you to register an image on the monitor during load. After that, the researcher is offered the following types of sports: running on a track, pedaling on a bicycle ergometer. The degree of minimum load is established in advance, after which it is gradually increased, based on the level of blood pressure. If a person worsens, the test is immediately stopped.

Conducting stress echocardiography using a treadmill

Often, research is carried out using medicines such as dipyridamole and others. This particular substance is injected into a vein, causing an increase in heart contractions. With such a test, the patient first conducts the study itself, then the drug is administered, and after that the test resumes again.

The duration of the ultrasound varies within minutes, not more. It is not surprising that after administering the medicine you may experience discomfort: dizziness, heart palpitations. As the drug is discontinued, its effect is gradually weakened, leading to a normal pulse.

For adequate echocardiography, the cabinet should be darkened.

The diagnostic value of stress echocardiography largely depends on the quality of the test and the researcher’s experience in interpreting the data. Both medical staff and patients should have sufficient space for free movement and stress testing.

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Advantages

Stress echocardiography is a more informative study than treadmill or VEM, because it allows you to detect myocardial ischemia that occurs during exercise, even when it is not visible on the ECG.

Stress echocardiography reveals earlier signs of ischemic heart disease than bicycle ergometry or treadmill test. This is due to the fact that with a lack of oxygen:

  • at first, the process of reducing the affected area worsens (as is seen with ultrasound);
  • then there are changes on the ECG (which is noted with a stress test);
  • and later there is pain behind the sternum, which the patient begins to feel.

In terms of sensitivity, stress echocardiography is comparable to radionuclide methods, but it is much more technically simpler and does not carry a radiation load on the patient and medical staff.

The accuracy of the diagnosis of stress echocardiography strongly depends on the qualifications of the doctor performing it. Usually, after 100 independently conducted tests, the specialist is well versed in the method and does not make mistakes. In general, stress echocardiography is recognized as the best, cheapest and safest non-invasive way to diagnose coronary artery disease.

The principle of diagnosis

  • dipyridamole (chimes)
  • enoximon;
  • adenosine.

Показания

Stress echocardiography can be prescribed in such cases:

  • diagnosis of coronary heart disease, for example, the presence of pain in the patient’s chest, especially associated with the load;
  • assessment of the prognosis of the disease with a known diagnosis, for example, clarification of the severity of myocardial damage after a heart attack;
  • assessment of the risk of a heart attack before any operation in patients with a high risk of heart complications;
  • preparation for angioplasty, stenting, coronary artery bypass grafting;
  • recognition of cardiac causes of dyspnea;
  • assessment of cardiac recovery after stenting or coronary artery bypass grafting;
  • determination of myocardial sites that do not receive a sufficient amount of oxygen;
  • determination of the severity of valvular defects.

With coronary artery disease, most patients are prescribed bicycle ergometry or treadmill, and this is quite reasonable. Stress Echocardiography requires high-quality equipment and highly qualified medical staff. Not every institution involved in the care of cardiological patients in Russia can carry out this study.

Stress echocardiography is most indicated for patients who have:

  • contraindications for stress tests, for example, high pressure;
  • the inability to perform a stress test, for example, with arthrosis or varicose veins;
  • dubious result of a stress test;
  • complete blockade of the left leg of the bundle of His on an ECG;
  • low fitness;
  • the presence of a pacemaker.

Противопоказания

In acute coronary syndrome, stress echocardiography is contraindicated.

There are absolute contraindications to this study, in which it is not applied, and relative – testing is performed when it is impossible to clarify the diagnosis by other methods and the need for urgent treatment.

Absolute contraindications to stress echocardiography:

  • the first 2 days after a heart attack;
  • acute coronary syndrome (increased, increased chest pain, weakened effect of nitroglycerin or increased need for it);
  • heart rhythm disturbances that can not be stopped medically and accompanied by pressure instability, dizziness, fainting, and other significant clinical manifestations;
  • aortic stenosis with an aortic valve opening area according to echocardiography up to 0,75 cm2;
  • acute inflammation of the heart muscle (myocarditis), external (pericarditis) or internal (endocarditis) membranes of the heart;
  • stratified aortic aneurysm (formation of a cavity in the wall of this vessel with its subsequent enlargement and rupture);
  • progressive heart failure, for example, the development of pulmonary edema;
  • pulmonary embolism, pulmonary infarction;
  • intolerance to drugs used for pharmacological testing.

These diseases are accompanied by a serious condition of the patient and intolerance to the load. In such situations, the usual ultrasound examination of the heart at rest is quite informative.

  • proven stenosis of the left coronary artery – a large vessel that supplies blood to a significant portion of the myocardium;
  • severe stenosis of the heart valves;
  • significantly increased blood pressure, not amenable to drug therapy;
  • left ventricular aneurysm (thinning and bulging of the heart wall, for example, as a result of a heart attack);
  • persistent bradycardia, for example, sick sinus syndrome;
  • tachyarrhythmias – in particular, continuously recurring supraventricular tachycardia;
  • AB blockade of the II-III degree;
  • mental illness;
  • acute infections, febrile conditions.

In most cases, doctors act on these diseases, stabilizing the patient’s condition, and only after that conduct stress echocardiography.

These complications rarely occur, in one case for 2-3 thousand studies. Doctors provide assistance to such a patient on time, and in most cases he will recover later.

A cardiologist directs stress echocardiography. The patient must first be examined. He performs ECG, daily monitoring of ECG, EchoCG at rest, exercise tests (bicycle ergometry or treadmill).

A specially trained physician of functional diagnostics with experience in conducting such a test performs the study. Despite the fact that stress echocardiography is an accurate, informative and safe diagnostic method, the lack of qualified personnel and the necessary equipment limits its use in Russian clinics.

Stress echocardiography (stress echocardiography)

Stress echocardiography is performed mainly to diagnose coronary disease or heart defects.

Indications for stress ECHOCG may include:

  • heart surgery;
  • identification of workable myocardial sites;
  • assessment of myocardial performance after a heart attack;
  • changes recorded by the electrocardiogram;
  • doubtful results of stress tests;
  • chronic forms of ischemic disease;
  • evaluation of the effectiveness of drug treatment;
  • prognosis for coronary disease;
  • assessment of possible complications before the upcoming heart surgery;
  • suspected angina pectoris;
  • assessment of a person’s ability to work.

Also, stress echocardiography is necessary for someone who:

  • sometimes feels pain in the heart;
  • collides with edema;
  • suffers from shortness of breath;
  • tormented with high blood pressure;
  • knows that he has any kind of heart disease.
  • acute thrombophlebitis;
  • acute heart attack;
  • obesity;
  • aortic aneurysm;
  • serious thyroid disease;
  • pregnancy;
  • intolerance to the drug used to conduct the study;
  • high pressure;
  • mental illness;
  • unstable angina;
  • acute infectious diseases;
  • severe heart rhythm disturbances and high heart rate.

Like any diagnostic method, the method of stress echocardiography has its pros and cons.

  • will allow you to identify irregularities in the heart, invisible in a calm state of the patient;
  • accurate and highly informative;
  • does not require special preparations;
  • painless;
  • does not irradiate the body.
  • impossible to carry out without trained specialists;
  • complications are possible;
  • not suitable for all patients, depending on the presence of any disease.

Summing up, what exactly is stress echocardiography, let’s say – this is a modern and highly informative method to detect cardiac abnormalities.

And if it is carried out by good specialists, then there is nothing to worry that something will go wrong. At the same time, stress echocardiography is a relatively inexpensive diagnostic method and will not hit hard on your budget. But you will know in what condition your heart is now.

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What it is?

Local disturbance of the contractile function of the heart is an earlier sign of coronary heart disease than changes in the electrocardiogram. Therefore, stress echocardiography is able to detect this disease at an earlier stage than conventional stress tests (bicycle ergometry or treadmill test).

Sometimes loading tests are impossible due to pronounced changes in the electrocardiogram, for example, with blockade of the bundle branch, left ventricular hypertrophy, and in other cases.

StressEchocardiography does not have such restrictions, since it does not evaluate the cardiogram, but the appearance of the heart muscle.

This examination can be performed in individuals in whom it is impossible to conduct stress tests due to cardiac restrictions (for example, due to joint disease).

However, the use of this examination as a routine technique is not recommended, since it requires highly qualified personnel and is associated with a risk of complications.

As prescribed by a cardiologist, certain drugs, in particular, nitrates and beta-blockers, are canceled. The rules for their cancellation are the same as with a normal load test. On the day of the study, you can use nitroglycerin to stop the attacks of angina pectoris, but you must warn your doctor about this before the examination.

6 hours before the test, you can not eat food, it is advisable to limit the intake of fluid.

The day before the study, you must give up caffeine, in the morning before the procedure you can not smoke.

If a test with physical activity is used, the patient will perform an exercise on a bicycle ergometer or treadmill according to the usual protocol. Before the load begins and after its completion, an ultrasound examination of the heart will be performed. This option is rarely used in practice due to technical difficulties in implementation.

Stress echocardiography with medications, such as dobutamine or dipyridamole, is most commonly used. These substances are administered intravenously and cause an increase in heart rate, as with exercise.

With a medical test, the patient undergoes echocardiography, then the drug is administered intravenously, after which the ultrasound is repeated. The duration of drug exposure is usually about 10 to 15 minutes.

During the study, an electrocardiogram is continuously recorded, which allows you to quickly respond to all changes in the activity of the heart. When the drug is administered, the patient may feel palpitations, discomfort in the heart or behind the sternum, dizziness.

After stopping the administration of the drug, the pulse rate decreases. In some cases, additional administration of other medications may be necessary to normalize the work of the heart. The patient’s condition is monitored until all functions of the heart are fully restored. The total procedure time is about one hour.

Coronary artery disease:

  • uninformative load test;
  • the inability to conduct a stress test due to heartless restrictions (diseases of the joints, nervous system, and others);
  • changes in the electrocardiogram that make the stress test impossible (WPW syndrome, blockade of the left bundle branch, severe left ventricular hypertrophy, and others);
  • after operations on the vessels of the heart;
  • determination of viability of myocardial sites with impaired contractility.
  • for measuring pressure in the pulmonary artery with mitral defects;
  • suspicion of mismatch in the size of the valve prosthesis;
  • examination for coarctation of the aorta.
  • Severe heart disease (acute stage of myocardial infarction, unstable angina, aortic aneurysm, severe heart failure, severe aortic stenosis and other heart defects, severe heart rhythm disturbances);
  • acute thrombophlebitis (due to the risk of thromboembolic complications);
  • pregnancy;
  • acute infectious diseases, including with fever;
  • intolerance to the medicine used for the test;
  • high blood pressure, frequent pulse;
  • decompensation of diabetes mellitus, severe thyroid dysfunction, severe obesity;
  • mental disorders;
  • patient failure.
  • An impressive list of opportunities for studying the features of the functioning of the heart muscle.
  • Portability of echocardiographic equipment, which allows tests to be performed outside the hospital.
  • The relatively low cost of diagnosis.
  • The possibility of a qualitative assessment of the nature of myocardial thickening.
  • Safety procedures for the patient.

Stress echocardiography can be performed on an outpatient basis or while the patient is in the hospital. Typically, the study is conducted by certified doctors who have received special training and are involved in the treatment of diseases of the cardiovascular system. Stress echocardiography consists of three stages:

  • Echocardiography alone. The patient is laid on the couch, the gel is applied to the left side of the chest, after which the doctor performs an ultrasound examination of the heart at rest. Heart rate and blood pressure are also measured.
  • Stress test. The patient is invited to either pedal or walk on a treadmill. In this case, physical activity increases gradually. It is important to inform the doctor in time if chest pain, shortness of breath, weakness in the legs, or dizziness have appeared. A stress test ends when it reaches a certain heart rate or changes appear on the ECG (an electrocardiogram is performed during the test).
  • After the load. It is proposed to lie back on the couch, the doctor performs repeated echocardiography.

The first stage of stress echocardiography with dobutamine is similar to the test with physical activity. During the second stage, pharmacological is carried out instead of mechanical loading. Dobutamine is administered intravenously for 20 minutes. With this, a certain pulse rate and blood pressure are achieved. Then they wait until the heart rate returns to normal, and then a second ultrasound of the heart is performed.

Typically, the duration of the procedure does not exceed 1 hour, but sometimes it can drag on for two and a half – three hours. As a rule, after examination, patients receive an opinion on their hands. Nevertheless, there are times when you have to wait for the results of two to three days.

The study of the heart can be carried out by various methods: electrocardiography, ultrasound, dopplerographic, duplex, radiographic, electrophysiological studies, radioisotope method, phonocardiography, etc.

For stress echocardiography we use the latest equipment: SonoScape s40 ultrasound scanner, infusomat, 6–12-channel electrocardiograph. The use of modern technology allows to obtain highly accurate survey results. At SM Clinic, stress echocardiography is performed by highly qualified specialists:

  • visualize the departments of the heart in different sections and examine in detail the segments of the left ventricle;
  • quickly and accurately identify changes in the myocardium (to determine the topic of coronary vascular damage), which cannot be determined in a calm state or during a regular ECG
  • examine patients who are contraindicated in physical activity.

Unlike conventional echocardiography, stress echocardiography with dobutamine is carried out in several stages.

  • Echocardiography in a calm state. You need to undress to the waist and lie on the couch on your left side. The doctor will apply a special gel to the chest and with the help of an ultrasound transducer and monitor will evaluate the condition of the heart and the technical ability (ultrasound window) to perform this test.
  • Stress Echocardiography. The standard StressEchoCG protocol involves continuous intravenous administration of dobutamine through a catheter inserted into the peripheral vein, starting with a minimum dose that gradually increases every 3 minutes until the doctor determines the criteria for terminating the load. The total duration of the load is no more than 15 minutes.
  • Echocardiography and ECG monitoring are carried out during the entire study with an assessment of local myocardial contractility at control points of the study in comparison with the initial state of the myocardium. It is possible to compare the results of the current stress echocardiography study with the previous one.
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The underlying principle of stress echocardiography

Stress echocardiography. What is this, you can understand from the name of the diagnosis. “Echocardiography” is an ultrasound examination of the heart, “stress” means artificial stimulation of the organ’s energetic work. The main field of activity of stress echocardiography is the study and diagnosis of ischemic heart disease. The initial sign of coronary disease – focal disorders of myocardial contractions, are not always visualized on an electrocardiogram. IHD (coronary heart disease) develops due to a deficiency in the supply of oxygen to the organ.

This factor manifests itself gradually:

  • the contractile activity of the affected area of ​​the myocardium is impaired;
  • malfunctions appear on the electrocardiogram;
  • painful squeezing behind the sternum begins to bother.

Having provoked the load, the uzist, determines the areas affected by coronary artery disease before it reveals an ECG. On the monitor of the ultrasound machine, the external signs of pathology are clearly displayed. Similar studies of cardiac activity with the use of load: bicycle ergometry (ECG with cycling) or treadmill (cardiogram with a breakdown on the treadmill), have less information.

With coronary artery disease, most patients are prescribed bicycle ergometry or treadmill, and this is quite reasonable. Stress Echocardiography requires high-quality equipment and highly qualified medical staff. Not every institution specializing in cardiological care in Russia can perform this study. Stress Echocardiography is most indicated for patients who have:

  • painless myocardial ischemia;
  • angina pectoris;
  • to assess cardiac dysfunction during exercise and rest. For example: heart rate, blood flow velocity, blood pressure, etc .;
  • assessment of the state of the myocardium after a heart attack, etc.

Stress echocardiography allows you to record the reaction of individual zones of the left ventricular myocardium to increased, sharp loads that are on the patient’s body. In addition to bringing the cardiovascular system to a state of overstrain, when performing a study, the performance of the heart muscle is also visualized in the form of a graph, which makes the method an effective tool for conducting complex diagnostics.

In what cases is this type of diagnosis used? Stress echocardiography is prescribed to patients:

  • with suspected development of painless myocardial ischemia;
  • the need to assess the condition of the coronary arteries;
  • study of the viability of myocardial tissue;
  • heart attack, chronic forms of coronary heart disease;
  • the need for surgical intervention aimed at shunting, stenting, angioplasty of the coronary arteries;
  • the need to evaluate the results of therapy with the use of medications;
  • forming a prognosis of the development of cardiac pathologies;
  • assessing the likelihood of complications after treatment of cardiovascular diseases;
  • preparation for complex operations on the heart, lungs, aorta;
  • the need to identify congenital pathologies of heart valves;
  • conducting an examination aimed at assessing the patient’s ability to work.

If conventional heart ultrasound is a harmless procedure, then stress echocardiography is a serious analysis. Which, without proper preparation, can even harm the body, although it can be produced many times.

48 hours before the analysis, they stop taking drugs (for this they consult with a cardiologist), it is also forbidden to smoke and drink alcoholic and caffeinated drinks.

3 hours before the start of the procedure, stop eating and reduce physical activity to a minimum. You can drink water at the same time.

For the procedure, you should dress in loose clothing and shoes, as physical activity will be assumed, because this is stress echocardiography.

Stress echocardiography itself is performed as follows:

  1. First, an ultrasound of the heart and large vessels near him is carried out in a calm state.
  2. After fixing the results, the actual stress echocardiography with physical activity is performed. To do this, the patient moves on a vertical or even horizontal exercise bike, and the diagnostician fixes all the indicators that change under load. This is the heart rate, cardiogram readings, blood pressure. And negative symptoms: headache and dizziness, shortness of breath, chest pain, etc.

Research is carried out until the patient has results that correspond to his age, gender, level of physical development. Then again do an ultrasound of the heart.

If stress echocardiography is performed using drugs, the procedure has a peculiarity: the doctor must record the results of the ECG throughout the study.

Then the results are recorded in a special protocol and saved even after decoding of echocardiography is performed. At the end, a doctor’s conclusion is drawn up, as well as recommendations regarding physical activity.

During the procedure, the ECG readings are continuously recorded, as well as the patient’s blood pressure. They do this both before the load and after it (treadmill, bicycle ergometer, etc.).

Due to stress echocardiography with physical activity, it is possible to detect myocardial ischemia in the early stages. To evaluate which tissues in the area of ​​scars of the heart muscles remained alive, to measure not only the dimensions of the refined walls of the heart, but also to evaluate their contractility.

Stress echocardiography is just an additional examination method. Therefore, it is used when the doctor needs to collect more information about the disease or when the classical methods do not allow to identify the disease. For example, with coronary artery disease stress echocardiography is used in the following cases:

  • if the load ECG test gives false positive results. They may be associated with medication, heart defects, the presence of left ventricular hypertrophy, etc .;
  • when it is impossible to accurately interpret the results of the ECG. It may be in the case of blockade of the bundle of His, unstable ECG readings at rest, as well as in the presence of a pacemaker;
  • if it is necessary to compare the results with anatomy (control of revascularization, correlation with catheterization);
  • to get more specific results.

In addition, stress echocardiography is used by cardiologists if you need to find out how affected the heart valves or clogged parts of the ventricles and atria. And find out how this will affect the work of the heart in the load.

  • in starting position;
  • at maximum load;
  • and during recovery.

Next, the patient is set electrodes for reading the ECG, as well as for the operation of the ultrasound apparatus. That is why the doctor receives not just a visualization of the heart, but can simultaneously receive the results of an analysis of heart rate, ECG, blood pressure, etc.

If the heart is in order, and all its parts work without pathology, with a smooth increase in load, the functionality of all parts of the organ should also smoothly increase.

If stenosis is located on some part of the coronary artery, the size of which is hemodynamically significant, over time, the part of the myocardial contractile tissue fed by this vessel will begin to work worse, or the contraction will stop abruptly.

Using ultrasound, you can calculate where this zone of temporary disturbance of myocardial contractility is located. And then evaluate the degree of damage to the coronary arteries. This will allow the doctor to know all the risks of the patient and choose the appropriate treatment.

Analysis of results

The result of stress echocardiography is the receipt of two-dimensional graphic images. The latter make it possible to identify failures in the contractility of the left heart ventricle. When decoding the results, the degree of thickening and mobility of myocardial tissue in individual zones is taken into account.

A preliminary analysis of the graphs is performed by a specialist immediately after receiving them. Upon completion of the diagnosis, the cardiologist can view the video recording of the study in slow motion. Individual fragments of the procedure are often stored on computer disks and represent a good information base for subsequent diagnostic measures.

The normal myocardial response in response to stress during stress echocardiography is characterized by LV wall hyperkinesis, an increase in the ejection fraction, the absence of wall kinetics disturbances, wall thickening during systole, and a decrease in end systolic volume. With a pathological response (a positive stress echocardiography test), zones with a violation of kinetics (akinesia, hypokinesia, dyskinesia), an increase in the final systolic volume of the LV, a decrease in the thickening of the walls in the systole, a decrease in PV to 35% and lower, an increase in the pancreas, etc. can be determined.

When deciphering the results, the cardiologist evaluates the condition of the walls, their systolic thickening (segmented tour) and other parameters. The severity of ischemic changes is determined by the number of affected areas of the left ventricle, the type of change in contractility of the myocardial segments (appearance, preservation of areas of hypo-dyskinesia, or the appearance of zones of myocardial hyperkinesis), the duration of development and disappearance of the revealed disorders.

Possible complications

In rare cases, the following negative manifestations are possible: convulsive syndrome, high-frequency contraction of the heart ventricles (fibrillation), ischemic attack, a sharp decrease / increase in pressure. In the diagnostic room should be provided with everything necessary for emergency resuscitation. Stress echocardiography is a procedure that is performed only by professionally trained medical specialists, and strictly on the recommendation of a treating cardiologist.

During stress echocardiography, unwanted effects may develop that will be the basis for terminating the study: headache, muscle tremors, nausea, ventricular and supraventricular extrasystole. Small complications of stress echocardiography include short episodes of paroxysms (up to 2 minutes), hemodynamically insignificant tachycardia.

The cost of the study varies depending on the type of stress tests. When pricing, take into account the duration and complexity of the test for a specialist, as well as the need for additional costs (for example, when conducting samples with drugs). In addition, the price of stress echocardiography in Moscow is determined by the type of medical and diagnostic institution (public or private), the urgency of the diagnostic procedure and the level of specialist training.

In Moscow, stress echocardiography costs 5133r. (average). The procedure can be completed at 67 addresses.

When testing, there is always a risk of complications:

  • myocardial infarction;
  • ventricular tachycardia;
  • acute heart failure;
  • ventricular fibrillation;
  • convulsions;
  • prolonged attack of ischemia;
  • a sharp decrease in blood pressure;
  • AB blockade of the II-III degree;
  • death.

In rare cases, the following negative manifestations are possible: convulsive syndrome, high-frequency contraction of the heart ventricles (fibrillation), ischemic attack, a sharp decrease / increase in pressure. In the diagnostic room should be provided with everything necessary for emergency resuscitation. Stress echocardiography is a procedure that is performed only by professionally trained medical specialists, and strictly on the recommendation of a treating cardiologist.

How to prepare for the study?

The human heart needs special attention, as it is an organon that supplies all the cells of our body with the most necessary. If the first failures in his work occur, we should contact a cardiologist to help him figure out the causes of the violation.

To conduct an ultrasound diagnosis, you really need to get ready. Of course, in most sources you will find information that an ultrasound of the heart can be done several times a day without preliminary preparation, but this is not so.

There are certain rules and recommendations that it would be advisable to consider before going to an ultrasound scan. So, before conducting an ultrasound of the heart, the patient must:

  • Do not physically strain, do not go to the gym, do not lift weights, do not walk on the 10th floor, etc.
  • Do not take sedatives;
  • Do not drink coffee;
  • Limit food intake, that is, do not overeat;
  • Do not be nervous.

The ultrasound procedure is not painful. Its duration is approximately 20 minutes. The patient should take a supine position, before this completely undress to the waist. A special gel will be applied to the chest, and the study is carried out by a sensor, which displays all the data on the size of the heart, its work, blood vessels and blood flow in general.

If conventional heart ultrasound is a harmless procedure, then stress echocardiography is a serious analysis. Which, without proper preparation, can even cause harm to the body, although it can be done many times. 48 hours before the analysis they stop taking drugs (for this they consult a cardiologist), it is also forbidden to smoke and drink alcoholic and caffeinated drinks.

As prescribed by a cardiologist, certain drugs, in particular, nitrates and beta-blockers, are canceled. The rules for their cancellation are the same as with a normal load test. On the day of the study, you can use nitroglycerin to stop the attacks of angina pectoris, but you must warn your doctor about this before the examination.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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