Difficulties in assessing ECG after exercise testing. Electrocardiography with exercise for children ECG after exercise permissible norms for men

To identify various cardiac pathologies, an electrocardiogram is often prescribed. The method is actually very simple. However, it is considered one of the most informative. If the procedure does not show clear results, the patient is prescribed a stress ECG. The technique allows you to identify hidden pathologies and prescribe adequate treatment.

General description of the procedure

Almost every person has had to undergo a procedure at least once called It is a registration of electrical impulses (currents) during contraction of the heart muscle. A special device, an electrocardiograph, allows you to record data and display it on a graph. The resulting result looks like a complex curved line. The doctor usually deciphers the obtained values.

A fairly simple method for diagnosing heart disease allows you to get accurate results. An electrocardiogram is one of the cheapest and most accessible methods. Another advantage is the absence of violations of the integrity of the skin.

Electrocardiography with exercise

There are several methods for performing electrocardiography, one of which is stress ECG. The usual procedure, when the patient is at rest, does not always show all the abnormalities in the heart. Registration of cardiac impulses during physical activity allows us to establish the exact cause of the pathology due to the active work of the heart muscle and the entire organism as a whole.

Techniques

There are several ways to perform stress electrocardiography. One of the common methods is functional tests. No special equipment is used, other than a stopwatch and a cardiograph. The patient is asked to perform simple exercises. It can be squats or steps on a step platform.

Bicycle ergometry is considered one of the most informative methods for diagnosing the performance of the heart muscle. To carry it out, an exercise bike is used, equipped with special sensors and a powerful computer. When performing an ECG with physical activity, all data will be transferred to a computer for recording and analysis.

The treadmill test has a similar diagnostic technique, only a treadmill is used for physical activity. If the patient begins to feel unwell, the diagnosis will be completed and the necessary medical care will be provided.

Indications for use

The procedure allows you to promptly detect existing problems with the heart muscle and establish the level of endurance in each patient. An electrocardiogram is one of the mandatory diagnostic methods for people who work in difficult conditions.

The procedure may be prescribed if a standard ECG does not show any abnormalities, but the patient complains of the periodic appearance of unpleasant symptoms. Direct indications for undergoing manipulation with a gradually increasing load are the following pathologies:

• the need to determine the type and degree of coronary heart disease;
• complaints of frequent pain in the heart area;
• hypertension;
• congenital and acquired heart pathologies;
• arrhythmia, tachycardia;
• the appearance of bluish skin or sudden weakness.

If the preliminary diagnosis on the electrocardiograph indicates the presence of a pathology of the heart, then it makes no sense to carry out a test with a load.

Contraindications

Before prescribing an exercise ECG to a patient, the specialist must ensure that there are no contraindications. Because in some cases this type of diagnosis can be life-threatening. In medical practice, there are absolute and relative contraindications to manipulation. The first group includes severe pathologies:

• condition after myocardial infarction (the procedure can be carried out no earlier than 14 days after the attack);
• arrhythmia that is not amenable to medication;
• severe infectious pathologies;
• pericarditis, myocarditis, endocarditis;
• acute heart failure;
• in severe form;
• suspicion of dissection of an aneurysm in a vessel.

If the patient has relative contraindications, only the doctor should determine the need for electrocardiography with physical activity.

Diagnosis is usually prescribed only as a last resort, when other methods have proven ineffective. This category includes such pathological conditions as lack of magnesium and calcium, severe diabetes mellitus, heart defects with moderate stenosis, hypothyroidism, left ventricular aneurysm, late pregnancy.

How is the procedure done?

To do a stress ECG, you need to contact a cardiologist and undergo a preliminary examination. If the patient has no contraindications, he may be prescribed a test on an exercise bike (bicycle ergometry) or treadmill. The most informative and frequently used is the first option.

Before starting the diagnosis, the specialist attaches sensors to the patient’s skin. The procedure will be carried out with simultaneous recording of blood pressure. Sensors are attached to the collarbone, shoulder blades and lower back. In the first three minutes, you need to make 180 revolutions of the simulator (60 revolutions every minute). Every three minutes the load will be increased until fatigue, dizziness or pain appear.

The patient must report his feelings and the doctor will complete the ECG procedure. After the load, data is recorded for another 10 minutes. This time is usually enough for the heart rate to return to normal. The results are sent to the doctor to make a diagnosis.

We correctly decipher the results

An ECG with stress allows you to obtain the most reliable information about the condition of the heart muscle and blood vessels. The conclusion contains the following indicators:

1. Work performed by the patient (J).
2. Threshold power (W).
3. Reasons for early termination of the study.
4. Conclusion about performance.
5. Dynamics of pulse and blood pressure.
6. The time it took for heart rate and blood pressure to normalize.
7. The value of blood pressure at the peak of physical activity.
8. Heart rhythm disturbances (normally there should not be one).
9. Coronary disorders (detailed description of the type of disorder, time of its occurrence).
10. IHD class depending on the level of physical activity at which deviations appeared.

Only a specialist is responsible for interpreting the results of a stress ECG. The norm of indicators differs depending on the age and gender of the patient. The slightest deviations from generally accepted norms do not indicate the presence of a pathological condition. If necessary, the procedure can be repeated after some time.

Test conclusion

A negative option indicates high performance and the absence of changes in the ECG with exercise. A test is considered questionable if a shift in the ST segment is detected (a change in the interval on the graph between the S and T waves). The reason for this phenomenon may lie in increased pulmonary ventilation, frequent stress, long-term therapy with antiarrhythmic medications, and potassium deficiency in the body.

If the test is positive, the patient experiences frequent extrasystoles and an ST segment displacement of more than 2 mm. In this case, it is important to note the period when such signs appeared, the maximum load,

What does the load on the right atrium indicate?

Valve pathologies can be noticed during an electrocardiogram. A sign of deviation is a change in the P wave. A timely diagnosis will allow the initiation of therapy aimed at eliminating this phenomenon.

Preparation for the procedure

To get a reliable result, you need to properly prepare for an ECG with stress. Before the test, you should avoid emotional and physical stress and stop drinking alcoholic beverages. For several days, you should avoid taking medications that affect the functioning of the heart muscle. Heavy foods can have a negative impact on the test result.

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ECG with stress - Martinet test (20 squats in 30 seconds).

Functional test- part of a comprehensive methodology for medical control of persons involved in physical culture and sports, as well as when entering a number of educational institutions. The use of such samples is necessary to characterize the functional state of the body involved and its fitness.

It is advisable to carry out the exercise test in the morning on an empty stomach. Three hours before the test, you should also avoid smoking, drinking drinks with caffeine and alcohol. You must come to the examination in comfortable clothing.

A test with physical activity in the form of the Martinet test (20 squats) is carried out in addition to the main ECG to assess the resistance of the cardiovascular system to physical activity and the processes of restoration of its activity after cessation of the load. This examination can be carried out both as part of a general medical examination and to assess the dynamics in the process of treating cardiovascular diseases. In addition, this examination is prescribed to persons during professional selection for work requiring high physical activity.

How is the diagnostic examination performed:

• First, an ECG is performed at rest.
• Then physical activity is performed - the Martinet test (20 squats in 30 seconds).
• After the load is completed, an ECG is recorded immediately after the load is performed, and then after 3 minutes. recreation. Analyze the magnitude of changes in indicators immediately after work in comparison with rest, the duration and nature of recovery.

Evaluation of the result. With a good functional state of the cardiovascular system, the change in heart rate and pulse pressure to the Martinet test does not exceed 50...80% of the resting values. The increase in heart rate after squats is determined compared to the initial one in %. For example, the initial heart rate is 60 beats/min, after 20 squats it is 81 beats/min, therefore (81–60): 60 x 100 = 35%.

Recovery lasts no more than 3-5 minutes. At the same time, a trained organism shows signs of economization of the activity of the cardiovascular system both at rest and under load.

Restoring heart rate after exercise. To characterize the recovery period after performing 20 squats in 30 s at the 3rd minute. recovery, an ECG is performed; the ability of the cardiovascular system to recover is assessed based on the difference in heart rate before exercise and during the recovery period

The results of functional tests are assessed in comparison with other medical control data. Often, adverse reactions to load during a functional test are the earliest sign of a deterioration in the functional state associated with illness, fatigue, or overtraining.

ECG with stress - bicycle ergometry This procedure is testing the work of the heart under increasing load. In addition to studying the electrical activity of the heart muscle, the contractility of the myocardium and its adaptive capabilities are also taken into account. Increased stress is caused either by physical exercise (walking on a treadmill, riding an exercise bike), or by using special medications that force the heart to work under stress. Stress ECG tests include treadmill testing, bicycle ergometry, and stress echocardiography with physical activity. Constant monitoring of the body's reaction at all stages of the procedure allows us to detect probable risks of serious cardiac pathology.

Why is this procedure performed?

The main purpose of stress ECG analysis is to determine the physiological state of the heart. The study examines the severity of coronary heart disease and the response to exercise under conditions of gradually increasing intensity.

Unlike other studies of cardiac activity, stress ECG tests almost completely show the presence of permanent or transient (non-permanent, temporary) foci of malnutrition in areas of the myocardium. Thus, it is possible to trace the connection between the occurrence of ischemia and the conditions under which it appears.

Features of the study and its safety

Exercise electrocardiography is considered a relatively safe method. However, unlike conventional ECG recording at rest and Holter monitoring, it still has certain risks. This is mainly due to the body's inadequate response to stress tests.

In rare cases, subjects may experience complications such as arrhythmias, heart attacks, loss of consciousness, or even death. The probability of developing an unfavorable response of the body is 1: 100,000. Considering even this minimal risk, the procedure is carried out under the constant supervision of medical workers.

Preparing for the test

Only proper preparation for this study can guarantee the reliability of the data obtained. Due to the fact that testing is carried out under conditions of increased stress, you should refrain from eating for two to three hours before the procedure. Only drinking water is allowed.

Before preparing, it is important to consult your doctor about taking certain medications. Sometimes it is necessary to stop certain medications before the study in order to get the most accurate results. This particularly applies to people suffering from diabetes.

Due to the fact that the test is accompanied by high mobility, it is necessary to wear comfortable clothes and shoes. Men usually remove their shirt and tank top, while women wear a supportive bra.

Immediately before the procedure, the patient must sign a written consent to the study. The health worker explains in an accessible form the above-described complications that may arise during the testing process.

The activity of the heart muscle is monitored using electrodes attached to the chest. That is why the skin of the person being examined must be clean. If hair is present, it should be shaved prior to testing.

Indications for ECG with exercise

The main reason why this procedure is prescribed is to supplement and clarify the data obtained from ECG or Holter (24-hour) monitoring. In addition, an ECG under stress may be prescribed for:

• recent myocardial infarction;
• pain in the chest area;
• progression of angina pectoris;
• problems with heart valves.

Technique for performing an ECG with stress

An ECG under stress is taken in a separate room. Initially, readings of cardiac activity at rest are examined. In the supine position, the doctor uses an ultrasound machine to study the work of the myocardium - resting echocardiography (a similar procedure can be carried out at any stage of the study).

Electrodes are then attached to the patient and he is asked to begin an exercise (treadmill or exercise bike). After this, they gradually begin to increase the intensity of the load. If there is the slightest deterioration in health during the test, the patient should immediately inform the doctor.

Sometimes the person being studied is not able to perform physical exercises. In this case, an effect similar to that during physical activity is achieved by intravenous administration of a drug such as Dobutamine. Next, cardiac activity is assessed.

Throughout the study, ECG, heart rate and blood pressure are constantly monitored.

Interpretation of results

Normally, as a result of the testing, the patient experiences a gradual increase in blood pressure and increased heart rate. This indicates that the heart is fully enriched with blood and effectively pumps it throughout the body.

If your heart malfunctions, you may experience symptoms such as:

• fatigue and shortness of breath;
• chest pain;
• a sharp rise or sharp decrease in blood pressure;
• the occurrence of arrhythmia or the appearance of ischemia on the ECG.

Thus, in addition to the state of the heart at rest, the stress tests described above make it possible to assess the dynamics of the electrocardiogram and the body’s response to physical activity. Stress ECG tests also help determine the degree of adaptation of blood vessels to changing environmental conditions.

Video material about the load test - bicycle ergometry

Various heart pathologies are diagnosed and monitored using electronic cardiography. Heart attacks, cardiac thresholds, thromboembolism and much more very noticeably change the functioning of the heart and blood vessels, which is clearly visible on the cardiogram.
One way to determine the presence of certain heart diseases is to perform a stress ECG. Many medical centers provide this opportunity.

The essence of an ECG with stress

Electrocardiography has been used for about a hundred years, having proven itself well even when it was introduced into the field of medicine, and so far no similar diagnostic methods have been invented. Many heart diseases are diagnosed precisely thanks to it.

But unfortunately, there are some pathologies that are more difficult to determine even with the help of an ECG. Patients present at the moment of remission of the manifestation of the pathology, and the symptoms give only a small hint of a probable diagnosis. Therefore, it was invented to conduct electrocardiography during a person’s physical activity.

What is the advantage of an ECG under stress? ECG diagnostics are carried out at a time of high physical stress on the patient. To do this, there are several options for old and proven methods of simulating everyday stress, as well as newer medical developments.

A stress ECG can be performed in the following ways:

• functional tests;
• diagnostics on a bicycle ergometer;
• method of American scientists - treadmill;
• using Holter monitoring.

The above load exercises during ECG data collection have several subtypes. Let's take a closer look at them.

Functional tests

This method is used to assess the work of the heart during qualification tests for certain professions - athletes, pilots, military personnel. With the help of functional tests, it is possible to determine hidden pathologies and the endurance of the heart to certain loads.

It is also permissible to use the methodology to assess the health of children before entering the sports section.

The test technique has several options:

• Martinet method - consists of 20 squats performed within 30 seconds. Readings are taken before physical activity, immediately after it and three minutes later;
• running tests - similar to the first test, only with running instead of squats;
• step test - has more than 20 types of tests, each of them has its own norms of indicators;
• clinoorthostatic – procedure for children. The necessary equipment is attached to the child, after which readings are taken in a lying and standing position. Normal indicators are an increase in heart rate within 20–40%.

Bicycle ergometer

The load can be played by a device similar to an exercise bike - a bicycle ergometer - it is offered by many private medical centers. During cycling, changes in the work of the heart are clearly recorded on the cardiogram, which may not be noticeable without load. As a rule, this method effectively determines ischemic disease, various disturbances in the normal rhythm of the heart, and other disorders, and also simply diagnoses the body’s normal response to physical activity.

One of the effective diagnostic methods with load is bicycle ergometry.

Before bicycle ergometry you need to prepare:

• as prescribed by the doctor, medications (beta blockers, nitrates) are discontinued several days before the start of the diagnosis;
• Diagnosis cannot be carried out after stress or physical activity, the patient must be calm both physically and emotionally;
• Before the examination itself, you need to change into light, comfortable clothes;
• During diagnosis, electrodes are attached to the patient’s body, so men with chest hair need to get rid of it;
• Three hours before the procedure you should not eat or drink any liquid.

The person being examined is put on a special belt on the chest or several electrodes are attached. The first data from the patient is taken while the body is at rest, then the diagnostic stage occurs with physical activity, which is forcibly increased after certain periods. The increase is stopped at the moment when the patient begins to complain about unpleasant symptoms - pain, fatigue, dizziness, and other signs. After this, readings of physical changes are taken for another ten minutes until the body returns to a normal state of rest.

Note! The subject may request termination of the procedure at any time.

It is recommended to conduct the examination in the morning, 2-3 hours after breakfast. This examination is used primarily for adults, but is sometimes acceptable in pediatrics for assessing heart function in adolescents whose weight exceeds 40 kg.

There are some contraindications for conducting the study:

• period of exacerbation of heart attack;
• infectious heart diseases;
• exacerbation of failure in the blood circulation of the brain;
• complex pathologies of the heart;
• heart failure at stages 2–4;
• arrhythmia, conduction block;
• level 3 arterial hypertension;
• various types of thrombosis;
• mental illnesses;
• other reasons.

You can undergo examination only after discussing all possible contraindications with your doctor.

It is similar to the bicycle ergometry method, but a treadmill with a changing angle of inclination of the plane is used as a simulator - simulating uphill running. The diagnostic method is acceptable for children - the simulator has no restrictions on the height and weight of the subject, unlike an exercise bike.

Treadmill is a diagnostic method similar to a bicycle ergometer, invented by American scientists

Indications of changes are taken during exercise and after exercise, after which an analysis of changes in the norm is carried out.

Holter monitoring

The method is considered conditionally loading: the patient wears electrodes throughout the day, and a special Holter device displays the indicators. A person lives in a normal rhythm, but he records every physical activity and emotional stress in his diary.

During such a study, one of the above tests is allowed.

At the end of the study, the cardiologist analyzes changes in the body under various conditions, interprets the cardiogram, and at this stage the information content of the diary plays an important role.

The diagnostic method described above has no contraindications, since there are no targeted loads on the patient’s body. The only exception can be a mental disorder.

Indications for ECG with forced exercise

Indications for the use of ECG with stress are the following:

• painful syndromes in the heart area that are not diagnosed during a routine examination;
• slight changes in the results on the electrocardiogram, which are not accompanied by signs of angina pectoris;
• changes in lipid balance without signs of ischemic heart disease;
• people with an increased risk of coronary artery disease;
• the likelihood of silent myocardial ischemia.

Forced stress ECG is prescribed only by a cardiologist

After the examination, the patient receives a complete result about the body’s response to physical activity, changes in blood pressure, indications of the recovery process after the end of physical activity, and, of course, the recommended permissible level of activity.

The ECG examination method under stress is a safe method of medical research. But given the strain on the heart during the trial, there is a risk of side effects and, in very rare cases, complications that can lead to a heart attack. Therefore, the examination should be carried out by qualified specialists in order to provide medical assistance if necessary.