Stress Test in Dnipro (Cycloergometry / Exercise Testing)

Indications for Stress Test (ECG with Exercise):

1. Detection of coronary artery disease at an early stage.
2. Detection of arrhythmias during physical activity if suspected.
3. Diagnosis of early stages of chronic heart failure.
4. Observation of excessive blood pressure rise during physical exercise.

Stress tests are crucial for evaluating the condition of patients with cardiovascular diseases. The goals of this diagnostic procedure include:

• Assessing the functional capabilities of patients with coronary artery disease and chronic heart failure.
• Determining physical exercise tolerance.
• Evaluating the correct functioning of a pacemaker.
• Monitoring the progression of a patient who has suffered a myocardial infarction during treatment.
• Assessing the rehabilitation progress in the postoperative period.

Preparation for Stress Test

Before undergoing a diagnostic exercise test, the patient should stop taking nitrates and beta-blockers at least 12 hours prior to the test. However, if it's necessary to assess the effect of anti-anginal medications on exercise tolerance in a patient with established angina, these medications should not be discontinued.

A positive exercise test (i.e., the test showing clinical signs of ischemia and corresponding ECG changes) is an indication for coronary artery examination using contrast agents (full coronary angiography).

Stress Echocardiography (EchoCG with Exercise Testing)

Stress echocardiography combines two-dimensional echocardiography with an exercise test. Cycloergometry (on a horizontal or vertical trainer) is typically used for the exercise. Ischemic changes in myocardial contraction occur earlier than typical ECG changes, making stress echocardiography a more sensitive method for detecting myocardial ischemia and confirming the diagnosis of coronary artery disease (angina) compared to exercise tests with ECG.

Preparation for Stress EchoCG

Weight limit: no more than 110 kg

1. Consultation with a cardiologist to ensure there are no contraindications to testing (e.g., unstable angina, unstable blood pressure).
2. As per the cardiologist’s recommendation, beta-blockers should be stopped 2 days prior to testing.
3. Testing is done when blood pressure is between 140-150/90-80 mmHg.
4. Bring medical documentation (hospital discharge, cardiologist’s recommendations, previous tests such as Stress Test, ECG, EchoCG) regardless of their date.
5. Eat no later than 2 hours before the test.
6. Wear comfortable clothing.

Stress EchoCG Allows:

• Detailed assessment of myocardial ischemia.
• Detection of myocardial viability in post-infarction areas.

Indications for Stress EchoCG:

1. Diagnosis of coronary artery disease (CAD).
2. Uninformative results from a stress electrocardiographic test (cycloergometry) or inability of the patient to undergo the test.
3. Determining risk levels and prognosis for patients before major surgery, those with CAD, hypertension, or non-coronary heart diseases.
4. Determining myocardial viability.

Contraindications to Testing:

• Acute myocardial infarction (first 2 days).
• Deep vein thrombosis, pulmonary embolism.
• Unstable angina.
• Acute inflammatory heart diseases (myocarditis, pericarditis, endocarditis).
• Tachyarrhythmias.
• Heart conduction blockages.
• Severe hypertension (above 200/100 mmHg).
• Hypertrophic cardiomyopathy.

During the stress test, the patient is monitored by a cardiologist. Physical activity will be stopped if the following symptoms appear during the test:

• Rapid increase in blood pressure
• Pallor or cyanosis of the skin
• Severe chest pain, angina attack
• Serious rhythm disturbances
• ECG readings indicating oxygen deprivation in the heart muscle
• Dizziness, darkening of vision
• Any significant deterioration in the patient’s condition

Conducting the Tests

Stress tests are always conducted in three stages:

1. Resting Data Registration: ECG, Echo-CG, blood pressure, and other parameters are measured. It is important for the patient to arrive early and rest before the test to allow the heart to stabilize.
2. Main Part – Exercise Test: The test involves physical exercise. In most cases, an ECG with 12 leads is recorded during the exercise. Simultaneously, echocardiography or other methods may be used to detect myocardial ischemia (such as introducing radioactive isotopes during peak exercise).
3. After exercise, the patient is allowed to rest, and the heart function is checked again. Continuous data may be recorded for 10-15 minutes after the exercise, providing a complete picture of how the heart rhythm and blood pressure recover.

Cycloergometry typically takes around 1 hour.