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Exercise testing is a measure to help diagnose and predict some coronary diseases. In the measures of exercise, stress echocardiography is used to help evaluate and survey the activity of the heart, playing an important role in the indication of treatment for patients.
1. What is stress echocardiography?
Stress echocardiography is a noninvasive functional probe used to investigate ventricular wall motion during periods of rest and during myocardial stress.
Stress testing can be done by physical exercise or by drugs (Dobutamine, Dipyridamole...), through ultrasound to evaluate coronary artery perfusion function or to evaluate left ventricular contraction. Allows direct comparison of myocardial contractility during rest and stress phases.
Stress echocardiography is a widely used method in practice because it can survey the heart's activity and myocardial perfusion.
2. Indications and contraindications of stress echocardiography
Indications:
People with coronary artery disease: Angina pectoris helps to diagnose and evaluate the extent; Silent myocardial ischemia: A method used to test people with high risk factors for coronary heart disease or to check because of occupational requirements (airplane flying ...), exercise, or before a shift. Major surgery... People after myocardial infarction (at least more than 7 days), to determine myocardial condition such as scar infarct, myocardial inertness..., myocardial ischemia, risk of recurrence Infarction... Patient monitoring: Monitoring in some cases such as coronary artery bypass grafting or dilation, monitoring the effectiveness of medical treatment, the ability to re-adapt and work of patients with coronary artery disease. . Cardiomyopathy: Assess left ventricular function including diastolic and systolic function; Heart valve disease: Assess the extent of valvular disease and myocardial function; With exercise stress ultrasound, dobutamine is especially indicated when the patient is unable to ride a dynamometer or run on the carpet due to pathologies of the respiratory tract, peripheral blood vessels, musculoskeletal system or nervous system. Contraindications:
Heart attack status less than 7 days; New onset of angina in the last 24 hours; Unstable angina pectoris ; There is stenosis of the left coronary artery; Myocarditis and acute pericarditis ; Tachyarrhythmias: Atrial and ventricular arrhythmias; Cases of multifocal ventricular extrasystoles; Second and third degree AV block; Bradycardia < 45/min at rest; Heart failure grade 4 according to the New York Heart Association (NYHA) classification; Aortic stenosis with a history of fainting, syncope; Obstructive hypertrophic cardiomyopathy; Patients with severe resting hypertension: Systolic blood pressure > 200 and diastolic blood pressure > 110 mmHg; Have a pacemaker; Having a serious physical illness such as severe infection, anemia... Drug poisoning: digitalis...
Siêu âm tim gắng sức là biện pháp được sử dụng nhiều trong thực hành
3. Advantages and disadvantages of stress echocardiography
Advantages of stress echocardiography:
Helps to assess regional movement disorders similar to conventional echocardiography at rest; It is a non-invasive method, does not cause bleeding, has few complications; Can be carried out in patients unable to exert themselves with the use of drugs; Can be conducted in patients with abnormal resting electrocardiogram such as bundle branch block... Assess ventricular ejection fraction; New regional movement disorders can be assessed in patients with a history of myocardial infarction; Can be combined with echocardiography to assess myocardial perfusion status; Color Doppler ultrasound can be combined; Patients can choose the appropriate method of physical exertion with drugs or by physical exertion. Disadvantages of stress echocardiography:
The stress echocardiography method is highly dependent on the experience of the operator. Therefore, it is advisable to choose a reputable medical examination address; The diagnostic value depends on the image quality, it is necessary to compare two ultrasound images at rest and during exercise; It is sometimes difficult to obtain a favorable ultrasound window; Limited if the patient has extensive disturbances on resting echocardiography; Restricted to patients with multiple coronary artery disease; In some cases, there are contraindications to vasodilators such as bronchospasm, low blood pressure... or dobutamine use when there is a risk of ventricular arrhythmias, left ventricular outflow tract narrowing... Affected by human drugs disease being treated eg beta-blockers; The cost of stress echocardiography is relatively high; “Physical” exertion during an echocardiogram with a bicycle dynamometer is not a routine exercise for the patient. So the patient may have difficulty in performing; Some complications can be encountered during exercise echocardiography such as: Changes in blood pressure that can increase or decrease blood pressure, arrhythmias, angina, myocardial infarction but very rarely.. Stress echocardiography has many advantages and is of high value in the diagnosis of ischemic heart disease, the diagnosis of myocardial ischemic heart disease plays an important role in the indication of treatment. However, this method also has some disadvantages that affect the diagnostic results. To minimize the disadvantages of the method, patients should visit cardiology facilities with conditions on equipment and doctors specializing in echocardiography. Currently, Cardiovascular Center - Vinmec International General Hospital is one of the leading centers in the country for examination, diagnosis, screening and treatment of cardiovascular diseases. With the convergence of a team of experienced, reputable experts in the field of surgery, internal medicine, interventional cardiac catheterization and the application of advanced techniques in the diagnosis and treatment of diseases. Cardiovascular management, along with a system of modern equipment, on par with the most prestigious hospitals in the world such as: 3 Tesla MRI machine (Siemens), 640 CT machine (Toshiba), other equipment Advanced endoscope EVIS EXERA III (Olympus Japan), Avace high-end anesthesia system, Hybrid operating room according to international standards... The Cardiovascular Center at Vinmec International General Hospital has achieved many successes. work and gain the trust of a large number of patients.
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