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What is ergometric testing and what is it for? The strain electrocardiogram (or ergometric test) is an instrumental examination that consists of recording the electrocardiogram (ECG) during the execution of a physical effort (unlike the basal ECG that is recorded in resting conditions) and in the measurement of blood pressure. In this way it is possible to slate and define the nature of any heart disorders, allow a check of the effectiveness of the therapy, establish a possible rehabilitation plan, examine the response of the cardiovascular system to exercise, ascertain suitability for sports activity and work for cardiovascular aspects, evaluating heart rate, atria response and any ECG alterations. During physical exertion, in fact, conditions are realized that involve an increase in the demands of work to the heart that could highlight any alterations not found at rest. It can also be considered the first choice instrumental examination for the diagnosis of ischemic heart disease. How does the ergometric test take place? The cycle and heergometer test is a maximum effort test, that is, protracted until muscle exhaustion, which is carried out by applying progressively increasing workloads. During the cycle and engine test, an electrocardiogram is continuously recorded and blood pressure is monitored, so you can determine the degree of stress tolerance by measuring workloads and assess moment by moment the presence of any anomalies. The part of the exam, with the application of the workload, will have an average duration of 15 minutes and will be followed by a deflacing period of 3-6 minutes. The electrodes will be applied to the chest; A resting basal electrocardiogram is then recorded. Physical exertion will then begin, usually by pedalling on an exercise bike (cycloergometer) or walking on a rotating carpet (treadmill). The effort is progressive and is increased by constant increase in the resistance opposed by the pedals of the cycle or the speed of the rotating carpet. It starts from a low workload that is progressively increased until you reach a certain heart rate value, calculated by your doctor based on the patient's gender and age. The choice of the size and speed of increased effort are chosen by the doctor under uniform and standardized protocols, based on the patient's clinical characteristics. During the examination your cardiac activity will be constantly monitored by the medical staff through electrocardiographic monitoring and regular detection of blood pressure and heartbeats at regular intervals. Symptoms (chest pain, dizziness, shortness of breath, excessive weakness) and their relationship to any changes in electrocardiogram and blood pressure will also be paid attention. The test can be interrupted by the doctor at any time if necessary (there are standardized clinical and instrumental criteria of arrest), but also on request at the appearance of the symptoms described above. What are the limits and risks? Some particular conditions and even taking certain medications may interfere with the evaluation of an ECG by effort. For example, the patient's inability (for orthopedic, neurological or psychic problems) to perform physical exertion is a contraindication to the ergometric test. Some characteristics of the basal ECG make the interpretation of electrocardiographic alterations during strain unreliable. In addition, taking certain medications, such as digital, anti-anginous drugs, beta-blocking drugs, some antidepressants can variously interfere with the interpretation and result of stress testing; therefore, in these cases it will be assessed with the doctor the possibility of their possible suspension before the examination is carried out. Finally, there are some conditions which contradict the execution of an effort test: 'myocardial infarct for less than 48 hours; Unstable angina; Some situations of heart rate irregularities (arrhythmias); Diseases of the aortic valve (severe aortic stenosis); Cardiac decompensation during clinical instability; Recent pulmonary embolism or heart attack; Iocarditis or pericarditis in the acute phase; Aorta aneurysm In some cases, a cardiac ischemia may be induced, which will occur with the appearance of chest pain or be detected by the doctor at the electrocardiogram; only rarely is the administration of drugs required to solve cardiac ischemia. Sometimes there may be a marked reduction in blood pressure that is accompanied by symptoms such as sweating and obfuscation of vision. However, the necessary health facilities are readily available to deal with these occurrences and the staff is trained to deal with them at the time of need. Life-threatening heart arrhythmias may appear in some cases. How to prepare for the test. Before taking the test, it is important to follow the following behavioral standards: 1. do not eat before the test: only a small snack is allowed 2-3 hours before; 2. Don't drink coffee or other exciting drinks; 3. Do not smoke for at least 2 hours before the start of the test; 4. do not make any significant muscle efforts in the hours before the test; 5. present with shorts, T-shirt, sneakers, towel, water bottle; 6. electrocardiograms and/or cardiological tests already performed. What are the possible alternatives? Ecocardiogram with pharmacological stress with administration of dobutamine or dipridamolo Scintigrafia myocardial with dipridamolo. Evaluation of the ST-T section to the dynamic ECG sec. Holter (24-hour ECG). Please note that the consequence of refusing to undergo the diagnostic survey involves a failure to diagnose and/or functionally assess your cardiac activity. It is guaranteed that all cautions, diligence and expertise will be observed in the execution of the procedure in order to avoid harmful events that could compromise health.

What is endoscopic transesophageal echocardiography? Echocardiography is a method by which the heart and blood flow are studied through the valves by means of ultrasound. Unlike radiation used in radiology, ultrasound is harmless, so no precaution is necessary and examination can be performed on any patient countless times (even in pregnant women). What is transesophageal echocardiography for? Transesophageal echocardiography is a second-level examination, generally indicated in the case where the transthoracic echocardiogram is deemed insufficient or uninterpretable in relation to the clinical question; in some cases it can be directly prescribed as a test of choice: the presence of conditions that are difficult to diagnose, such as rare congenital malformations, thoracic aorta diseases or complex heart valve defects. Preparation To perform the transesophageal echocardiogram you need to be fasting from midnight before the day of the exam. The medicines can be taken by trying to drink only the smallest amount enough to swallow the drugs. In case of diabetes it is important to consult with your doctor to define the appropriate dose of insulin that will obviously have to be reduced for fasting. Who can perform transesophageal echocardiography endoscopically? There are no particular contraindications to echocardiography: anyone can undergo the examination. How does endoscopic transesophageal echocardiography work? The patient should remove any glasses and prosthesis, lie on the side and position himself with a slightly flexed torso and neck pours the legs. He then has to swallow a probe similar to the one used for gastroscopy, inserted through a mouthpiece placed between his teeth. The total duration of the exam is about 10-15 minutes. Is endoscopic transesophageal echocardiography painful or dangerous? Transesophageal echocardiography is neither painful nor dangerous, but the passage of the probe through the mouth could generate some discomfort. For this reason, for better tolerance to manoeuvre, the doctor or nursing staff perform a local anesthesia (spraying a spray in the throat), to which they can associate, in the most sensitive patients, a mild intravenous sedation. In this case, the state of vigilance may be reduced, after the examination it will not be possible to drive or carry out activities that require special attention for at least 5-6 hours.

What is stress echocardiography and what is it for? Stress echocardiography allows the doctor to observe what changes occur in the heart if subjected to a stimulus, or "stress", precisely, which can be both physical, induced by a muscle commitment of the patient, and pharmacological. When stress is pharmacological, the patient's heart - which during the examination is lying on the bed of the echocardiography laboratory - and its circulatory system is stimulated through the injection of specific drugs, which induce them to behave as if they were to support a physical effort. Before performing pharmacological eco stress, the cardiologist always makes an assessment of the heart through the normal echocardiogram, to consider whether the examination is technically feasible and if there are no contraindications to the execution of the examination. How does stress echocardiography take place? FARMACOLOGIC STRESS: The patient is made to lie on a cot, on the left side, as for a normal transthoracic echocardiography. Electrodes are applied to the chest to monitor the echocardiogram, and a sfigmomanometer, which monitors the progress of blood pressure. At the same time, an IV (drboclisis) administers, in a controlled dose, the drug that will cause the heart the same changes induced by physical exertion (Dobutamine) or changes in the coronary circle (Dipiridamolo). During the examination, at coded time intervals, images of the heart in motion are recorded. Intravenously, through the IV, other drugs considered necessary by the cardiologist for the favorable outcome of the test (e.g. Atropine), or to reduce the heart rate at the end of the test (metoprolol). The IV will then be removed at the end of the exam. PHYSICAL STRESS: The patient is positioned on the cycloergometer. Electrodes are applied to the chest to monitor the echocardiogram, and a sfigmomanometer, which monitors the progress of blood pressure. The patient is invited to pedal: at time intervals established by standardized international protocols, the hardness of the pedals is increased to progressively increase the workload and therefore the physical effort. During the examination, at coded time intervals, images of the heart in motion are recorded. Is stress echocardiography painful? Stress echocardiography is not a painful examination. In some cases, however, it can happen that patients with angina pectoris complain about the usual pain. This is very important for the cardiologist, as it can verify the correlation between the symptom and changes in heart function and electrocardiogram. When is the exam interrupted? The examination is interrupted when the maximum dose of medication indicated for that particular patient has been injected or when the desired frequency with exercise is reached; it can be interrupted by the cardiologist, before the completion of the protocol, even in case of the appearance of significant alterations of the electrocardiographic path or motility of the walls of the heart to the echocardiogram, for changes in the parameters at the entrances or when the patient complains of symptoms that the cardiologist deches significant. Is stress echocardiography dangerous? During this type of test, a dangerous arrhythmia, a seizure of angina, acute decompensation, a heart attack or a cardiac arrest may appear. For this reason, in the laboratory where the test is performed, drugs and tools are always available that can make each of these rare complications regress as quickly as possible. The incidence of complications is, however, the same as a normal strain test on treadmills or stationary bikes, or a spark. Preparation Before undergoing stress echocardiography, it is necessary for the patient to consult the treating physician, who will determine if necessary to suspend ongoing therapies that could address diagnostic doubt. The suspension of the drugs, which must not be decided by the tester, but by those who require it, must take place in different ways, depending on the properties of the drug itself. In principle, it should be noted that, if the treating physician has decided to have the patient suspend the current therapy, this must occur in the following ways: 48 hours before the examination for nitroderivates, calcium antagonists, ACE inhibitors, Digital, Aminophylina 5 days before the examination for beta blockers (which should be suspended gradually) In addition, it is very important that the patient: do not fumes for at least 12 hours Not , Coca Cola, coffee for at least 12 hours Sia fasting for at least 6 hours (in case of diabetes it is advisable to recommend with your treating physician, in order to establish the dose of oral antidiabetic or insulin). You can drink without special restrictions. Take with you the copy or original of the clinical documentation relating to the problem that needs to be clarified (clinical record, ECG, stress tests, coronary artery, etc.). It is preferable for the patient to show up for the accompanied examination. Exam duration: 40 minutes

What is it and what is the Holter ECG The dynamic ECG according to Holter is a continuous 24-hour detection of the heartbeat that allows you to accurately assess the presence of arrhythmias, the type, frequency and recurrence of the same in specific 24-hour periods. It also allows you to evaluate the frequency of beats (maximum, minimum and average in the 24 hours of recording). As is the case with the 24-hour Holter ECG recording On the patient's chest that is properly shaped and cleansed, the nurse places electrodes on each of which is hooked a cable connected to the beat detector (Holter). Before being discharged, the patient is given a diary sheet on which he will have to report carefully the ongoing drug therapy, any symptoms he has encountered during the 24 hours of registration (e.g. pain, dizziness, headache, vomiting...), activities carried out. The device may not function properly if: - The patient's skin is not properly shaped and/or cleansed, - One or more electrodes are not properly connected to the patient, - One or more electrodes detach during the 24 hours of recording. In these cases, the recording hours will be less than the expected 24 hours or there will be recording artifacts that will reduce the quality of the ECG track. During the 24 hours of the recording the patient is urged not to perform intense physical activity that can make him sweat so as to disconnect the electrodes, not to take a shower and to wear a mesh over the electrodes so as not to accidentally remove them. Please respect the time indicated by the nurse for the return of the Holter device so as not to incur delays and inconvenience for other users. It is useful, as a comparison term, to bring an ECG into view if performed previously. What can I do when monitoring Holter? Holter monitoring does not require restrictions on routine therapy or activity (except for activities that may lead to excessive sweating). Indeed, it is important to live as active a life as possible during the Holter registration, and possibly carry out activities associated with the onset of the symptoms that are being studied. It is important to note any symptoms and changes of activity on the appropriate notebook (diary) in order to correlate the symptoms to any rhythm disorders. What are the limits and risks? Holter 24-hour MONITORING does not involve any kind of risk.