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.