Over the past 50 years, veloergometry (VEM) has become so widely and universally used method of diagnostics of CHD that some firms (Shiller, etc.), have long produced equipment with ready VEM protocols. In this connection we draw attention of cardiologists and functionalists that the carried-out inspections on stress systems of I-II generations cannot be the proofs of CHD for many reasons.
Firstly, all those ECG features that are interpreted as indisputable signs of CHD are not:
1. Depression of the ST segment - is not a specific symptom , coronary heart disease, as it appears and everyone has a completely healthy person when it reaches its ”critical” load. That is, one that causes myocardial ischemia. In sports there are techniques with loads that cause depression ST segment. That is, ST-segment depression is not a symptom of CHD, but a parametric indicator of the boundaries of the norm of the functional state of the cardiovascular system. Which, like JAL, should be statistically calculated in multi-vector arrays with vectors by age, sex and level of fitness and exist in the form of age norm tables. Because only having tables of "age norm of ST depression" it is possible to determine whether ST depression at a given load is a variant of norm or pathology. That, in turn, requires that such tables are already in the memory of the stress system and she herself expected % decrease in the age norm.
2.ST-segment elevation occurs when it is transferred, transient spasms of the coronary arteries, scar changes of the myocardium, tachycardia, pericarditis, a number of exotic diseases and, as specific only for CHD, is not considered, although often occurs.
3. Inversion of the tooth P - occurs in a number of pathologies. In early repolarization, as juvenile configuration, ventricular extrasystole with BLF, family anamnesis of the southern peoples, cerebrovascular accidents, lesions n.Vagus, idiopathic findings. For coronary artery disease is characterized classically right isosceles form of the tooth, called the "coronary". That, you should agree, a bit…
That is, 100% reliable ECG - signs of CHD at veloergometry on stress systems of I-II generation do not exist. Not to mention the fact that the diagnosis of "ischemic heart disease", based on the fact that its etiology is stated, "in 96-98% of ischemic heart disease due to coronary atherosclerosis" shall be assigned from clinical to post-mortem, or needs to be adjusted to its etiology.
Even more questions are raised by the standard technique of VEM. In which, load, as well as in sports, is set to be surveyed in kilogrammetres (KGM). For sports, where the goal is to identify the PWC 170, (that is, the amount of external work at a pulse of 170, measured in KGM.), it is natural, but the medical has other purposes. She is interested in what (precise) amount of work a person has myocardial ischemia. That means that here it is necessary to consider work already not only external, but also internal which is estimated in MET. What is that lifting 1kg., child, boy and man, producing the same amount of external work, perform work internal, that with age increases dramatically. Therefore, if we can neglect it in young people, we must take it into account in the elderly. Moreover, it gives a significant difference in the examination of the same patients at VEM and treadmill, where its level increases many times.
In turn, inner work (as oxygen consumption in MET) depends on gender, weight, age, basal metabolism, but most of the training, increasing the athletes at times. So we come back to the need for ranked tables that should be in the memory of the stress system. That is, to the needs of cardiac clinics in programmable stress systems. In the stress systems of the other generation. VEM on stress systems of I-II generation can, of course, determine the presence of certain pathological reactions from heart rate, blood pressure, to identify hidden conduction and rhythm disturbances, to determine the limit of individual level of physical activity, but here it is already necessary to decide how justified such examination will be compared to the risk to life that accompanies it.
The legal side of VEM. Worldwide, it is recognized that VEM is a potentially life-threatening procedure, so it should be carried out only in those hospitals where there is an intensive care unit or equipment for intensive care and resuscitation. At the same time, VEM doctors themselves are considered relatively safe, since the probability of death at VEM = 1 case per 10 000. However, the death rate for air travel is 1 per 10 000 000 (that is, 10 000 less than for VEM), but it is recognized as dangerous so that all air campaigns in the world are obliged to insure their passengers.
That is, not only the relatives of those killed by (or at) VEM may demand from the Ministry of health compensation comparable to the compensation for the death of an air passenger, or even more, but even anyone who has not been insured by the hospital before VEM can recover from it substantial compensation for the survey, which significantly threatened his life. Thus, the receipt of the consent to carrying out VEM will serve as the aggravating circumstance for administration of medical institution which knew about such danger, but didn't insure the patient. The amount of such claim can be easily calculated according to the schedule of VEM danger for the patient, based on his diagnosis and age.
