Test opterećenja srca (ergometrija) je nezaobilazna metoda ispitivanja u kardiologiji. Ergometrija pruža podatke o preostalom fizičkom kapacitetu, subjektivnim tegobama u vrijeme i nakon opterećenja, pokazuje ishemijske promjene na elektrokardiogramu i aritmije i daje uvid u prognozu bolesnika sa ishemijskom bolešću srca.
U upotrebi su dva protokola opterećivanja. Na biciklergometru koristi se kontinuirani test opterećenja sa povećanjem opterećenja za 25w svakih 3 min. Od testova na pokretnoj traci preporučuje se test po Bruceu. Oba testa podjednako su mjerodavna u kliničkoj praksi i medicini rada. Razlike postoje u visini pojedinog stepena opterećenja, vremenskom trajanju testa i angažovanosti mišićnih grupa u radu koje mogu dovesti do bitnijih razlika u rezultatitima testiranja. Zbog toga se rezultati testa na biciklergometru izražavaju u jedinicama potrošnje kiseonika, w i/ili kpm, a na pokretnoj traci jedinicama potrošnje kiseonika ili trajanjem testa. Preporučeno je takođe da visina testa opterećenja bude submaksimalna (85% maksimalnog pulsa za godine starosti i pol) ili simptomima ograničen test koji se prekida kod pojave relevantnih simptoma. Iskusniji ispitivači mogu primijeniti i maksimalni test opterećenja.
Kod koronarnih bolesnika nakon preboljelog infarkta, primjenjuje se u prve tri nedelje test sa niskim opterećenjem. Nakon 6-8 nedelja može se upotrijebiti simptomima ograničen test opterećenja.
Specifičnost testa je 90-95%, a senzitivnost 60-70%. Pokazalo se da je senzitivnost testa opterećenja zavisna od broja zahvaćenih koronarnih arterija i da u slučaju dvije ili tri kritične stenoze glavnih koronarnih arterija iznosi preko 90%. Od posebnog su značaja visina postignutog testa opterećenja i pojava angine pektoris.
Indikacije za ergometrijsko testiranje:
- Evaluacija prognoze, terapije i rehabilitacija bolesnika sa koronarnom bolesti
- Evaluacija rezultata hiruških zahvata na koronarnim arterijama i zaliscima
- Izdvajanje od koronarne bolesti ugroženih osoba iz inače asimptomatske populacije
- Utvrdjivanje sposobnosti za profesionalni posao, rekreaciju i sportske aktivnosti
- Prognoza bolesti kod bolesnika sa ishemijskom bolesti srca na osnovu testa opterećenja
Rezultati testa opterećenja su važan faktor u izboru bolesnika za hirušku revaskularizaciju miokarda i ocijenu uspeha operacije
Ergometrija kao nespecifičan test može služiti i za ocijenu fizičkih mogućnosi bolesnika sa ishemijskom bolesti srca.
Koronarni
bolesnici sa anginom pectoris podnose najčešće samo niska fizička
opterećenja, a bolesnici nakon infarkta i hiruške revaskularizacije
miokarda srednje teška fizička opterećenja. Rezultate ergometrijskog
testa treba uporediti sa opterećenjem bolesnika u svakodnevnom životu,
profesionalnom radu i rekreacionim aktivnostima.
Srčani bolesnik prekida test opterećenja zbog simptoma koji ga
ograničavaju u daljem naporu, ili zbog postizanja maksimalnog tj.
submaksimalnog opterećenja, najčešće pri opterećenju koje je znatno
ispod očekivanog aerobnog kapaciteta. Bolesniku treba dopustiti samo ona
opterećenja koja ne izazivaju porast pulsa više od 85% vrednosti pulsa u
testu opterećenja, a i tada takva opterećenja mogu biti samo kratkog
trajanja.
Kontraindikacije za test:
- srednja do teška aortna stenoza
- upalna stanja (perikarditis, miokarditis, endokarditis)
- hipertenzija sa RR u mirovanju ≥180/100 mmHg
- brza nekontrolisana fibrilacija pretkomora ili drugi poremećaji srčanog ritma
- kardijalna dekompenzacija
Dva dana prije izvođenja testa potrebno je smanjiti dozu beta-blokatora, a jutro prije dolaska ne uzimati zbog uticaja na srčanu frekvenciju i ishod testa. Obavezno ujutru prije dolaska uzeti ostalu terapiju za regulaciju pritiska.
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