Electrocardiographic methods and rhythm assessment
Methods for registering the electrical activity of the heart remain the basis of diagnostics in cardiology.
- 12-lead ECG: This is a mandatory standard. It is critically important for the initial detection of supraventricular tachycardias (SVT), as well as for subsequent monitoring of how effective and safe the prescribed antiarrhythmic therapy or catheter ablation has been.
- Long-term monitoring: Includes 24-hour or multi-day Holter monitoring. The choice of a specific type of cardiac monitor always depends on the frequency of attacks, the nature of symptoms, and individual patient preferences. Wearable or fully implantable cardiac event recorders are also used.
- Analysis of implantable devices: Modern artificial pacemakers (PMs) and cardioverter-defibrillators (ICDs) have built-in memory. The physician can retrieve information from them to detect hidden episodes of fast atrial rhythm.
- Electrophysiological study (EPS): Used for an in-depth study of the conduction system. It can be performed both non-invasively (transesophageal approach) and intracardiac.
Heart structure visualization and functional tests
Visualization and provocative techniques are used to rule out organic pathology and assess the response of the cardiovascular system to stress.
- Transthoracic echocardiography (EchoCG): Serves as the most important visualization method. The main goal of the study is to identify any structural changes of the heart. EchoCG is strictly indicated in cases of bradycardia, left bundle branch block (LBBB), as well as AV blocks (starting from grade II Mobitz II, high-degree blocks, and complete third-degree AV block). If the clinic lacks the capability to perform the study, the patient must be referred to a specialized medical organization.
- Functional tests: To assess heart function under changing hemodynamic conditions, exercise stress testing, various vagal maneuvers, and a passive orthostatic test (tilt test) are used.
Comprehensive examination before specialized treatment
Before performing major interventions (surgical, radiation, or chemotherapy treatment), a thorough assessment of the patient's functional status is required. This examination is performed strictly according to indications and involves several body systems:
- Cardiovascular system: EchoCG, Holter ECG monitoring, and duplex ultrasound of the arteries and veins of the neck and lower extremities are prescribed.
- Respiratory system: Pulmonary function testing (PFT) and ventilation lung scintigraphy are performed.
- Gastrointestinal tract: Evaluated using esophagogastroduodenoscopy (EGD).
- Neurological status: An initial consultative appointment with a neurologist is required.
Patient management algorithms and quality criteria
The quality of medical care is assessed by a strict list of criteria, starting with the initial examination, which necessarily includes taking complaints, anamnesis, and a full physical examination.
- Patients with arterial hypertension: If high blood pressure persists despite treatment (often observed with iatrogenic hypercorticism in patients with congenital adrenal hyperplasia), special monitoring is required. The cardiologist examines them at least once a year. According to indications, ECG, EchoCG, 24-hour ambulatory blood pressure monitoring (ABPM), and Holter monitoring are performed. The main goal is the early diagnosis and correction of macrovascular complications.
- Pacemaker function check: Pacemaker testing must be performed on a strict schedule. In the first six months after implantation (including for dual-chamber devices), the check is performed twice. Thereafter, monitoring is carried out at least once a year.
- Dispanserization (follow-up) monitoring: Registration with a cardiologist is mandatory for individuals with an implanted electronic artificial pacemaker, as well as for patients with bradyarrhythmias and intracardiac conduction disorders if they are associated with a high risk of sudden death.
To remember the indications for mandatory EchoCG in conduction disorders, use the "Three B" rule: Bradycardia, left bundle branch Block, AV node Blocks (starting from grade II Mobitz II).
Class and exam questions
What methods are used to diagnose supraventricular tachycardias?
The basis is a 12-lead ECG. To clarify the diagnosis, Holter monitoring, analysis of implantable device memory, and an electrophysiological study (EPS) are used.
How often should patients with iatrogenic hypercorticism and arterial hypertension be examined?
The cardiologist must examine such patients at least once a year. ECG, EchoCG, ABPM, and Holter monitoring are prescribed according to indications to prevent macrovascular complications.
In which cases is a patient with arrhythmia placed on dispanserization follow-up?
Cardiologist monitoring is mandatory in the presence of an implanted pacemaker, as well as for bradyarrhythmias and conduction disorders associated with a high risk of sudden death.
What else to study on this topic
- Assessment of functional status before surgical intervention
- Interpretation of 24-hour ABPM data
- Methodology for performing transesophageal electrophysiological study
- Ultrasound duplex scanning of neck and lower extremity vessels
- Analysis of implantable cardioverter-defibrillator (ICD) memory
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