ECG, exercise ECG, Holter monitoring, ABPM examination, echocardiography, coronarography

Holter ECG

24 hours long ECG recording

Indications
• Exclude significant bradycardia
• Exclude significant pausa (longer than 2400 ms)
• Conduction disturbances (AV block)
• Atrial fibrillation
• Frequency control
• ST abnormalities

Ambulatory blood pressure monitoring - ABPM

24 hours long • Indications
• Exclude white coat hypertension
• Exclude hypotension
• Diagnosis of hypertension
• Evaluate the effectiveness of therapy

Exercise testing

Exercise stress testing is currently used most frequently to estimate prognosis and determine functional capacity, to assess the probability and extent of coronary disease, and to assess the effects of therapy

Contraindications for exercise ecg

• Acute myocardial infarction (MI; within 2 days)
• Unstable angina not previously stabilized by medical therapy– Appropriate timing of tests depends on the level of risk of unstable angina
• Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Acute aortic dissection

Indications of termination for exercise ECG

• Drop in systolic blood pressure (SBP) of more than 10 mm/Hg from baseline, despite an increase in workload, when accompanied by other evidence of ischemia
• Moderate-to-severe angina
• Increasing nervous system symptoms (eg, ataxia, dizziness, near-syncope)
• Signs of poor perfusion (cyanosis or pallor)
• Technical difficulties in monitoring electrocardiographic (ECG) tracings or SBP
• Subject’s desire to stop
• Sustained ventricular tachycardia
• ST elevation (>1 mm) in leads without diagnostic Q waves (other than V 1 or a VR)

Echocardiography

• The size and shape of your heart, and the size, thickness and movement of your heart’s walls
• How the heart moves
• The heart’s pumping strength (EF %)
• If the heart valves are working correctly.
• If blood is leaking backwards through your heart valves (regurgitation)
• If the heart valves are too narrow (stenosis)
• If there is a tumor or infectious growth around your heart valves
• Pericardial effusion
• Systolic right chamber pressure (PE!!)

Transoesophageal echocardiogram (TOE)

To exclude endocarditit’s
• To exclude thrombus in the atrium before CV

Coronarography and PCI

• Gold standard for ACS
• Stent implantation: BMS or DES stent placement