Problems with the cardiovascular system are a must when seeking medical help. Such diseases often lead to severe complications, disability and even death. For this reason, it is necessary to be examined in time and start treatment. Pathologies of the cardiovascular system can occur for many reasons and have various manifestations. Some patients have an asymptomatic course of ailments, which makes it difficult to timely diagnose and often leads to decompensation of the process. There are many examinations to assess the state of the cardiovascular system. One of them is the orthostatic test. It is performed on patients in whom it is difficult to identify the disease or its cause due to the absence of a characteristic picture or the initial stage.
Orthostatic test: indications for the study
The study is carried out in various diseases associated with dysfunction of the cardiovascularsystem and its innervation. An orthostatic test is necessary to assess blood flow, since in pathologies it can slow down or, conversely, increase. Most often in diseases there is a delay in venous return. As a result, various orthostatic disorders occur. They are expressed by the fact that a person may experience discomfort when changing the position of the body from horizontal (or sitting) to vertical. The most common are dizziness, darkening of the eyes, low blood pressure and fainting. Complications of orthostatic disorders are: ischemia of the heart with the development of angina pectoris and myocardial infarction, collapse. The reasons can be not only changes in the blood flow itself, but also in the nervous structures responsible for it. In this regard, disorders can be associated with both cardiac pathology and the central nervous system. The main indications are: changes in blood pressure (both hyper- and hypotension), insufficiency of the coronary circulation, autonomic nervous system.
Types of orthostatic tests
Research can be done in many ways. There is both an active and a passive orthostatic test. The difference lies in the functional load on the patient's muscular apparatus. An active test implies an independent transition of the patient from a horizontal to a vertical position. As a result, almost all skeletal muscles contract. To conduct a passive test, a special table is required, to which the patient is fixed. In this case, the load on the muscles can be avoided. This study allows you to assess the state of hemodynamics before and after a change in body position. Normally, for each person, the main indicators change due to a small change in pressure, as well as due to physical activity. In case of insufficiency of the cardiovascular system, there is an increase (less often - a decrease) in the difference between blood pressure and heart rate before and after the test.
Orthostatic test methods
Depending on the type of orthostatic test, the methods of carrying out are somewhat different from each other. The most common is the Shellong method. This method is regarded as an active orthostatic test. How to conduct research on Schellong?
- The patient lies down on the couch, he should be as calm as possible. A special blood pressure monitor is connected to it.
- The doctor measures the pulse, then records the results of heart rate and blood pressure for the last 15 minutes.
- The patient is asked to stand up and stay upright.
- During this time there is a continuous measurement of pulse and blood pressure.
- The patient lies down again and the doctor records the results after 0, 5, 1 and 3 minutes.
- After the test, a graph of the dependence of the pulse and blood pressure on time is plotted.
Interpretation of results
Despite the fact that changes in hemodynamic parameters with a change in body position occur in each person, there are average indicators. Deviation from the norm in the direction of increasing and decreasing heart rate and blood pressure indicatesdisorders of the cardiovascular or nervous system. When the patient is lying or sitting, the blood is distributed throughout the body and slows down. When a person gets up, it starts to move and goes through the veins to the heart. With stagnation of blood in the lower extremities or the abdominal cavity, the indicators of the orthostatic test differ from normal. This indicates the presence of the disease.
Orthostatic test: norm and pathology
When evaluating the results, attention is paid to systolic and diastolic blood pressure, heart rate, pulse pressure and autonomic manifestations. An ideal indicator is an increase in heart rate to 11 beats / min, a slight increase in other parameters and the absence of reactions of the nervous system. Slight sweating and a constant state of pressure before and after the study are allowed. An increase in heart rate by 12-18 beats / min is considered satisfactory. An orthostatic test with a large increase in heart rate and diastolic pressure, severe sweating and tinnitus, a decrease in systolic blood pressure indicates serious hemodynamic disorders.
