→Description

Echocardiography is a noninvasive diagnostic technique that uses ultrasound to obtain images that allow visualization of cardiac structures and large vessels.

→We can divide it into:

 »Transthoracic echocardiography: if the images are obtained through the thoracic wall

 »Transesophageal echocardiogram (TEE): if the images are obtained through the esophagus.

→What does it consist of?

Echocardiography uses sound waves of a certain frequency (ultrasound, sound waves that the human ear can not hear) to produce an image of the heart and see how it works. Sound waves are transmitted through the body by means of a transducer or probe, which is a device similar to a microphone; These waves bounce in the heart and return to the transducer in the form of echoes that become electrical signals that, in turn, produce images of the heart, which are seen on a screen. It is widely used in cardiology because of its availability, speed and non-invasive character.

→Types

There are different ways of processing the ultrasound signal:

 »One-dimensional or M-mode echocardiography: Uses an ultrasound beam directed towards the heart; Is usually used to see only the left side (or main pumping cavity) of the heart and allows recording both the depth and the movement pattern of certain cardiac structures. Two-dimensional echocardiography or 2D mode: Produces a livelier, moving, broader image of the heart. It is one of the most important diagnostic methods.

 »Doppler echocardiography: Shows how the blood circulates through the heart and large vessels, on the screen is seen in the form of colours. When focusing on the study of movement of the walls of the heart is known as tissue doppler echocardiography.

 »Three-dimensional echocardiography: Provides images in three dimensions and in real time.

 »Contrast echocardiography: Ultrasound contrast agents are used; Its function is to improve the echocardiographic image. Contrast is a substance that is given by injection into a vein, and when receiving the ultrasound, it is as if there were many bubbles filling the heart cavity and facilitating the distinction between the walls of the heart and the cavity.

→What is it for?

It is used to assess the functioning of muscle and heart valves, as well as to provide morphological data of other cardiac structures, such as the pericardium.

→What risks does it have?

Any.

→Possible side effects

Any.

→What does it consist of?

The electrocardiogram is the record in a role of the electrical activity of the heart
In a record like the photo shown in the previous tab, it is observed that on the baseline whenever a heartbeat occurs the electrical activity of the heart produces a characteristic tracing the electrocardiograph detects and graphically represents the electrical activity of the heart. It consists of a system of cables that are placed on the patient to collect the electrical activity. The cables are connected to the skin of the torso by means of adhering metallic discs called electrodes (Photo 2).

→What is it for?

The ECG is a simple test but can provide a very varied and important information. It tells us the rhythm and frequency (or number of beats or pulsations) of the heart, it can detect heart diseases, it allows to study the effect of certain medicines or detect alterations of the rest of the organism that affect the functioning of the heart. It is fundamental in the study and detection of arrhythmias.

→What risks does it have?

Under normal conditions, if the appliance and the electrical connections work properly, it is a risk-free test.

→Possible side effects

This test, under normal conditions, does not have to have side effects; In some people a redness may occur in the area where the electrodes are placed.

→Is any preparation necessary?

The patient has to lie on a stretcher wide enough to rest relaxed to avoid muscle contractures that alter the registry, and have the chest naked to place the electrodes. You have to prepare the skin and clean it well to get a good contact with the electrodes. In some cases, it is necessary to shave the hair to the patient.

→Indications

This test is recommended in the initial assessment of all patients with cardiovascular disease or to evaluate the response to treatments that may induce ECG changes. The use of serial electrocardiograms in patients with heart disease is also indicated if there are changes and even if there is no variation in cases of syncope (fainting), chest pain and extreme tiredness. Before an operation, it is considered indicated to perform an electrocardiogram to all patients with heart disease except in cases of insignificant or mild involvement, in which it would not be essential. In patients at high risk for heart disease the indications are similar. If patients remain stable and no heart disease is seen, an annual ECG is sufficient. It is considered appropriate to perform an ECG in healthy persons over 40 years of age, in patients who will be given medications that may alter the functioning of the heart or those who will be subjected to an exercise test, in case of Hard work or professions where you can risk the lives of many people. Before a surgical intervention is advised in those over 40 years and in asymptomatic diabetic patients.

→Contraindications

It is a test that has no contraindications, although in some cases it can be difficult to get a good electrocardiogram if the patient is agitated or has tremor because the muscle contraction interferes with the recording.

→Is it necessary to sign informed consent?

Do not.

→Other denominations

It is also known as holter of arterial pressure or by Ambulatory Blood Pressure Monitoring (ABPM).

Arterial Hypertension

It is a chronic disease characterized by higher stress levels than is considered normal. A distinction is made between systolic blood pressure (what people commonly call "discharge") greater than 140 mmHg and diastolic blood pressure ("the drop") and greater than 85 mmHg. Blood pressure is variable throughout the day and from one day to the next, so the diagnosis of arterial hypertension should be made by taking several measures separately over time, except in certain cases where a very severe elevation may be sufficient for the diagnosis.

→What does it consist of?

Repeated arterial blood pressure measurements are performed over a period of time with an automatic measurement system that stores the records in a computerized database and then analyzes those data on the computer. The patient is placed the cuff to be inflated in the flexure of the elbow of an arm. This sleeve is connected to a recording device, which is attached to the waist or with a band over the shoulder. Once the device is placed, the patient goes home and it is recommended that he live a normal life. After 24 hours, he returns to the hospital and removes the device. Then the recording device is connected to the computer and the recorded voltage measurements are read. The report can be recorded on the computer so that the doctor can later analyze it or print the result on paper.

→What is it for?

The ECG is a simple test but can provide a very varied and important information. It tells us the rhythm and frequency (or number of beats or pulsations) of the heart, it can detect heart diseases, it allows to study the effect of certain medicines or detect alterations of the rest of the organism that affect the functioning of the heart. It is fundamental in the study and detection of arrhythmias.

→Who does it?

In the case of the 24-hour voltage holter, a professional places the cuff and the recorder and prepares the system for recording. When the recording is finished, the device is removed by the nurse or the patient or a relative if they have been previously instructed. The nurse downloads the information to the computer and subsequently a doctor with appropriate training interprets the data obtained depending on the patient's clinic.

→What risks does it have?

The holter of blood pressure of 24 hours has no risk.

→Possible side effects

This test, under normal conditions, does not have to have side effects; In some people redness, may occur in the area of the cuff or in rare cases a small hematoma.

→Is any preparation necessary?

It is preferable for the patient to wear loose-fitting button-down clothing for comfort. You should keep your arm immobile when you notice that the tensioning is going to take place (the sleeve is inflated) for one minute until it is finished so that the Holter works without problems and the shots are as reliable as possible. You will not be able to shower for 24 hours and you should have a normal life.

→Indications

This is a test that is indicated in the study of variable tension figures, elevated shots, headaches...

→Is it necessary to sign informed consent?

Do not.

24-hour ECG Holter

→What is it for?

This test is useful in the diagnosis and treatment of arrhythmias, especially when the patient's symptoms or sensations can be correlated with electrocardiographic abnormalities. This test also helps assess prognosis in patients who are at high risk for arrhythmias. Was initially used to detect tachycardias (cardiac pulsations higher than normal) or bradycardia (slowing of pulsations). The technical advances have allowed that it can be used to detect parameters that suggest the possibility of dangerous arrhythmias, changes that can be associated to lack of irrigation in the heart or to alterations in the regulation of the heart rate associated to poor prognosis.

→Who does it?

In the case of continuous 24-hour holter, a professional places the electrodes and cables and prepares the system for recording. The patient with a 24-hour holter is told to note down anything he notices and the time, so he can correlate it with the record when recording data is obtained. When the recording is finished, the device is removed by the nurse or the patient or a relative if they have been previously instructed. The nurse downloads the information to the computer and subsequently a doctor with appropriate training interprets the data obtained depending on the patient's clinic.

→What risks does it have?

Continuous 24-hour holter has no risk.

→Possible side effects

This test, under normal conditions, does not have to have side effects; In some people a redness may occur in the area where the electrodes are placed.

→Is any preparation necessary?

It is preferable for the patient to wear loose-fitting button-down clothing for comfort. It is necessary to get a good adhesion of the electrodes to the skin, so it is necessary to clean the area well, and if there is a lot of hair, it may be necessary for the patient to be shaved. It is not possible to wet the device, so it is necessary to remind the patient that it is not possible to shower or bathe and it is advisable for the patient to live as normal as possible.

→Indications

This is a test that is indicated in the study of arrhythmias and in some patients with coronary risk problems and that usually manifest as palpitations, tachycardia, dizziness, fainting or chest pain.

→Contraindications

Minimal patient collaboration is required so that the electrodes are not started and the symptoms noted. It is advisable to avoid approaching electric blankets, magnets, metal detectors and high voltage areas, such as power lines, as they can affect the recording.

→Is it necessary to sign informed consent?

Do not.