Pacemaker checkup and programming

During checkup of a pacemaker (= a device stimulating the heart at the necessary moments, thereby provoking the heart to contract and express pumping activity), that having been implanted under the skin surface, a special instrument is used to get information through the skin surface about battery condition (similarly to other battery powered instrument, pacemaker battery can also run down), intensity of the stimulating current and state of other settings. When necessary, the settings can be modified also through the skin surface (without causing injury) using the same instrument and method (e.g. the heart rate can be modified when the pacemaker should start to stimulate the heart, minimum heart rate during daytime and nighttime can be set such as an automatic heart rate increasing function).

Heart ultrasound (Echocardiography)

It is a test performed by a device functioning based on ultrasound technique (same as orientation of bats and dolphins), which is capable of investigating different parts of the heart and the blood flow within the heart without any adverse side effects and causing no pain. The examination is usually performed on a patient lying on his left side. It is one of the most useful tool among cardiological examination methods, by which different parts of the heart and also great vessels originating from and entering into the heart can be well visualized (normal heart morphology or pathologically structured heart eg. as a consequence of congenital birth defects). The heart chamber sizes and their wall thickness can be measured, the „pumping power” (= ejection fraction) of the heart can be estimated, scar of a previous myocardial infarction can be detected.

Electrocardiographic stress testing (using exercise bicycle)

It is an examination performed with assistance of a special stationary bicycle, during which continuous ECG monitoring and frequent blood pressure measurement are completed during gradually intensified levels of physical exercise. The test is applicable to determine cardiovascular exercise capacity and detect changes (normal or abnormal) induced by stress testing. The most frequently applied indications are diagnosis of blood supply disturbances of the heart's musculature (=ischemia), evaluation of prognosis in ischemic heart disease, assessment of effectivity of the initiated drug treatment, determination of exercise capacity following myocardial infarction, risk stratification after infarction, determination of recommended level of regular physical activity as part of rehabilitation care after infarction, and finally, evaluation of physical condition of healthy individuals prior to their activity demanding great physical effort.

Holter ECG (Ambulatory ECG monitoring)

It is a portable device (to able to be hung up to the neck or onto a belt) continuously recording the electrical activity of the heart on a 24-hour basis. It is suitable for investigation and follow-up of arrhytmias and disorders of pacemaker activity and electrical conduction (pathologically slow or too fast heart beating, frequent premature beats, irregular heart beating = atrial fibrillation, potentially life-threatening arrhytmias), also for detection of pacemaker dysfunction, measurement of average heart rate, detection of blood supply disturbances of the heart's musculature (silent ischemia) and of symptom free arrhytmias, and eventually, evaluation of effectivity of antiarrhytmic drug treatment.

ABPM (Ambulatory blood pressure monitoring)

It is a portable device (to able to be hung up to the neck or onto a belt) developed to measure the patient's blood pressure and pulse every 15-20 minutes during daytime and 20-30 minutes at night. Thus the device records blood pressure values measured during ordinary and everyday activity of the patient. The method is suitable for spectral visualization of blood pressure values measured during the whole day, thereby is it applicable in detecting white coat hypertension (elevated blood pressures only in the office) and hypertension presenting during nighttime and the early morning hours, in calculating daytime and nighttime average values and their ratio compared to each other (=diurnal index, normally the nighttime blood pressure values are lower), and eventually, in assessing effectivity of the applied antihypertensive drug treatment.

ECG (Electrocardiography)

It is an examination performed in order to visualize the electrical activity of the heart with assistance of vector imaging technique, which is executed in lying position of the patient and using 10 electrodes. The examination is suitable for investigation of the electrical activity of the atria and ventricles, to check-up disorders of electrical conduction and abnormalities of the sinus node and other sites of the heart capable of having pacemaker activity. It is also essential in detecting a previous myocardial infarction and current disturbances in the blood supply of the heart.

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