The electrocardiogram (EKG) is a non-invasive and very useful investigation to diagnose a multitude of heart conditions. Performing EKG involves installing electrodes on the patient's body, allowing the electrical activity of the heart to be recorded. The investigation lasts on average 5-10 minutes and can be repeated whenever needed.

Resting EKG does not require special training and the patient should not discontinue his medication prior to this investigation. EKG is a pain-free and contraindication free investigation

Resting EKG is recommended when the patient has at least one of the following symptoms: chest pain, palpitations, difficulty in breathing, excessive fatigue, especially during exertion.

EKG Holter monitoring involves recording the electrocardiogram for 24 hours or more, when the patient is in daily living conditions and not in cabinet or hospital conditions. The recording is achieved by of 6 electrodes mounted on the patient's body, electrodes that are connected to a small device, attached to the waist.

EKG Holter monitoring indications:

• Diagnosing and assessing the severity of cardiac arrhythmias and intermittent driving disorders that occur during a day
• In the case of patients who have symptoms such as palpitations or loss of consciousness (syncope) in order to highlight the electro-cardiographic changes underlying these symptoms
• Diagnosis of silent ischemia in asymptomatic patients with ischemic heart disease

EKG Holter monitoring does not require special patient training, and the patient should not discontinue medication prior to this investigation.

24-hour HTA monitoring (ABPM) - represents the measurement of blood pressure at regular intervals for a predetermined period (24 h). The investigation provides information on the patient's blood pressure values in daily life conditions and on the circumstances in which it fluctuates.

TA monitoring is recommended for diagnosing and assessing the severity of hypertension. It is also indicated for:

• Assessment of borderline hypertension
• Assessment of oscillating HTA
• Evaluation of the effectiveness of the indicated treatment
• Correct diagnosis of pregnancy hypertension
• Investigation of symptoms that suggest hypo-tension
• When there is suspicion of HTA "white robe" (when there are high values of TA in the medical office in patients without other cardiovascular risk factors compared to its values at their home)

The stress test is a non-invasive investigation that involves recording the electrocardiogram and measuring the blood pressure while the patient is traveling on a treadmill, according to a predetermined protocol, which implies the gradual increase of the intensity of the effort, depending on the physical condition of the patient and the associated comorbidities.

The stress test stops when the theoretical maximum heart rate is reached, the patient experiences chest pain, difficulty breathing or dizziness, no longer increases the effort, even if no ECG changes have occurred, electrocardiogram changes or sustained arrhythmias appear, on the electrocardiogram arterial growth is exaggerated.

Indications of the stress test:

• Diagnosis and stratification of risk in patients with ischemic heart disease
• Determining the severity of ischemic heart disease when the diagnosis is established
• Diagnosis of stress-induced symptomatic and recurrent arrhythmias
• Follow-up of patients who have benefited from various treatment methods: drug, percutaneous transluminal angioplasty (dilation) with or without stent mounting, aortocoronary bypass
• Evaluation of the stress response in hypertensive patients wishing to make important efforts
• Cardiologic health assessment for athletes, pilots, drivers, police officers, military officers

Contraindications of the effort sample:

• Severe cardiac or other organ disorders: unstable angina, acute myocardial infarction, tight aortic stenosis, therapeutically uncontrolled severe hypertension, anemia, acute infections, etc.
• When the electrocardiogram at rest shows changes that do not allow the interpretation of the test (for example in the left branch block)
• When the patient is unable to exert effort (peripheral arteriopathy, osteoarthritis, walking disorders, etc.).

Preparing the patient to perform the stress test:

Patients are advised to be lightly dressed and wear comfortable footwear.

Drug treatment for high blood pressure or angina will not be discontinued before the test. At the doctor's recommendation, when the patient's situation allows, the beta-blocker treatment will be discontinued in the morning of the test or the digital treatment 5 days before the test.

Cardiac ultrasound is a method of exploring the heart through ultrasound. It is painless, non-invasive, non-radiant, does not require anesthesia or prior patient preparation and is risk-free. These advantages have made cardiac ultrasound a routine method in the diagnosis of cardiological disorders and in the subsequent monitoring of patients.

There are several modes of ultrasound examination: M mode, two-dimensional echo-cardiography, Doppler examination (pulsed, spectral and color) and tissue Doppler.

Two-dimensional ultrasound provides real-time images of cardiac structures.

Doppler echocardiography provides information on the hemodynamic characteristics of blood flow within cardiac structures.

The tissue doppler provides information on the dynamics of cardiac structures, being particularly useful in evaluating diastolic and systolic functions.

All these modes are complementary and together lead to a complete assessment of cardiac function during a cardiac cycle (systole + diastole).

Considering the importance of the technological performance, the RoNeuro Institute has a cardiovascular ultrasound of high versatility and diagnostic performance - VIVID S5 - qualities that are essential in the diagnosis and monitoring at the highest level of our patients.