An electrocardiogram (ECG) is a graphical representation of the electrical activity of the heart.The electrical activity is related to the impulses that travel through the heart to determine the heart rate and rhythm, these shapes are quite different in relation to the shape, size and conduction disturbances electricity so-called conduction blocks.It is evident by what we say how useful is the monitoring of ECG in medical diagnosis; both for normal and pathological situations resulting from physical and physiological causes. The parameters of ‘ECG are altered, more or less strongly, when there is some cardiac problem of any nature. It is important for one who interprets the track, know what variations may exist, how to seek and to know wath’s meaning. The ECG gives us, in fact, information about: heart rate, rhythm of the heart, or the presence of any ‘blocks’; presence of any abnormal beats (extrasystoles), signs of heart attack or ischemia and alterations of various electrical waves that may indicate morphological alterations of the cardiac chambers such as those induced by disease.

A Holter electrocardiogram (Holter ECG) is a system that provides the continuous monitoring of the cardiac activity.The patient is connected to the unit at least 24 hours, during which it can continue to carry out his normal activities. During the day, he is asked to write down in a diary the various activities (sleeping, eating, taking drugs, work, copulate, running) and the appearance of any symptoms, so that each recorded event can be linked where possible , with one of the activities described by the patient. The devices currently in use also provide for the presence of a button the patient can operate in the event like the onset of chest pain or other relevant symptoms. At that moment a signal remains recorded, which constitutes a point of repere during the reading of the track by the physician.BenefitsThe Holter ECG allows you to highlight occasional arrhythmias we are not able to identify during the short time of a standard electrocardiogram. For patients with more transient symptoms the Holter ECG can be used for several days, using the most modern systems the specific software automatically performs a preliminary analysis, counts the cardiac complexes and indicates the average heart rate, maximum and minimum, and highlights areas that deserve closer inspection, arrhythmia, tachycardia and bradycardia, pathologic pauses and electrical modifications typical for coronary heart disease.

Ambulatory blood pressure monitoring (Blood pressure Holter) is a continuous record of the patient’s blood pressure for a period of 24 hours. While the monitor is worn is important to continue with the usual daily activities. Your doctor may use this test to: decide if you need blood pressure medication, adjust the type or dose of blood pressure medication you are already taking, help diagnose symptoms such as dizziness, headache or loss, the test is also used to rule out a condition called ‘white coat hypertension’,the increase in blood pressure when a patient is visited a doctor, but normal at other times. How is the test? A blood pressure cuff is placed on the patient’s arm, connected to a small instrument placed at the shoulder or belt. The recorder is worn for 24 hours in which you have to keep your daily activities. After 24 hours, the blood pressure monitor is returned to the clinic and data are analyzed.

Echocardiography (ultrasound of the heart mono-and twodimensional, Doppler and color Doppler) is a test that uses sound waves emitted by a probe resting on the chest of the patient to visualize the heart to highlight possible abnormalities in the size of the heart chambers, the movement and the thickness of the walls of the heart and heart valves. With the help of the Doppler and color Doppler technique, it is possible to study the heart valves and the blood flow through these. The examination is totally painless and can be repeated when necessary to evaluate the trend in time of abnormal and the effectiveness of therapy undertaken. When you run this examination? The indications to perform an echocardiogram are spreading widely as it provides valuable information on the structure and on the functions of the heart. Much of cardiac pathologies are indication echocardiography, especially diseases of the heart valves of the structures of the heart such as the pericardium, the heart muscle, the ischemic heart disease. You run the test if you need:
– qualitative and quantitative assessment of valvular heart disease
– evaluation of cardiac wall motion and its anomalies
– evaluation of congenital heart disease
– assessment of myocardial damage in disease of high social interest and significant impact of the population like: hypertension, myocardial infarction, diabetes, etc …
– evaluation of the results of a corrective surgical intervention in congenital heart disease or acquired ones
– evaluation of prosthetic valves withsemiquantitative measurement of gradients and flows in the presence of stenotic or insufficient valves
– diagnosis of all heart disease in pregnancy with the possibility also of intrauterine diagnosis of severe congenital heart defects
– Evaluation of the damage induced by the treatment of cancer with chemotherapy or radiation therapy of the chest

With echocardiography you can:
1. assess the ventricular function by calculating the size of the various structures, volume and mass of the left ventricle, study the global systolic function (with the calculation of ejection fraction), systolic function of the various segments of the wall of the ventricles and with the doppler it’s also possible to obtain information on hemodynamic status of the heart, both in the systolic and diastolic blood pressure;
2. obtain hemodynamic assessments, (information before echocardiography was provided only when the study invasive cardiac catheterization), like: stroke volume and cardiac output, pressure gradients, valve surface, intracardiac pressures, systolic and diastolic function
3. evaluate the functions quantifying valvular abnormalities (stenosis, congestive) heart valves and prosthetic valves, the pressure within certain structures (pulmonary artery), cardiac output, the amount of shunt communications between pathological cardiac structures;
4. assess the situation of the myocardium in the course of coronary artery disease by examination of the motility (Kinesys), the thickness and quality of the wall. In this field, echocardiography plays an important role in the diagnosis of coronary artery disease, recognition and early treatment of myocardial infarction and its complications, the prognostic stratification of post-MI patients, the follow-up of patients undergoing cardiac.
5. revascularization procedures both surgical and angioplasty. Before the advent of ultrasound, some fields of cardiac disease were hardly explored, while now, in a few minutes, you can make precise diagnoses and take the most appropriate therapy. An echocardiogram is a useful test for a first diagnosis of heart disease and to control the development of cardiac dysfunction over time. For example, in ischemic heart disease echocardiography enables the diagnosis of myocardial ischemia or through the detection of abnormalities, transient or stable, respectively, to define the site and extent and their evolution over time. It is very useful in the diagnosis of congenital heart disease is the child and adult. With echocardiography we may obtain decisive evidence about the timing and modalities for surgical procedures on the heart valves.

THE CLINICAL APPLICATIONS OF ECHOCARDIOGRAPHY

Assessment of stiffness vascular (vasculare rigidity)The VaSera is a screening tool for the diagnosis of atherosclerosis recently introduced in the European market. At this time the non-invasive assessment of arterial stiffness (rigidity) is done by the measurement of pulse wave velocity (carotid-femoral Pulse Wave Velocity). This methodology is used in the research laboratory trials (the ‘gold standard’). However this method has some limitations – PWV is influenced by various factors, in particular by variations of the blood pressure and by the waves of arterial reflection. The innovative index CAVI (Cardio Ankle Vascular Index) that characterizes the VaSera, solves these problems because: – It ‘independent of variations in blood pressure.- I do not feel the effects of wave reflection.- Adequately reflects the overall behavior of the arterial system.- The values obtained are reproducible.A further index measured with oscillometric mode is the ABI (Ankle Brachial Index) that identifies the presence of peripheral vascular disease, a mayor marker of cardiovascular risk. This evaluation is very important to assess the severity of vascular diseases, when the patient has damage of more vascular districts: coronary, cerebral, etc.

The echocolordoppler method is applied to the study of various vascular districts In particular it should be noted the study of vessels that arise from the aorta ( neck vessels) represented by two pairs of arteries: the carotid and vertebral. This are ‘strategic’ vessels because they carry blood to the brain, the tightening of them – stenosis (such as given by atherosclerosis) can result in a cerebral deficits. With this examination can highlight alterations of their walls (thickenings, deposits given by atherosclerosis), the presence of plaques of various nature (soft, hard or mixed whose surface can be regular or irregular) able to determine, more or less, stenosis and / or occlusions with more or less severe clinical manifestations ranging from the transient ischemic attack (TIA) to the stroke.The preferential localization of the plaques is at the level of the carotid bifurcation because the hemodynamic conditions are favorable to the formation of these lesions. The Doppler ultrasound of T.S.A. is suitable for the study of all diseases related to disorders of the functionality of the central nervous system (dizzy syndromes, movement disorders, language, memory impairment), and for the prevention of such diseases in individuals at risk like diabeties, hypertension, heavy smoking, dyslipidemia.The examination also allows if the vessel is perfectly healthy or has even minimal trobles, this difference is crucial to decide how intense must be the preventive treatment.

CCSVI or chronic cerebrospinal venous insufficiency (and multiple sclerosis) is a hemodynamic syndrome, in which the cervical and thoracic veins are not able to remove effectively the blood from the central nervous system (CNS) due to stenosis and malformations of the cerebrospinal veins : the internal jugular, the spine, lumbar, azygos and hemiazygos and iliac. This disease of the circulatory system was first described by Paolo Zamboni (professor at the University of Ferrara) in 2008 and, in September 2009, the IUP (International Union of Phleobology), the largest scientific organization for the study of venous diseases, accepted this syndrome by unanimous vote CCSVI was included in the chapter of congenital malformations, those that develop between the 3rd and the 5th month of intrauterine life. These malformations assume the forms of rings of fibrous tissue, shrinkage, septa inside the vessel (intraluminal septa) and membranous obstruction, abnormal valves, twisting veins, venous hypoplasia (born too small veins and agenesis of the vein (veins that have formed to nothing)All these malformations produce a reduction of the venous blood flow or the stop for an alteration of the internal caliber of the vein and not a reduction of the outer section of the vessel. Compared to these various malformations in the same document some general guidelines of treatment are given, including angioplasty (baloon dilatation), which applied to CCSVI. In an open pilot study conducted in Italy, also claims to have identified a potential link between CCSVI and multiple sclerosis (MS).