Daily arterial pressure monitoring - features of the procedure. Long-term monitoring of blood pressure (24 hours) SMAD Daily monitoring of blood pressure

The date: 21.10.2019

Cardiological examination methods are divided into 4 large groups:

Communication of a doctor with a patient

Despite the continuous development of medical technologies, the personal conversation of the doctor and the patient technique will not replace. A good cardiologist should carefully ask the patient about his complaints, the history of the development of the disease, important for understanding the disease of the moments of the past and real life of the patient.

A simple examination of the patient can also give a valuable information for a doctor.

But the value of listeners and performance techniques with the development of technologies is really reduced. In the environment of American doctors, the familiar foundoscope (device for listening) is increasingly replaced by the ultrasound scanner with a mobile phone size.

FUNCTIONAL DIAGNOSTICS

ECG (standard 12-channel hoist electrocardiography)

The technique for the development of which Villem Einthoven received the Nobel Prize, is applied by cardiologists for more than 100 years. The first devices were the size of a large machine, the patient was sitting, lowering the arms and legs in a bucket with water.

Pictures on this site are increasing and moving with the left mouse button!

Modern devices are small consoles to the computer. Unfortunately, the number of wires, clips and suckers is not reduced yet.

What pathology is detected on an ECG with a great degree of probability?

ECG allows you to evaluate the work of the heart to generate and carry out electrical impulses. The following violations are visible on the ECG (if they took place at the time of recording):

Rhythm disorders (arrhythmia - tachyarhythmias (rhythm acceleration), bradyrithmia (associated with rhythm), flickering arrhythmia (atrial fibrillation), extrasystolism and so on
Blood Heart Muscle Violations (Ischemic Heart Disease, the most formidable manifestation of which is a myocardial infarction)
Violation of the electrical impulse on the conductive heart system ("blockages"), as well as a number of rare and little-known state-known state patients.

What pathology ecg does not reveal?

ECG does not reveal:

The pathology that is not at the time of recording (10-30 seconds). For example, in the morning you had an attack of arrhythmia, you came to an ECG record - and the heart works fine. In order to write a rarely manifested pathology, American Norman Halter has developed a daily recording technique (Holter monitoring ECG).
Pathology not accompanied by electrical manifestations - small degrees of valve defects (including mitral valve prolapse)

What pathology is detected on an ECG with an average degree of probability?

Thickening of the walls of the ventricles and atrial
Pronounced stages of valve vices

Such pathology is much more accurately determined on echocardiography, the conclusion of the ECG ECG on these issues may be false or inaccurate.

In which cases the ECG gives false-positive results?

False-positive results are when the ECG is determined by the sharp pathology, and it really is not. This is possible, for example, in the menopacteric period of women, when ECG becomes similar to "sharp". The main difference is the same picture of the ECG remains for years, and the acute pathology is because it is called the sharpness that the shape of the teeth can vary in minutes. In addition, the ECG similar to the ischemic picture can be recorded, for example, in people with autoimmune rheumatic diseases.

If you have a consistently unusual shape of the teeth, we have a good copy of the ECG with you, otherwise, in the case of registration of a new ECG, an urgent hospitalization may be offered.

What applications should not be afraid?

Sinus arrhythmia - This is the normal dependence of the pulse rate from respiratory movements.

Early repolarization syndrome - A completely harmless feature of the ECG.

Violation of intraventric and internal conductivity - There is no clinical picture, restrictions and treatment does not require.

Blockade of the right leg of a beam of His - This is already pathology, but again the clinical significance is very small. In children and adolescents can be an option for the norm.

Migration of the driver's rhythm driver - restrictions and treatment does not require.

What is required from the patient when writing an ECG?

Just in case (if there are no disposable napkins in the clinic) you need to take a pair of napkins to wipe the skin moistened to better contact with the electrodes.

Some particularly outstanding clinics that do not have gel may demand to shave hair on the chest in hairy men, but the ECG gel (or ordinary ultrasonic) solves this problem in principle, and on the gel, the chest sucking electrodes hold normally.

To record the ECG, the patient must free from clothing the chest completely, wrists and ankles (the need to shoot thin tights for women is negotiated with the staff staff - it is usually not required, simply splashes the conductive spray).

Next, the patient falls on the couch, the electrodes impose on it and the record begins, which continues from 10 to 30 seconds. During recording, the patient must lie calmly without movement, it is necessary to breathe superficially so that there is less interference from the chest movements.

Halter monitoring (hmm)

Norman Halter, setting the goal of ECG recording at a freely moving person, first developed the devices transmitting ECG on the radio. On the back, the patient hung a wound with the transmitter, and the stationary receiver recorded and processed the ECG. Later, wearable long-lasting devices were developed, which currently have a size less than a cigarette pack.

What pathology does Holter monitoring reveal?

Halter is a "long" (day) ECG, so monitoring identifies the same pathology as the ECG, but much more significant. These are violations of rhythm and conductivity, ischemic heart disease, the so-called "primary electric heart disease". The special value of hmm has the "transient", that is, non-permanent, violations.

What are the options for monitors?

Halter monitors differ in the number of recording channels (from two to twelve. Standard ECG is written in 12 channels). It is clear that the more channels, the more accurate the data.

When first in the life of Holter monitoring, it is better to wear a 12-channel Halter. Ischemic heart disease is also significantly accurately determined by the 12-channel holder. And even information about arrhythmias 12-channel gives significantly more (for example, it can sometimes be understood from which ventricle "focus" extrasystoles).

However, for example, with repeated studies of the famous arrhythmia there are enough channels.

In addition, there are Halter devices with an additional function of daily control of blood pressure (Halter + SMAD). Such devices are inherent in all the advantages of SMAD and all flaws (buzz when pumping air into the cuff).

Is Holter Waist for Establishing Violations?

Not. There are cases when during the daily record of violations do not manifest themselves (there is no attack - no record). In these cases, a multi-consuming (up to 7 days) monitoring is used for "capture".

With rare (less often a week), the attacks are used so-called event recorders (devices similar to wrist watch). They start recording when you click on the button. The disadvantage of these devices is to record only one channel (and the Halter writes from 2 to 12 channels), as well as the impossibility of evaluating the ECG to the attack.

In suspected dangerous, very rarely manifested pathology, it is possible to cross the miniature apparatus (the so-called looper recorder) under the skin, while the recording can be conducted to several months, and the "new" fragments automatically delete old records.

How to prepare for Holter monitoring?

The first thing to be done is to sign up for the procedure. Typically, monitoring is quite popular, the devices hang on patients and the queue in state clinics can be delayed up to a month.

For hairy men, it's not bad at home to shave your hair on the chest so that the electrodes fit tightly to the skin. Otherwise, it is possible that this procedure will have to be carried out in a significantly less comfortable environment in the clinic. For a three-channel Holet, it is enough to shave the left half of the chest, and for a 12-channel - shave in the middle of the breast of the strip approximately 12 cm wide and all the remaining areas on the left half of the chest.

In the case of an empty relationship of the clinic to patients, you may need batteries, usually one, less often two finger (or misminist) format, better than Duracell. May also require buy disposable plastic cholet electrodes in the medical equipment (their number depends on the number of monitor channels).

Some of the patient may require a pledge passport (although this is contrary to the law) or some money.

All organizational issues should be specified when writing to monitoring, not to remain "with the nose" (and without research). In a normal clinic, you only need your presence, all the little things organize the clinic.

Patients often ask the question: "Does records in Holter monitoring a mobile phone prevent?". No, it does not interfere, the transmission of the ECG signal goes on the shielded wires and the radio interference of significant influence on the signal does not provide.

How is the procedure for Holter monitoring?

At the appointed time, you come to the clinic, and the staff (usually do nurses, less often doctors) gluits the electrodes on you and hangs the device (usually it is placed in a tissue handbag on the strap or has a clips for fastening on the belt, as covers for cell phones).

You give you a diary of Holter monitoring, in which you will fix the events you who are interested in, and (in good clinics) a certificate for law enforcement agencies with a photo of the device and an explanation that you carry a diagnostic medical device, and not a shakhid belt.

In the monitoring diary, you need to record the time of such events (beginning and end):

stress

reception of drugs

meal

signs of illness, if they are: pain, interruptions, dizziness, etc.

During recording (unless otherwise specified with the doctor), you need to give yourself a physical activity: the lifting of the stairs, fast walking, etc.

A day after the start of the recording, you need to return the monitor to the clinic. This is possible in two versions:

You come to the clinic personally and staff takes off the device.
If you can not appear in the clinic, you can turn off the device (in most cases it is done by extracting the battery), then disconnect the electrodes, after which the device in the package can be delivered to the clinic to your representative. With this option, you need to ask my sister during the installation of the monitor, how to turn off the device.

After removing the monitor, the doctor examines the record and makes a conclusion (usually it takes from an hour to two, although the clinics can prescribe and much longer - up to two days). When removing the monitor, be sure to learn the time when you can take the conclusion. In advanced clinics, you can send it to email.

Are there any inconvenience for a patient under Holter monitoring?

Yes, the wearing of the monitor is associated with some small inconveniences. First, the Halter is an electronic apparatus that cannot be poured with water. Accordingly, splashing in the bath or under the shower it will not work with it. Wash your arms and other parts of the body that are not in contact with the device, you can.

The monitor is sizes and weight, wires are connected to it, the patient has electrodes on the body - this can some extent interfere with sleep and active movements.

In addition, in our turbulent time of terrorist acts, the appearance of wires in crowded places from underwear to serious trouble with law enforcement agencies, so the patient at his request can give a certificate with a photo of the device and clarifications of its safety for others.

What to do with the conclusion?

Holter monitoring, as well as any technical research method, is to help attending a doctor. Therefore, all therapeutic and dalun diagnostic appointments after acquaintance with the results of monitoring should make your attending doctor - a cardiologist or therapist.

Daily blood pressure monitoring (SMAD)

The development of ECG Halter Monitoring devices led to a parallel development of equipment for long-term blood pressure recording. Externally, SMAD devices also represent small boxes for recording, only a cuff is attached to the tube, like a tonometer.

What are the indications for daily monitoring of blood pressure?

They are divided into diagnostic and control

Diagnostics - with pronounced hesibrations of blood pressure at the doctor's reception, to determine the degree of existing hypertension, to evaluate the Daily Profile AD, to identify transient episodes of hyper and hypotension.

Control - to assess the correctness of treatment.

How to prepare for daily monitoring of blood pressure and how is the procedure?

Everything is almost the same as in Holter monitoring (see above), just hairy breasts should not shave men.

Are there any inconvenience when monitoring hell?

Yes. The same as for the cholet (electronic device, it can not be in contact with water).

In addition, you will be accompanied by the buzz of the pump and hand over the cuff, during the day every 15 minutes, at night - every half hour. Consider this if the day of monitoring coincides with important working moments (meetings, etc.).

Load Samples (Veloergometry and Tredmil - Treadmill)

The essence of these techniques is an ECG and blood pressure recording with gradually increasing dosage physical exertion.

This study can clarify the situation on two issues:

there are no ecg signs of ischemic heart disease on the background of physical exertion
what is the tolerance of physical exertion in numbers (important for athletes).

How to prepare for load samples?

Before cycle ergometry, it is necessary to undergo the procedures for Holter monitoring and echocardiography. It is recommended to carry out a load sample in the first half of the day, 2 hours after a light breakfast. You need to take with you towel procedure, sportswear and shoes.

Is there any contraindications for load samples?

There is. EchoCG and Halter are made for this before the study. The doctor evaluates the data and makes a conclusion about the possibility (or inability) of the study.

Rady diagnosis

Echo kg - echocardiography (old name - heart ultrasound)

Daily monitoring of blood pressure is carried out throughout the day in the phases of activity (walking, work, physical, mental load) and recreation (sleep, walk in nature, in the lying and sitting position). A small apparatus is around the clock on the human body and automatically measure the indicators at certain intervals.

Such diagnosis is of great value to control the effectiveness of treatment, with a complex history, increased risks of the development of complications.

Daily blood pressure monitoring is carried out for more accurate diagnosis of pressure problems under conditions as close as possible to the usual human life.

It makes it possible to trace the dynamics, the patterns of change of indications throughout the day, establish the dependence of pressure jumps from certain factors. In turn, this makes it possible to put a more accurate diagnosis and assign suitable treatment, refute either to confirm suspicion of hypertension / hypotension in incomprehensible situation, establish factors affecting hell, trace the dynamics of treatment.

For a period of 24-48 hours to the patient's body, a special device weighing about 300-500 grams, capable of fixing blood pressure values \u200b\u200bin a variety of life conditions.

The study is carried out outpatient, and the mechanism will automatically carry out measurements and fix the data obtained in its memory for approximately every 15 minutes during the daytime and every 30 minutes at night during sleep (depending on the settings). The patient does not need to record the values \u200b\u200bof the blood pressure, but it must describe in detail its routine of the day.

The data obtained can be transferred to the computer and learn more in detail. The doctor will evaluate such indicators:

The average value of hell for the entire period of the study at night and daytime;
Episodes when the level of blood pressure rose / lowered to maximum values;
Daily index indicators of diastolic and systolic pressure;
The hell in the first half of the day and after awakening.

For whom it is intended?

Indications for the conduct of SMAD are:

- Some people feel the fear of doctors, so there can be worried at the reception. This will be displayed during pressure measurement: the device will show an increase in blood pressure, although in fact a person is not sick, but simply worried. The daily control will make it possible to accurately establish whether a person has a pressure problem or not.
Suspicion on.
Hidden hypertension or, as it is also called, hypertension of the working day, when pressure drops are observed only in working conditions.
The need to monitor the effectiveness of the treatment of problems with blood pressure.
In the process of treatment, it was revealed that drug drugs do not help eliminate pressure problems.
To track the rhythm of oscillations of indicators throughout the day. Smad allows you to identify the causes and patterns of circadian rhythm violations.
In case of insulin-dependent diabetes mellitus.
For examination of pregnant women if they have deviations of the indicators of hell from the norm.
Genetic predisposition to hypertension.
Declaring the diagnosis in cases of pathologies of the nervous system of vegetative nature.
Large pressure jumps (high pressure drops sharply and vice versa).
Creates a threat to the development of complications.
To establish the cause of sudden losses of consciousness (one of those may be hypotension).
To establish factors affecting the change of blood pressure.
When the unite measurements show borderline values, the symptoms are expressed ambiguously and there is no possibility to put an accurate diagnosis.

In such situations, daily monitoring AD provides valuable information, which will help put an accurate diagnosis, suggest the cause of pressure problems and designate as adequate treatment as possible, as well as correct inefficient medical measures.

Contraindications of techniques

Despite its informativeness and research value, SMAD has some contraindications to conduct. These include:

Blood pathology during exacerbation periods, including thrombocytopenia.
Skin diseases and other lesions (wounds, abrasions) in the shoulder area.
Diseases accompanied by damage to vessels.
Hand injuries, shoulder joint.
When carrying out the scabs, the patient's condition had deteriorated on the previous time.
Injuries, diseases of vessels that may interfere with the conduct of the procedure (for example, the impaired cross-artery permeability).

Before using the Machine for SMAD, you must be consulted with the therapist.

Advantages and disadvantages of pressure control method

Today, SMAD becomes a very popular method of controlling pressure testimony and tracking features of hypertension / hypotension. The advantages of this method should include:

the ability to get more accurate, objective readings;
the results of such a study are independent and more truthful, since the measurement is carried out under conditions close to ordinary life - this makes it possible to eliminate the impact on the result of the examination of the fear of doctors or one-time, random factors;
with the help of SMAD, it is possible to identify hidden, not having expressly pronounced symptoms, blood pressure disorders;
makes it possible to prevent the development of the disease in genetic susceptibility;
very informative with incomprehensible situations (loss of consciousness of not identified etymology, constant weakness, incomprehensible or sleep, short-term systematic jumps of blood pressure, etc.);
makes it possible to evaluate the effectiveness of treatment of problems with blood pressure, adjust the non-response purpose of drugs or their dosage;
helps to assess the condition of a pregnant woman with the problems of hell, to identify and prevent the development of complications during childbirth, to decide on the admissible form of the delivery in a specific situation;
measure pressure is possible at home.

The disadvantages of this method include unless small inconvenience at the time of the procedure: it is impossible to take a bath, swim in the river, sea, visit solaries, baths; You must be careful not to damage the device.

A person may experience some discomfort from the constant wearing of the device, especially during sleep. However, compared to the benefit of SMAD, such temporary inconvenience is insignificant.

Perform daily monitoring hell with such a device as a tonometer. Usually used a small lightweight device (up to 500 grams of weight), which is attached to the belt under clothing, and the cuff is fixed in the shoulder area or wrist. It fixes the results and maintains them in its memory, and after completing the procedure, the instrument data are displayed on the computer.

The machine for daily blood pressure monitoring can be purchased in pharmacies or shops of Medservis, medical equipment.

It is convenient to take a touch meter with a microcomputer, in this case the measurement results will be automatically saved in the device's memory. Otherwise, you will need to independently write all the readings.

Today, modern tonometers that are worn on the wrist are developed. They are very comfortable, like a clock or bracelet. However, for people over 50 years old, such devices are not suitable, since with age vessels lose elasticity, and the pressure on the wrist will not be measured for sure.

For a more accurate diagnosis of a person's condition, it is recommended to purchase tonometers that register not only pressure readings, but also a pulse. If we talk about the specific brands of the meters, the best reviews are used such devices:

Price category	Brands
From budgetary options	CsMedica.
Medium price category	V. WELL, MICROLIFE, A & D
From expensive devices	Omron, Qarido.

Some tonometers can analyze the correct fixation of the cuff, which is also important for obtaining accurate indicators.

To get really objective, truthful results are very important to choose a high-quality apparatus and an experienced doctor to decipher the values. Cheap low-quality devices can issue a high error

Rules and technology research

Before using the device, it is necessary to get acquainted with the instructions for it, and exercise all actions according to the prescribes. Otherwise, the tonometer can show inaccurate results or in general break.

To determine exact indications and the correct procedure, it is recommended to follow these rules:

When using a shoulder tonometer, you need to ensure that the lower edges of the cuffs are placed above the elbow joint on one or two fingers;
To obtain more accurate indicators during the measurement of blood pressure (the beginning of the measurement, you can feel the squeezing of the cuff) it is not recommended to move. If it happened that the movement cannot be stopped, the device on which the device is fixed, should be kept free, relaxed and motionless throughout the measurement time (before starting the measurement, the device gives a beep);
Before going to bed, remove the device (without disconnecting from the cuff) and put it next to the pillow or on the bedside table;
You can not press the tube that connects the monitor and cuff. If the monitor compressor functions, and the cuff is not inflated - it is necessary to check the condition of the tube and the reliability of the connection;
If the conditions for measuring unsuitable (there is no possibility to provide the hand of immobility), it is better to stop the measurement by pressing the "Stop" button, after the set time the device will try again;
If you need to remove the cuff, it is necessary to disconnect it from the monitor;
On the monitor should be an indication of time if it is not, it may mean that the device was discharged.

The objectivity of the results also largely depends on the correctness of the preparation and conduct of the procedure.

In order to prepare for SMAD and ensure the conditions for obtaining accurate data, follow several actions before the procedure.

Since the device will work for a long time, you need to check whether the battery is charged well;
Program the device under the details of a particular patient, set a certain interval through which the pressure measurement will occur;
Measure the size of the surroundation of the forearm to select a suitable cuff;
Install the system: right-handers cuffs are fixed to the forearm of the left hand, left-handed - right in order to avoid the bias of the cuff. It is recommended to fix with double-sided discs or sticky tape.
The cuff can be fastened over the sleeves of a thin T-shirt or sweatshirt. Soft fabric will not worsen the results of the study, but will help to avoid such unpleasant phenomena as sweating, skin irritation and itching.

It is very important during the period of the procedure not to think about it, not analyzing independently data. Such thoughts are able to cause excitement and, accordingly, increase pressure.

During sleep, it is also necessary to try to relax and do not remember the procedure.

How do daily monitoring of pressure and pulse? The procedure is very simple. The main thing is to read the instructions for the device, prepare the device, follow the instructions of the doctor and do not worry.

Classic way. A cuff is fixed on the forearm or wrist, a small device is connected to it (it can be fixed on the belt or put in the pocket). Installation of the device is carried out by a doctor, after which the instruction is carried out, and the patient is sent home. Pressure monitoring takes place in the outpatient conditions in day and night. The total duration of the procedure is 24-48 hours, during which the patient must wear a device. The number of measurements and their frequency is established by a specialist (usually within 50 times a day - every 15 minutes during the day and 30 minutes at night).
Monitoring for Holter. This method assumes fixing at once two indicators: hell and heart rate, which allows you to determine the presence of hidden pathologies and give a more detailed assessment of the condition of the cardiovascular system. In addition to a compact tonometer, small electrodes are fixed at certain points of the chest zone (they cannot be removed throughout the entire study), and the data is displayed on a special device. Pulse frequency is considered on the principle of electrocardiography. The duration of the study is 24-48 hours, but by decision of a specialist, the term can be extended several times.

Your day you live as usual, no change. The main thing is to protect the device and do not focus on the measurements, as well as not to be afraid of squeezing the cuff.

After allotted time, it is necessary to recover again to the reception to the doctor, remove the device and provide diary data. Usually research results are provided in a few days.

During the day, it is necessary to keep a diary in which all moments are recorded, associated with the Conduction of SMAD, namely:

Data	Characteristic
Periods of activity	Walking, running, driving a car, watching a telecast, work at a computer, cooking and reception of food, different types of physical exertion - any activity should be recorded in the diary. At the same time, for each type of activity indicates the specific time of it
Periods of rest	In sitting and lying position, note the duration and quality of recreation (the presence of distracting or irritating factors)
Sleep	The period of waste to sleep is recorded with the mandatory designation of time. If possible, mark the time of night awakening and describe your condition
Changing well-being	It is necessary to designate cases when the patient felt a headache, rapid pulsation, rapid heartbeat, pain in the heart of the heart, darkening in the eyes, dizziness, nausea. This column should also describe a change in the state after receiving the prescribed drugs.
Means and drugs	Be sure to lock the time when you have trembled, drank or made a snack, and also accepted the appointed medicine. Additionally, you can specify the composition of the dishes and the name, dosage of drugs
Problems with device	If in the process of measuring hell slept cuff or twisted, it should also be noted indicating the time of subsequent pressure measurement

The diary needs to be filled as accurate as possible so that the doctor can objectively assess the results, put the correct diagnosis and appoint adequate treatment. If it happened that the device needs to be removed (for example, the end time the procedure has accounted for on the output), you must turn off the monitor. It is forbidden to remove the battery from the instrument, since the results of the study will be lost.

For a child, the method of holding a smart has no difference, the procedure is carried out in the same way as in adults. Differences are available only at the decoding stage of the results.

Indicators taken by a tonometer during the SMAD process are transmitted to a personal computer. The results are usually deciphered by a comparison method with average values \u200b\u200bthat are taken for 24 hours (eight of which are daytime, and eleven - night). After analyzing the data, the doctor makes conclusion.

The state of a particular patient is estimated in comparison with the indicators of the blood pressure, which are considered the norm. In a healthy person, the following values \u200b\u200bare mediated:

daily indicators: 120 (± 6) at 70 (± 5);
day values: 115 (± 7) at 73 (± 6);
night meanings: 105 (± 7) by 65 (± 6).

The normal level of daytime ads are considered to be indicators135 at 83 and night time: 120 to 70. If the values \u200b\u200bexceed the performance 140 to 90 during the day and 125 at 75 at night, the pressure is considered high.

High pressure in the night or its insufficient decrease (normal during sleep, the level of blood pressure decreases by 10-20%) may indicate the availability of a number of diseases or the risk of their development:

Diseases of the kidneys in the chronic stage.
Problems with sleep, including insomnia.
Adrenal tumors.
Diabetes.
From the side of the cardiovascular system - stroke, hypertension, ischemia, angina, myocardial infarction, hypertrophy, etc.

The heart rate indicates the condition of the heart: if the heart rate comes to 90 and more blows per minute, it may be a tendency to develop tachycardia. If the heart rate is less than 60-50 per minute - this indicates the development of bradycardia.

(No ratings no)

Daily monitoring of blood pressure is a survey that allows you to identify the dynamics of blood pressure changes (AD) during the day, subject to human activity. The technique is used to diagnose hypotension and hypertension. Common name - Abbreviation SMAD.

People with impaired cardiovascular system arterial pressure is inconstant. Permanent increase or decreased blood pressure periods under which specific clinical signs of violation appear - it is rather an exception than the rule. Typically, pressure jumps during the day, depending on the load, psycho-emotional state and even the diet of the person.

To reliably diagnose hypotension or hypertension by one-time measurement of blood pressure by the doctor is very difficult. This is due to the patient's individual reaction to the stressful situation that occurs when visiting the clinic. Moreover, even a special term, describing the increase in pressure in the doctor's office, the White Kolata Hypertension.

Unlike disposable pressure measurement, the SMAD allows you to get more reliable data

If a person is uncomfortable feeling in the clinic, the data of blood pressure measurement by the doctor cannot be considered reliable. The pressure of the house, at rest, and indicators during the examination by a specialist will be varied, often very significant. Avoid mistakes and accurately determine the dynamics of changes in blood pressure at rest, under normal household load and under the action of other factors allows SMAD.

Alternative to Smad is a diary of pressure indicators that the patient itself leads. But such data cannot be considered accurate, since a person may forget to measure pressure or intentionally distort the values, in an attempt to deceive the doctor.

Permanently carried out by the help of a special device during the day. Daily pressure monitoring of the pressure is the most accurate method of modern diagnosis of blood pressure disorders in patients of any age groups.

What determines SMAD?

The Smad apparatus fixes the slightest vibrations of blood pressure and represents them in the form of a graph. The obtained results of SMAD are decrypted by the doctor, allowing you to accurately make a diagnosis and choose the optimal treatment regimen.

The method shows:

normal or "working" patient pressure;
changes in indicators under load;
Hell at night;
pulse pressure.

At the same time, the patient must lead a special diary, which will help accurately decipher the results of SMAD. In the diary all moments of loads, the diet, the awake time and the time of waste to sleep are recorded. If during the day a person was subjected to stress, it is also fixed in the records, which then must analyze the doctor.

Decoding SMAD does not constitute a long time, thanks to a large number of information. The device is very sensitive and recorded even the slightest pressure deviations. The data obtained during monitoring includes the following information:

chart change hell within 24 hours;
mean values \u200b\u200bof systolic, diastolic and pulse pressure;
values \u200b\u200bof the lower and top blood pressure during sleep;
change indicators when loading;
the degree of pressure reduction at night.

Having understood what data can be obtained by smoothly monitoring and what it is, you should know when this method is applied in cardiology, as well as all its advantages and disadvantages.

Example of the result of SMAD.

When is the examination assign?

SMAD allows you to determine the dynamics of pressure change in various diseases. Indications for the monitor of the indicators of SMAD:

determination of the degree of hypertensive disease;
diagnosis of situational pressure increase;
hypotension;
monitoring pressure in pregnant women.

Watching with SMAD, how pressure changes during the day, can be assigned to patients who recently transferred myocardial infarction or stroke. This allows timely to adjust the treatment regimen.

Indications for SMAD monitoring is diabetes, gestational disorders, vessel atherosclerosis, heart failure, renal failure. People with these diseases and disorders constitute a major group of risk of developing hypertension.

During pregnancy, SMAD is used to monitor the status of a woman. Bad performance of daily blood pressure in late terms is an indication of the emergency cesarean section.

SMAD hypertensives must be carried out to determine the dynamics of the progression of the disease and the selection of the optimal therapy scheme. Simultaneously with SMAD in this case, an ECG electrocardiography is necessary. SMAD also monitors heart rate changes, therefore it is assigned to heart disease.

In addition to SMAD, which determines the blood pressure (blood pressure), individual groups of patients may be assigned to measure cholesterol and glucose levels for accurate diagnosis.

Preparation for the examination

If the patient was appointed Smad, before starting these surveys, the doctor conducts detailed instruction. Preparation for analysis or research SMAD:

normalization of the day mode;
refusal of clothing, moving movement;
cancellation of physical exertion;
failure to swim.

During the wearing of the device, it is impossible to take a bath or shower, since the ingress of moisture will come to the conclusion of the device. On the eve of the installation of the device, the patient is allowed to take any sedative preparation. Sleeping with the device on the chest is not very convenient, so it is important to sleep before it is installed.

If the patient takes any drugs that can distort the data of SMAD, the doctor should be prevented. In this case, in this case will give detailed instructions on the preparation for SMAD, in some cases the drugs are canceled, or reduce their dosage to avoid distortion of blood pressure values.

How is monitored?

The most common and accurate research method used in cardiology, on the holder is a smart and an electrocardiogram. Halter survey implies round-the-clock monitoring of the smoothie with the fixation of the features of the heart of the heart at the moments of changes in blood pressure.

The survey algorithm is simple:

on the shoulder install a wide cuffs in which air flows;
the cuff is attached to the device;
the device is located on the trainer on the chest;
every half an hour is the measurement of blood pressure;
all data is fixed in the instrument's memory.

The main operation is performed by the device. The smooth device is a mini-computer or a very smart tonometer, which not only measures the pressure, but also remembers the values, analyzes them and builds a graph of the change aft. The patient remains to adhere to just a few rules:

live according to ordinary graphics;
to engage in household matters without regard to the device;
do not take a shower;
abandon any drugs (after agreeing it with a doctor);
do not allow the inflection of the handset tube with the mounted cuff.

The device performs measurements every 30 minutes. The doctor issues a special diary to the patient, in which any load is fixed during the day. There are also any changes in psycho-emotional state and other factors that can provoke a pressure leap.

Halter research also includes measuring heart indicators

How to behave patient?

The installation of the device practically does not cause discomfort. A person feels the same as with the usual pressure measurement with a home tonometer. The only minus is a permanent handling of the hand with a cuff, with a frequency once in half an hour.

To avoid distortion of data obtained during the survey, follows:

behave as usual;
avoid intense loads;
do not change the diet;
do not take preparations from hypertension;
do not be nervous;
abandon narrow clothing;
watch that the tube of the device does not squeeze.

Stress and psycho-emotional loads can distort the results of the survey. They must be avoided. It is better to minimize contacts with the day of wearing the device, do not irritate in trifles and try to stay in a relaxed state.

On the day of pressure monitoring, recycling and night shifts should be avoided. Waste to sleep should be carried out in the usual time for the patient. At the same time, it is important not to forget to fix it in the diary.

Need to record all events capable of influenced

Cons of appliances

By itself, Smad is like a small bag over the shoulder, however, wearing it stands on the neck or chest. The device is compact, but may be noticeably surrounding. Hide the device under free clothing.

The main inconvenience when wearing the device is periodic compression of the artery on hand at the moment of pumping the cuff air. Feelings are similar to the work of an ordinary tonometer, but repeated every half hour. At the same time, the sudden start of the operation of the device can catch a person by surprise and provoke a small stress jump pressure. However, it practically does not distort the values, since literally after 2-3 pumping the cuff patients get used to the operation of the device.

Another problem is a disturbance of the sensitivity of the arm at the wearing cuff. This is due to the same compression of the artery. At the same time, some people feel fatigue in her hand with a cuff.

People with particularly sensitive skin may appear irritation or diameter after the day wearing cuffs. This is explained by the fact that it is most often made from an artificial material that does not give the skin to breathe. The problem relates rather to aesthetic and quickly goes away even without treatment.

A serious minus of the appliance is the need to constantly monitor the tube connecting the cuff with a tonometer, not squeezed. During a waste to sleep, you will have to choose this position of the body, which will not prevent the normal air flow into the cuff. Unfortunately, sleeping with a device for SMAD is very uncomfortable.

Contraindications

There are no absolute contraindications to conduct a survey. You may need to transfer the installation of the device to another date, if a person has a skin rash or a dermatological disease in the field of installation of the cuff, for example, psoriasis appeared.

Installation of the device is impossible for fractures, strong bruises, burns and other injuries of the hand to which the cuff is placed. In this case, the study is transferred until a person is fully recovered, and the skin will not recover.

In case injuries or skin injuries, research is transferred

Cost of examination

Daily blood pressure monitoring should be applied only by a cardiologist. The average cost of this survey depends on which clinic the device is installed, as well as from the type of device.

The study on the Halter method will cost an average of 2,300 rubles. In fact, the price variation is very large. In different clinics, SMAD costs from 1200 to 3,500 rubles. At the same time, the price does not affect the quality of the survey, since all instruments for pressure measurement work according to one principle, so you can always place in which this procedure will be cheaper.

The cost of SMAD also depends on the region. In the provincial clinics, the examination costs up to 1500 rubles, in the capital - from 2000.

Is it possible to deceive the smast?

Hypertension, neurocirculatory dystonia for hypertensive type and severe heart failure are diseases in which young people may not take into the army. To confirm the diagnosis, daily monitoring of arterial pressure is assigned, as the most optimal method for determining the dynamics of changes in blood pressure.

Young people who do not even serve, are often asked about how to fool Sad. The following recommendations can be safely published in the heading of harmful councils, but they really help to increase blood pressure and deceive the device for SMAD.

At the time of installation, the cuff should be delayed. It is necessary to breathe only after it is filled with air.
At the time of measurement of pressure, you should strain the buttocks and pull your leg socks. These manipulations are invisible to others, but the body takes them for training, so the pressure rises.
Toning preparations that will help lift the pressure - the tincture of lemongrass, ginseng, Eleutherococcus. They can take 15 drops three times a day a few days before the installation of SMAD.
During the wearing device, hand should be lowered with a cuff below the heart level. If a person lies on the bed, you need to highly raise my legs at this time. In this case, normal blood flow and pressure rises.
In order for the average value of the SMAD to exceed 155 per 100 mm.rt.st. You can take energy drinks, coffee, coffee beans, very strong black tea or caffeine in pills.
Those who want to accurately deceive the smat, one important rule should be remembered - in a dream, the pressure drops on average by 20%. If after all the methods listed above the methods of raising the pressure at night tightly fall asleep, hell will fall, and the average survey rate will not exceed 140 mm.T. Thus, in order to be falsely diagnosed with hypertension, it will be necessary to sleep during daily pressure monitoring.

The listed methods negatively affect the work of the vessels and hearts. After events for deception, SMAD will have to rest intensively and restore at least two weeks.

Increased blood pressure (AD) acts as a serious problem requiring treatment. Daily arterial pressure monitoring is used in questionable readings of a conventional measuring method. Since the person in the hospital is influenced by many stimuli, the values \u200b\u200bof blood can distort. Therefore, to get accurate data to doctors helps SMAD, which reveals the hidden pathology of the patient.

Method accuracy

SMAD is considered the most accurate method in determining pressure pathologies. It is impossible to deceive, because the device records the slightest vibrations of the parameters. In addition, the study is not carried out alone, often the HALTER diagnosis is used, which fixes the pulse value. With the help of the technique, even a hidden threat is revealed, which the usual measurement of hell is unable to fix.

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Advantages and disadvantages

Daily pressure monitoring, like any method, has good and bad parties. SMAD shows the possibility of developing cardiovascular pathologies. The test is carried out in the treatment of heart and pressure. To positive attributes:

registration of indicators over a long time interval;
absence;
the possibility of fixing and afternoon and at night;
determination of vibrations of temporary indicators;
accuracy due to the natural situation.

Examples of deficiencies are mainly based on the unpleasant sensations during the examination, especially with excessive nervousness of the patient. These often include numbers of limbs when wearing cuffs, skin irritations or diameters caused by a cuff, as well as the financial side of the service. Daily examination, in contrast to one-time measurement, will require investment.

One-time dimension of blood pressure does not always give truthful data, which affects the construction of the treatment technique.

Indication for appointment

Arterial pressure monitoring is carried out under such circumstances:

When not to spend?

The examination of a person is not conducted in the following situations:

dermatological damage to the skin, mainly upper limbs;
the pathology of the circulatory system, causing bruises at the slightest exposure to the skin;
injured upper limbs;
undage of vessels and the arteries of the upper extremities;
psycho-emotional disorders.

Preparation for the procedure

The procedure is appointed by the doctor who is obliged to explain the patient how to prepare. SMAD preparation requires the execution of certain rules to measure reliable information. These include:

cancellation of drugs;
elimination of physical exertion;
cancellation of water procedures;
fullness of sleep at night;
refusal of squeezing clothes, extraneous influences on the cuff should not be;
recalling sedatives at night with strong nervousness on the eve of the hell check.

Before passing the diagnosis of blood pressure, you need to abandon the reception of drugs.

Immediately in front of the test:

the patient must lower the hand down and stop moving when the device begins to automatically pump the cuff;
important verification of the position of the pipe and cuffs during monitoring.

Structure of research

The study passes using auscultative or oscillographic method, but the use of each of them separately gives inaccurate data. In medicine, it is customary to connect 2 methods so that the scat records are as accurate as possible. For the middle of the upper limb to the middle of the upper limb, the cuff is superimposed with a tube connected to it connected to a register feeding and lowering air. The device is equipped with an ultra-sensitive sensor capturing the slightest pressure fluctuations.

The meters are configured individually for each patient, taking into account its regime, a period settled on vacation and work. The instructions on the number of measurements and their frequencies are carried out by the attending physician, which offers to start a diary, where the results should be recorded. The device performs measurements at least 50 times a day, during the daytime, they make monitoring every 15 minutes, in the night period - every 30 minutes. When jumping at certain hours, the pressure is required every 10 minutes.

Monitoring for Holter.

The medical community prefers simultaneously check the daily pressure and fix the pulse frequency indicators. In a pair, these techniques help trace the indicators of the dynamics of the development of diseases of the cardiovascular system, reveal hidden ailments. The method developed a scientist from America - Halter. Special electrodes fixing the cardiac rhythm data are attached to the man's chest and bring them to a special device. The automatic instrument system works, on the principle of electrocardiography, saving results in the device's memory. Along with this, the cuff hangs on the shoulder, which monitors the pressure. In the case of controversial issues on patient cardiology, Halter monitoring is extended for several days.

Contraindications are distributed exclusively on people with mechanical damage to breast skin (due to the inability to attach the device). To monitor focusing on the Halter, advise people with such complaints:

Device for measurement

Make monitoring helps instruments - tonometers that fix and store a large amount of information in memory. After the procedure is completed, the device for daily blood pressure monitor displays data on a PC (personal computer) that processes an array of data. The instrument for measuring pressure is sold in pharmacies at different price categories, with different levels of setting.

Hypertensive disease is considered a common violation that leads to dangerous health effects. To avoid complications, it is worth conducting detailed diagnostics. One method of identifying accurate indicators is the daily monitoring of blood pressure. This procedure allows you to establish accurate indicators and pick up adequate therapy. So what is SMAD?

Daily arterial pressure monitoring is carried out to assess the condition of the cardiovascular system. It consists in a regular dimension of blood pressure and its oscillations during the day. For the study, a special apparatus is applied - a sphygmomanometer.

An ordinary measurement of the indicator by means of a tonometer, which is carried out only a few times, does not display the full picture. Pressure indicators during the day all the time fluctuate. This process affects many factors - emotional state, physical exertion, the use of drugs.

Hell monitoring makes it possible to take into account all the likely daily pressure fluctuations and write them throughout the day. In the average parameters of the oscillations, you can identify the damage to the cardiovascular system, the need for therapy and subsequent diagnostic studies.

Daily pressure monitoring can be carried out in a variety of situations. It allows you to solve such tasks:

Identification of arterial hypertension is an increase in pressure. SMAD is used in borderline states or the presence of doubts in the correctness of the diagnosis. This technique is also needed when high pressure detection against the background of heart failure or neurological deviations.
Diagnosis of hypotension - pressure reduction. This procedure is required for all sorts of violations that are associated with a decrease in such an indicator.
Control of drug therapy. Daily monitoring AD makes it possible to understand how effective the prescribed treatment is. In some cases there is a need to choose another drug. Using SMAD, it is possible to control the dynamics of changes in different pathologies and the effectiveness of therapy.

Often, the procedure is required for an objective assessment of the condition of the heart and blood vessels for a short period of time. Such a need may arise when recognizing suitability for the service in the army. The identification of many cardiological deviations requires a large amount of time. Periodical monitoring can make this process faster.

Important: This diagnostic procedure can be applied to people who have adverse heredity. It is carried out even by those persons who do not suffer by the lesions of the cardiovascular system.

Daily monitoring of blood pressure is a very informative procedure. Key indications include the following:

Contraindications

This study can be carried out not always. Key contraindications include the following:

recurrence of skin pathology in the field of cuff laying;
traumatic lesions of hands that exclude the possibility of applying a cuff;
exacerbation of blood coagulation disorders and the presence of a tendency to bleeding;
violation of the arteries of shoulders, which is confirmed by the instrumental method;
human refusal.

It should be borne in mind that the study may not give results with significant violations of the rhythm of the heart. It is also not used at - more than 200 mm Hg. Art.

Training

So that the survey is successful, it is very important to properly prepare for diagnosis. At this stage it is necessary to check the operation of the technical device:

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The tool is used at home 30 minutes before meals.

It is important to ensure that the registrar has been provided with the right amount of nutrition. Therefore it is worth checking the battery charge level and understand whether it is enough for a day of continuous operation.
Connect the device with a computer and program it under the individual parameters of a person. The device makes information about the patient, the mode of operation of the registrar. It is worth installing the interval through which pressure measurement will be performed during the day and night. If you need to use a signal on the eve of the measurement, it is required to program. Also, the specialist sets the indicators that will be visible on the monitor.
For the correct selection of the cuffs, it is necessary to measure the forearm of the patient.

To carry out the procedure, the apparatus cuffs are imposed on the zone of the non-working hand: in the right-hander - on the left, in the left-hander - respectively, on the right. So that the device does not displaced, it needs to be well fixed. In some cases, special discs that have a sticky coating are used for these purposes.

Perhaps the simultaneous monitoring of ECG and Hell

Be sure to inform the patient relative to the algorithm for the procedure:

Technique of procedure

In patient cardiology, supply special devices that will be on it during the day:

The forearm zone is put on the cuff and fix it in such a way as to keep the situation for the study period.
The belt is fixed by the main device. It weighs about 300 g and does not cause discomfort in a patient.

After receiving the necessary instructions, a person can go home and start home affairs. A device that needs to be worn on the body will supply a signal at a given time intervals.

During this period, it is important to refer to the filling in the diary. This will help the doctor get a complete picture of the relationship of changes in pressure and type of human activity.

After the end of the home diagnostics, the device is turned off. Then you need to go to the doctor, provide him with the device and data for decryption. Based on the information received, the doctor makes conclusion.

To determine the pressure to be informative, you need to adhere to such recommendations:

It is important to monitor that the tube that serves the connection of the device and the cuff is not cured.
When signs of malfunction of the instrument should consult a doctor. Do not try to repair the device yourself.
The cuff must be fixed about a couple of fingers above the elbow bend. When changing the position of the device, the patient must fix it.
It is important to try not to fall in the area of \u200b\u200belectromagnetic radiation sources.
During the diagnostics, water procedures should be abandoned, since the device is forbidden to wet.
When the device performs measurement, you need to relax limbs. The start and end of the measurement indicates the signal.

Usually, the pressure measurement is carried out every 15 and 30 minutes in day and night, respectively, but if necessary, the doctor can change the device settings.

Decoding results

To decipher the results of the procedure, it is worth consulting a doctor. Monitoring data are processed using a computer program. This is carried out automatically. Key indicators of the procedure include the following:

Advantages and disadvantages of the procedure

This method of measuring blood pressure has a high diagnostic value. This is due to a number of benefits. Thanks to carrying out daily monitoring, it is possible:

Perform a large number of measurements for a long period of time - more than 50.
Get reliable results. This is due to the fact that a person during the procedure remains as calm.
Fix pressure indicators not only during the daytime, but also at night.
Analyze the temporary pressure curve.
Change with complex pathologies.
Predicting the progression of cardiovascular diseases.
Determine the degree of defeat of target organs. This is due to the bond of such violations with the average daily pressure indicators.
Monitor the performance of the therapy.

One-time pressure measurement in the hospital does not allow to obtain such accurate results. It provokes problems with the definition of the diagnosis and the choice of medication. Also, the doctor may have difficulty assessing the effectiveness of therapy.

Please note: daily monitoring evaluates pressure indicators many times. Due to this, it is possible to determine at what time the parameters were violated. This allows you to choose a dose and time of use of drugs so as to maintain normal pressure during the day.

The key minuses of the method consist in violation of the sick comfort. These include the following:

daily monitoring is quite expensive;
when squeezing the cuff can observe the shoulder numbness;
there is a risk of skin irritation under the cuff;
it is possible to break sleep due to the round-the-clock operation of the device;
there are several contraindications to the procedure.

Daily monitoring is considered an informative procedure that allows you to assess blood pressure within 24 hours. Due to this, it is possible to put the correct diagnosis and choose adequate therapy. In addition, the procedure allows us to evaluate the effectiveness of the treatment and adjust the scheme for the use of drugs.

Have questions? Specify them in the comments! A cardiologist will be answered on them.