Prueba de esfuerzo o ergometría

ergometria

La prueba de esfuerzo o ergometría es una prueba muy habitual en Cardiología, donde se utiliza con fines diagnósticos y pronósticos.

En este post repasaremos que es y para que se utiliza, y daremos algunas recomendaciones para la correcta realización de la misma.

¿Qué es?

Consiste en la realización de ejercicio físico al tiempo que se monitoriza la tensión arterial y el ritmo del corazón.

El ejercicio se puede realizar en diversos escenarios, siendo los más frecuentes el tapiz/cinta rodante y la bicicleta estática (como en los gimnasios).

Existen diversos protocolos establecidos para realizar la prueba de esfuerzo, pudiéndose adaptar en función de las características del paciente y siendo la duración aproximada entre 6 y 12 minutos, dependiendo de la capacidad del paciente. Generalmente se inicia el ejercicio de forma suave, y de forma periódica (cada 3 minutos) se va incrementando la intensidad del ejercicio al tiempo que se recogen la tensión arterial y el electrocardiograma. La prueba finaliza por deseo del paciente (síntomas o cansancio) o del personal sanitario (objetivo alcanzado, alteraciones del electrocardiograma o tensión arterial excesiva), iniciándose la fase de recuperación en la que se continúa monitorizando el ritmo cardiaco y la tensión arterial durante al menos 3 minutos más.

¿Para qué se utiliza?

La mayoría de las patologías cardiacas (angina, disnea, arritmias…) se exacerban con el esfuerzo, de ahí la importancia de estudiar el corazón en condiciones reales.

Existen tres objetivos fundamentales de la prueba de esfuerzo:

  • Valorar la angina de pecho: como hemos repasado en otro post, la angina de pecho aparece típicamente con el esfuerzo, de ahí que el electrocardiograma en reposo pueda ser normal. Con esta prueba buscamos provocar la angina, al mismo tiempo que observamos lo que ocurre en el electrocardiograma. De esta forma, no solo podemos diagnosticar cardiopatía isquémica, si no también podemos establecer su pronóstico (en función de la intensidad de ejercicio necesaria para provocar el dolor y los cambios eléctricos que aparecen) y monitorizar la respuesta al tratamiento.
  • Valorar el estadio físico: tanto en enfermos del corazón como en deportistas se utiliza la prueba de esfuerzo para valorar la capacidad funcional en un momento en concreto y de forma seriada. En los primeros con el objetivo de establecer el pronóstico y monitorizar su enfermedad. En los segundos con el fin de adaptar un programa de entrenamiento físico.
  • Valorar el ritmo cardiaco: si bien el esfuerzo físico se acompaña de aumento de la frecuencia cardiaca para asegurar el correcto aporte de sangre a los músculos, cuando esto no ocurre de forma adecuada pueden aparecer problemas (fatiga, palpitaciones, pérdida de conocimiento…). La prueba de esfuerzo ayuda a detectar problemas relacionados con el ritmo cardiaco durante el esfuerzo.

Recomendaciones

Antes de la prueba:

  1. Medicación: salvo indicación médica NO se debe suspender ninguna medicación para la realización de la prueba.
  2. Ropa: ropa cómoda y calzado deportivo.
  3. Comida: evitar comidas copiosas, ayuno prolongado y sustancias excitantes (café, tabaco, te…).
  4. Vello: debido a la necesidad de una correcta valoración del electrocardiograma, se recomienda que los varones con mucho vello se rasuren antes de la prueba.
  5. Ejercicio: se recomienda evitar ejercicio físico intenso en las 12 horas previas.

Durante la prueba:

  1. Tratar de realizar el máximo esfuerzo posible para que los resultados sean fiables.
  2. Avisar de los síntomas que aparezcan.

Pablo Elpidio García Granja
Médico Residente de Cardiología, Hospital Clínico Universitario, Valladolid

REFERENCIAS:

 
Revisado: febrero 2017

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