Stange Test

STANGE TEST with breath-holding to detect circulatory sufficiency (of the heart, cardiovascular system). The breath-holding (asphyxia) test is feasible in any setting, is simple, requires no equipment, and is performed as follows. The subject, sitting, rests for three minutes, then after a maximum inhalation and exhalation holds the breath, simultaneously pinching the nose and thereby giving a signal to mark the time on a watch (a stopwatch is desirable). At the moment of the first forced inhalation, or inability to continue holding the breath, the patient releases the nose, giving a signal for the second time marking. Then the subject is offered a load in the form of five squats within 10 seconds, and again the sitting breath-holding after maximum inhalation and exhalation is determined. If it is impossible to perform the specified load for one reason or another, one can limit oneself to some other load, such as bending the torso forward, raising the arms upward, etc.; it is important to observe a certain tempo and duration of the load (10 sec.). It is desirable that the subject trains initially, i.e., performs the breath-holding test about three times; often the subject does not immediately grasp the task and after a maximum exhalation makes an additional inhalation. In healthy individuals, breath-holding before the load can last 25 seconds or more (average from 24 to 54 seconds; A. Kulabko, Gench), and after the indicated load not less than 18 seconds. In healthy adolescents these figures are somewhat lower and equal to 18-20 and more seconds before the load and 13-15 seconds after the load, which is explained by the intensification of oxidative processes at this age. In cases of impaired function of the cardiovascular system (circulation), the breath-holding figures are already low in rest—15-20 seconds and lower—and after the load often reach 7-12 seconds and lower. It is also important to note the presence or absence of dyspnea after breath-holding during this test. During this test, not only absolute figures but also the percentage ratio of the breath-holding figures in rest and after the load are of great significance. The difference does not exceed 25-30% with normal breath-holding figures in rest. Repeated tests in the same individuals reflect, to a certain extent, the dynamics of the state of the cardiovascular system (circulation). In the stage of decompensation, low figures are characteristic; as the process improves (compensation occurs), the number of seconds of breath-holding increases. In individuals in whom shifts in the state of circulation cannot be noted, the results of the test also remain constant. The respiratory test (breath-holding)—a will test—and consequently the influence of reflexes from the vagus nerve on the respiratory center is largely excluded (Gench). Physiologically, the mechanism of the respiratory test is as follows: with myocardial weakness, tissue hypoxia occurs faster due to a decrease in systolic and minute blood volume, as well as slowed circulation. An increase in the amount of carbonic acid and acidic valences in the blood leads to earlier excitation of the respiratory center (Kabakov). The time of breath-holding is also reduced in patients with Graves' disease, in whom oxygen consumption is sharply increased, and, conversely, it is prolonged in myxedematous patients, in whom basal metabolism is reduced. In long-term decompensated heart patients accustomed to anoxemia, the time of breath-holding can sometimes be prolonged or normal. The condition of the respiratory organs in the absence of secondary phenomena from the cardiovascular system has little influence on the results of the test. Lit.: Gench, Functional study of the heart in practice, Vrach', Obozr., 1928, No. 11; Zelenin, Kabakov and Kogan, On the assessment of working capacity in chronic diseases of the heart muscle, Ter. Arkh., vol. XI, issue 7-8, 1933.

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Strashun.