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TMT Or Stress Test It is very common to find the heart patients who have normal ECG. One must remember that the ECGs are taken at rest when the heart is beating at its lowest rate. In some of cases the patient would also agree that at the time of rest there is no pain in the chest, the angina symptoms would only come when they increase the heart rate, while doing some physical exertion like walking. In this condition,where we need a TMT test. The patients might gradually increase their heart rate, thus increasing the blood requirement of the heart muscles. Simultaneously ECG records are taken. Patients have to physically bring to bear for this test which uses a computerised machine. The continuous ECG monitoring during the exercise would reflect to the blood and oxygen deficit in the muscles of the heart during the exercise. TMT test is also called as Exercise Stress Test, Computerised Stress Test or simply Stress test. It is the very easy, popular and common test performed on heart patients to determine the severity of the heart disease. Taken at an interval, this test can also show the improvement or deterioration of patient’s angina. A negative TMT or Stress Test is declared when the patient can reach a certain heart rate without showing any ECG changes. This rate is known as target heart rate and it is also calculated by a formula (Target Heart Rate = 220 – age of patient). If this rate is reached by the patient without producing any ECG changes, though the TMT can be called negative, but it would not mean that the blockage is zero. It is meant only by the person performing the test probably has a blockage of less than 70%. A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures a heart’s ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by drug stimulation. Cardiac stress tests compare the coronary circulation while the patient is at rest with the same patient’s circulation during maximum physical exertion, showing any abnormal blood flow to the myocardium (heart muscle tissue). The results can be interpreted as a reflection on the general physical condition of the test patient. This test can be used to diagnose coronary artery disease (also known as ischemic heart disease) and assess patient prognosis after a myocardial infarction (heart attack). The cardiac stress test is done with heart stimulation, either by exercise on a treadmill, pedalling a stationary exercise bicycle ergometer, or with intravenous pharmacological stimulation, with the patient connected to an electrocardiogram (ECG). People who cannot use their legs may exercise with a bicycle-like crank that they turn with their arms. The level of mechanical stress is progressively increased by adjusting the difficulty (steepness of the slope) and speed. The test administrator or attending physician examines the symptoms and blood pressure response. With use of ECG, the test is most commonly called a cardiac stress test but is known by other names, such as exercise testing, stress testing treadmills, exercise tolerance test, stress test or stress test ECG. A stress test may also use an echocardiogram (ultrasonic imaging of the heart) or a nuclear stress test (in which a radioisotope is injected into the bloodstream).

An electrocardiogram — abbreviated as EKG or ECG — is a test that measures the electrical activity of the heartbeat. With each beat, an electrical impulse (or “wave”) travels through the heart. This wave causes the muscle to squeeze and pump blood from the heart. A normal heartbeat on ECG will show the timing of the top and lower chambers. The right and left atria or upper chambers make the first wave called a “P wave” — following a flat line when the electrical impulse goes to the bottom chambers. The right and left bottom chambers or ventricles make the next wave called a “QRS complex.” The final wave or “T wave” represents electrical recovery or return to a resting state for the ventricles. Why is it done? An ECG gives two major kinds of information. First, by measuring time intervals on the ECG, a doctor can determine how long the electrical wave takes to pass through the heart. Finding out how long a wave takes to travel from one part of the heart to the next shows if the electrical activity is normal or slow, fast or irregular. Second, by measuring the amount of electrical activity passing through the heart muscle, a cardiologist may be able to find out if parts of the heart are too large or are overworked. Why would I have this test? An ECG is one of the most common heart tests. It is the only way of uncovering certain problems with the heart’s electrical impulses. There are a number of reasons why someone may have an ECG, including an irregular heartbeat, shortness of breath when they exert themselves, significantly high blood pressure, palpitations or a suspected heart valve problem. It can also be a useful way of ruling out problems. If your doctor recommends an ECG, think of it as a basic investigation. What does the test involve? The ECG is a simple test, with 10 electrodes used to record 12 different views of your heart’s electrical activity. You don’t need to do anything to prepare for it. An electrode is attached to each ankle and wrist with sticky pads and six more are attached to the chest. The patient lies almost flat with the head and chest raised a little. Relaxing for a few minutes before the recording is made is important, as this allows the electrode connections to stabilise and means the ECG will be more reliable. During this time, your details can be recorded on the ECG machine. Will it hurt? No. There’s no pain or risk associated with having an electrocardiogram. When the ECG stickers are removed, there may be some minor discomfort. Are there any after effects? Very rarely someone may have a slight skin reaction to the electrodes, but normally there are no after effects. What will it tell my doctor? An abnormal ECG can tell your doctor if you have any of these issues: irregular heartbeat (an arrhythmia) problems with the spread of electrical activity within the heart an enlarged heart areas of the heart with reduced blood supply a ‘silent’ heart attack (an interruption to blood flow in the coronary arteries without usual heart attack symptoms). In an acute emergency, the ECG can help your doctor treat you. For example, the electrical source of a high heart rate may be located, which will determine appropriate treatment.

Peripheral Vascular Disease

Electrophysiology Studies (EPS) What are electrophysiology studies? Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias). Quick facts Electrophysiology studies test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from. These results can help you and your doctor decide whether you need medicine, a pacemaker, an implantable cardioverter defibrillator (ICD), cardiac ablation or surgery. These studies take place in a special room called an electrophysiology (EP) lab or catheterization (cath) lab while you are mildly sedated. Why do people have electrophysiology studies? When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias. During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity. Doctors use EPS to see: Where an arrhythmia is coming from. How well certain medicines work to treat your arrhythmia. If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called catheter ablation. If a pacemaker or implantable cardioverter defibrillator (ICD) might help you. If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating). During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity. What are the risks of EPS? Risks may include: Arrhythmia. During EPS you may have abnormal heart rhythms that make you dizzy. If this happens, your doctor may give your heart an electric shock to bring back a regular heartbeat. Blood clots sometimes can form at the tip of the catheter, break off and block a blood vessel. Your doctor may give you medicine to prevent blood clots. Infection, bleeding and bruising at the site where the catheter went in (groin, arm or neck). Your doctor or nurse will help you avoid these problems. How do I prepare for EPS? Don’t eat or drink anything for 6 to 8 hours before the test. Tell your doctor about any medicines you take, including over-the-counter medicines, herbs and vitamins. He or she may ask you not to take them before EPS. Don’t stop taking your medicine until your doctor tells you to. Have someone drive you to your appointment and take you home. If you usually wear a hearing aid, wear it during your procedure. If you wear glasses, bring them to your appointment. What happens during EPS? At a hospital or clinic, doctors and nurses do EPS in a room that has special equipment for the tests. You may hear this room called the electrophysiology laboratory, or EP lab. Some call it the catheterization laboratory (cath lab). During the test: A nurse will put an IV (intravenous line) in your arm. You’ll get medicine (a sedative) that will help you relax. But you’ll be awake and able to follow instructions during the test. Your nurse will clean and shave the part of your body where the doctor will be working. This is usually in the groin but may be the arm or neck. You’ll be given a shot – a local anesthetic will be given — to make the area numb. Your doctor will make a needle puncture through your skin and into your blood vessel. A small straw-sized tube called a sheath will be inserted into your artery or vein. The doctor will gently guide several specialized EP catheters into your blood vessel through the sheath and advance them to your heart. A video screen will show the position of the catheters. You may feel some pressure in the area where the sheath was inserted, but you shouldn’t feel any pain. Your doctor will send small electric pulses through the catheters to make your heart beat at different speeds. You may feel your heart beat stronger or faster. Electrical signals produced by your heart will be picked up by the special catheters and recorded. This is called cardiac mapping and allows the doctor to locate where arrhythmias are coming from, Your doctor will remove the catheters and the IV line. Your nurse will put pressure on the puncture site to stop any bleeding. EPS usually last 1 to 4 hours. If the type and location of the arrhythmia is identified and an appropriate therapy decided, cardiac ablation or insertion of a pacemaker or ICD may be performed during or immediately after the EPS. “I could feel my heart speeding up, which was weird. But it didn’t hurt. It was more like hiking up and down hills really fast.” Esmerelda, age 38 What happens after EPS? You’ll be moved to a recovery room where you should rest quietly for 1 to 3 hours. During this time: Stay still as long as your nurse tells you to. Be sure to keep the arm or leg used for the test straight. Your nurse will check on you often to see if there is bleeding or swelling at the puncture site. After the sedative wears off, your doctor will talk to you about your test results. Before you leave, you’ll be told what to do at home. What happens after I get home? Follow the instructions your nurse or doctor gave you, including taking any new medicines that were prescribed. Most people can start eating food and taking their medicines within 4 to 6 hours after the test. Most can do their usual daily activities the day after the test. Don’t drive for at least 24 hours. The puncture site may be sore for several days. A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or EP lab.