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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).

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. What should I watch for? Call 9-1-1 if you notice: A sudden increase in swelling around the puncture site. Bleeding doesn’t slow down when you press hard on the site. Call your doctor right away if you notice: Your arm or leg that was used for the sheath feels numb or tingles. Your hand or foot feels very cold or changes color. The puncture site looks more and more bruised. The puncture site begins to swell or fluids begin to come from it. How do I learn the results of my EPS? Most of the time, doctors will ask you to make an appointment to discuss the results of your test. You’ll discuss your treatment at that appointment. How can I learn more about EPS? Talk with your doctor. Here are some good questions to ask: Are there medicines that I can use to control my abnormal heartbeats? Will I need a pacemaker or implantable cardioverter defibrillator (ICD) now or in the future? What caused my irregular heartbeat? Am I at risk of serious heart rhythm problems in the future?

Who Needs a Pacemaker? Doctors recommend pacemakers for many reasons. The most common reasons are bradycardia and heart block. Bradycardia is a heartbeat that is slower than normal. Heart block is a disorder that occurs if an electrical signal is slowed or disrupted as it moves through the heart. Heart block can happen as a result of aging, damage to the heart from a heart attack, or other conditions that disrupt the heart’s electrical activity. Some nerve and muscle disorders also can cause heart block, including muscular dystrophy. Your doctor also may recommend a pacemaker if: Aging or heart disease damages your sinus node’s ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats. The damage also can cause your heart to switch between slow and fast rhythms. This condition is called sick sinus syndrome. You’ve had a medical procedure to treat an arrhythmia called atrial fibrillation. A pacemaker can help regulate your heartbeat after the procedure. You need to take certain heart medicines, such as beta blockers. These medicines can slow your heartbeat too much. You faint or have other symptoms of a slow heartbeat. For example, this may happen if the main artery in your neck that supplies your brain with blood is sensitive to pressure. Just quickly turning your neck can cause your heart to beat slower than normal. As a result, your brain might not get enough blood flow, causing you to feel faint or collapse. You have heart muscle problems that cause electrical signals to travel too slowly through your heart muscle. Your pacemaker may provide cardiac resynchronization therapy (CRT) for this problem. CRT devices coordinate electrical signaling between the heart’s lower chambers. You have long QT syndrome, which puts you at risk for dangerous arrhythmias. Doctors also may recommend pacemakers for people who have certain types of congenital heart disease or for people who have had heart transplants. Children, teens, and adults can use pacemakers. Before recommending a pacemaker, your doctor will consider any arrhythmia symptoms you have, such as dizziness, unexplained fainting, or shortness of breath. He or she also will consider whether you have a history of heart disease, what medicines you’re currently taking, and the results of heart tests. Diagnostic Tests Many tests are used to detect arrhythmias. You may have one or more of the following tests. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart. The test can help diagnose bradycardia and heart block (the most common reasons for needing a pacemaker). A standard EKG only records the heartbeat for a few seconds. It won’t detect arrhythmias that don’t happen during the test. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors. Holter and Event Monitors A Holter monitor records the heart’s electrical activity for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart’s electrical activity at certain times while you’re wearing it. For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms. You can wear an event monitor for weeks or until symptoms occur. Echocardiography Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves are working. Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and injury to the heart muscle caused by poor blood flow. Electrophysiology Study For this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records the heart’s electrical signals. Your doctor uses the wire to electrically stimulate your heart. This allows him or her to see how your heart’s electrical system responds. This test helps pinpoint where the heart’s electrical system is damaged. Stress Test Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests, such as an EKG or echo, are done. If you can’t exercise, you may be given medicine to raise your heart rate.

Coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced “cabbage”) surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. A normal coronary artery transports blood to and from the heart muscle itself, not through the main circulatory system. There are two main approaches. In one, the left internal thoracic artery (internal mammary artery) is diverted to the left anterior descending branch of the left coronary artery. In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow. CABG is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death. CABG does not prevent myocardial infarction (heart attack). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. However, two alternative techniques are also available, allowing CABG to be performed on a beating heart either without using the cardiopulmonary bypass, a procedure referred to as “off-pump” surgery, or performing beating surgery using partial assistance of the cardiopulmonary bypass, a procedure referred to as “on-pump beating” surgery. The latter procedure offers the advantages of the on-pump stopped and off-pump while minimizing their respective side-effects. CABG is often indicated when coronary arteries have a 50 percent to 99 percent obstruction. The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both. Arteriosclerosis is characterized by thickening, loss of elasticity, and calcification of the arterial wall, most often resulting in a generalized narrowing in the affected coronary artery. Atherosclerosis is characterized by yellowish plaques of cholesterol, lipids, and cellular debris deposited into the inner layer of the wall of a large or medium-sized coronary artery, most often resulting in a focal partial obstruction in the affected artery. Either condition can limit blood flow if it causes a cross-sectional narrowing of at least 50 percent.

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.

What is Cardiac Rehabilitation? What Does Cardiac Rehab Involve? Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts: Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health. Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab. Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress. Cardiac Rehab is a Team Effort You don’t need to face heart disease alone. Cardiac rehab is a team effort. It’s a medically-supervised program in which you partner with your doctors, nurses, pharmacists — plus family and friends — to take charge of the choices, lifestyle and habits that affect your heart. What’s Next? You’re in the driver’s seat…but here’s what we suggest to get started: Ask your doctor if you are eligible for cardiac rehab. If you are eligible for cardiac rehab, register for a program. In consultation with your medical team, set some heart-health goals and create a cardiac rehab plan. Take an active role in your care to achieve your goals. Keep taking your medicines correctly. Call 911 if you experience new or worsening symptoms.