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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.

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.

Holter and Event Monitors Also known as ambulatory EKG; continuous EKG; EKG event monitors. Holter and event monitors are small, portable electrocardiogram devices that record your heart’s electrical activity for long periods of time while you do your normal activities. These monitors can record how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart. Information from these recordings helps doctors diagnose an arrhythmia, or irregular heartbeat, and check whether treatments for the irregular heartbeat are working. There are many types of monitors, such as episodic monitors, autodetect recorders, 30-day event recorders, and transtelephonic event monitors. Your doctor will decide which monitor is best for you. Most monitors have electrodes with sticky adhesive patches that attach to the skin on your chest. Some monitors and electrodes used for long-term recording may be implanted under your skin to make it easier for you to bathe and perform your daily activities. Your doctor will explain how to wear and use the monitor and tell you whether you need to adjust your activity during the testing period. You should avoid magnets, metal detectors, microwave ovens, electric blankets, electric toothbrushes, and electric razors while using your monitor. Usually, you will be instructed to keep electronic devices such as cell phones, MP3 players, and tablets away from the monitor. After you are finished using the monitor, you will return it to your doctor’s office or the place where you picked it up. If you were using an implantable recorder, your doctor will remove it from your chest. There is a small risk that the sticky patches that attach the electrodes to your chest can irritate your skin. You may have an allergic reaction to the electrode adhesive, but the reaction will go away once the electrodes are removed. If you are using an implantable recorder, you may get an infection or have pain where the device was placed under your skin. Your doctor can prescribe medicine to treat these problems.

What is peripheral vascular disease? Peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest. It can also affect the vessels that supply blood and oxygen to your: arms stomach and intestines kidneys In PVD, blood vessels become narrowed and blood flow decreases. This can be due to arteriosclerosis, or “hardening of the arteries,” or it can be caused by blood vessel spasms. In arteriosclerosis, plaques build up in a vessel and limit the flow of blood and oxygen to your organs and limbs. As plaque growth progresses, clots may develop and completely block the artery. This can lead to organ damage and loss of fingers, toes, or limbs, if left untreated. PVD is also known as: arteriosclerosis obliterans arterial insufficiency of the legs claudication intermittent claudication

Congenital heart defect - corrective surgery Congenital heart defect corrective surgery fixes or treats a heart defect that a child is born with. A baby born with one or more heart defects has congenital heart disease. Surgery is needed if the defect could harm the child’s long-term health or well-being. Patent Ductus Arteriosus Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. Before birth, the two major arteries-the aorta and the pulmonary (PULL-mun-ary) artery-are connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation. Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby’s circulation. In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood pressure in the lung arteries. Atrial septal defect (ASD) repair: The atrial septum is the wall between the left and right atria (upper chambers) of the heart. A hole in that wall is called an ASD. In the presence of this defect, blood with and without oxygen can be mixed up and over time, cause medical problems and arrhythmias. Sometimes, an ASD can be closed without open-heart surgery. First, the surgeon makes a tiny cut in the groin. Then the surgeon inserts a wire into a blood vessel that goes to the heart. Next, two small umbrella-shaped “clamshell” devices are placed on the right and left sides of the septum. These two devices are attached to each other. This closes the hole in the heart. Not all medical centers do this procedure. Open-heart surgery may also be done to repair ASD. In this operation, the septum can be closed using stitches. Another way to cover the hole is with a patch. Ventricular septal defect (VSD) repair: The ventricular septum is the wall between the left and right ventricles (lower chambers) of the heart. A hole in the ventricular septum is called a VSD. This hole lets blood with oxygen mix with used blood returning to the lungs. Over time, irregular heartbeats and other heart problems can happen. By age 1, most small VSDs close on their own. However, those VSDs that do stay open after this age may need to be closed. Larger VSDs, such as small ones in certain parts of the ventricular septum, or ones that cause heart failure or endocarditis, (inflammation) need open-heart surgery. The hole in the septum is most often closed with a patch. Some septal defects can be closed without surgery. The procedure involves passing a small wire into the heart and placing a small device to close the defect.

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.

Peripheral Vascular Disease