Stress Test (TMT)

Treadmill test (TMT) also known as stress ECG or exercise stress test is an investigation aimed at detecting coronary artery disease before it manifests as a heart attack

Stress Test (TMT)

Stress Test (TMT)

What is TMT
Treadmill test (TMT) also known as stress ECG or exercise stress test is an investigation aimed at detecting coronary artery disease before it manifests as a heart attack or causes major damage to heart. TMT is essentially an ECG done during exercise.

Why Exercise Stress Test?
The reason behind doing an ECG while exercising is that when the coronary artery disease is in early stage it may not have symptoms at rest as less oxygen is required by heart when there is less workload.

In early disease the capacity of coronary artery to supply oxygen is still not compromised enough to be inadequate at rest. But as the patient exercises the heart starts beating faster and as heart starts beating faster the oxygen consumed by heart for carrying out the extra work increases.

In Normal state the coronary arteries can accommodate extra flow of blood but when there is underlying coronary artery disease and narrowing of the arteries, they are not able to carry the extra blood and oxygen required for the exercising heart.

Thus a heart which had no symptoms may become symptomatic during exercise. But this situation may occur only at a very high level of exertion. In today’s lifestyle patient may not be doing such levels of exertion and thus may not have any symptoms.

Conversely, patients may be having ischemia and may not notice symptoms. In some patients there is no typical angina or chest pain and the patient instead has shortness of breath on exercising, which the patient may consider to be a normal response to exertion.

How a TMT helps in uncovering hidden heart disease?
By doing a TMT we make the heart rate increase to a predetermined level according to age of the patient. If the coronary blood vessels have a significant narrowing then they are not able to keep up the blood supply as per increasing requirement and the ECG recording shows changes at peak exercise.

This way we can be able to catch heart disease years before it shows changes in resting ECG or typical symptoms. Early detection leads to early medical therapy and preventive actions and can save the patient from a progressive worsening of disease before major irreversible damage has been done.

What is the advantage of early detection?
Early detection and treatment can ensure a normal and healthy life in these patients. Although the test itself may be false positive or false negative. It is a great screening tool of combined with proper history taking and risk stratification.

Who should get a TMT test?
Any person who is at risk, for example diabetic, smoker, having a family history of heart disease or one having high cholesterol can get TMT done as screening test. It can also be used for pre-operative risk stratification and for patients having symptoms of chest discomfort on exertion.

Persons who may be at risk of heart disease and are planning strenuous physical activity are also candidates for getting TMT.

Any person even if asymptomatic can get this test for screening.

How is the test done?
The TMT test requires the patient to walk on a treadmill in a graded protocol while his/her pulse Blood pressure ECG etc are constantly monitored and supervised by the doctor. When a patient reaches the predetermined heart rate or gets tired the test is stopped.

The doctor conducting test constantly monitors Blood pressure pulse ECG and patient symptoms and test is stopped anytime before completion if any of these parameter show a problem. The ECG and other parameters are continued to be monitored for few minutes after stopping exercise.

Those who have a positive TMT may be started on medication and advised further tests. Those with negative TMT may be considered free from significant coronary artery disease or may still need further tests if there is high index of suspicion.

Exercise /Treadmill Test Preparation

Nothing to eat two hours prior to the procedure.
No caffeine products morning of the procedure.
If you are diabetic, please consult your physician.
Take prescribed medications unless directed not to do so by your physician.
Bring a list of medications with you.
If your are on a Beta Blocker or Nitrates, you may have to stop them one day prior.
Wear comfortable clothes and sports shoes.
If possible get familiar with walking on a treadmill if not already familiar.
No smoking on the morning of the procedure.
Male patients: If the patient is not averse to shaving, chest hair should be shaved.

Precautions & Safety
Get assessment by the doctor before treadmill to see if you have any medical condition in which TMT should not be done

Exercise stress test is a safe test when done under proper medical supervision after screening the patient. However it should be ensured that doctor is present in the vicinity for early recognition and management of any emergency situation.

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