Introduction: What is a Treadmill Stress Test?

 

Coronary artery disease, or CAD, is the leading cause of death in Hyderabad, India. To know If you have Coronary artery disease or CAD, either a stress test (treadmill test or TMT test)  or coronary angiogram test (CAG) helps.  An EKG stress test or ECG stress test can help determine if your CAD has progressed to the point where medical intervention may be needed to save your life. Find out more about how the treadmill stress test works and whether it’s right for you here. We are not discussing other stress tests like stress echocardiography or stress 2d echo in this article.

A stress test evaluates your heart’s response to physical exertion by observing the effects of exercise on your blood pressure, heart rate, and electrocardiogram (ECG or EKG). If we put it simply, the stress test is an ECG test when your heart is under the stress of exercise.

Your doctor may conduct this test if you’re having symptoms of coronary artery disease (CAD), such as chest pain or shortness of breath, to determine the severity of your coronary blockages. Understanding how stress tests work will help you prepare for the day of your test and know what to expect when you visit your doctor. ‘’TMT test is an alternative to Coronary angiogram if you can do it’’ says dr. Malleswara Rao.

Other names for stress tests are:

• Stress ECG test
• TMT test
• Treadmill test
• Stress exercise test

What is an exercise stress test?

A treadmill test is a medical procedure that evaluates your heart health by subjecting it to physical exertion. During a stress test, you’ll exercise on a treadmill and your heart rate, ECG, and blood pressure will be measured as you exercise. The electrical activity of the heart is analyzed on graph paper during the stress. Any deviation from the normal readings is reported.

 

How Does TMT test Work?

The stress test is a safe, painless, and non-invasive test that uses ECG tracings to look at your heart during exercise. The ECG tracings indirectly reveal how well your coronary arteries dilate (widen) in response to an exercise. The more they widen, the healthier they are and less likely they are to cause a heart attack or other serious problems later on. Healthier arteries mean no ischemic changes in the ECG graph during a treadmill test.

The patient’s electrocardiogram (ECG), blood pressure, and heart rate are continuously monitored during exercise.

Why You Should Take the Treadmill Stress Test

There are several reasons why you may need a stress test. Your doctor uses the TMT test often for establishing the diagnosis of coronary artery disease (CAD).

If you have one or more risk factors for cardiovascular disease and have complaints of CAD such as chest pain or shortness of breath, your doctor may suggest screening through the use of a Treadmill test to try to catch coronary blockages before you have a heart attack or other serious problems.

Risk factors for heart diseases include:

• Being over age 45 if you’re a man and over 50 if you’re a women
• Having a first-degree relative, such as a parent or sibling, who developed heart disease at an early age (under 55 in males and under 65 in females).
• Having a high cholesterol result in a lipid profile or lipid panel.
• smoking cigarettes
• Having  overweight or obesity
• Having high blood pressure (hypertension).
• Having   diabetes

Symptoms of CAD or coronary artery disease include:

• chest pain
• shortness of breath
• Palpitations
• Fainting
• Swelling of ankles and feet

If you’re experiencing any of the above symptoms, your doctor may have you undergo a lipid panel blood test.

 

Who Should Have a Stress Test?

If you have symptoms of heart disease, are over age 50, or have a family history of heart disease and other risk factors such as diabetes or high blood pressure, it’s important to talk with your doctor about getting a stress test. He or she may also recommend one if you have been recently diagnosed with diabetes and were found to have evidence of heart disease.

What if I am too nervous for a stress test?

If you’re too nervous to do it alone, ask a friend or family member to be there with you. Someone who is supportive of your goals and whom you trust can help calm your nerves and make you feel more at ease.

Do I need to fast for a stress treadmill test?

In most cases, you need to fast for 4 to 6 hours before your TMT test. Fasting is not mandatory but being in fasting helps you perform the test comfortably. In any case, it’s important to ask your healthcare provider in advance whether you need to fast before the test. Always follow the instructions that your provider gives you.

What to Expect During a Treadmill Stress Test?

 

You can expect to experience the following during a stress test:

You will be informed about the whole procedure

Your data and medical records will be entered

Your target heart rate will be calculated by the computer based on your age. Test gets completed once you run till you reach the target heart rate.

The test is done in different stages. They are

• Pretest supine
• Pretest standing
• Stage 1
• Stage 2
• Stage 3
• Stage 4
• Stage 5
• Stage 6
• Recovery 1 minute
• Recovery 3 minutes
• Recovery 5 minutes

Stage one has a speed of  and tilt of

After the end of 3 minutes, the speed and tilt of the treadmill increase to

Similarly, at the end of every 3 minutes, the speed and tilt of the treadmill increase, and stress on your heart also gets increased. You are asked to run on the treadmill till you reach your target heart rate. Many people reach their target heart rate in stage or stage 3. For few, they achieve this only in stage 4 or stage 5. You can always stop the test by pressing the button on the treadmill machine if you think you can not proceed further, you can tell the technician to stop the test too. Once you reach your target heart rate, the technician will stop the treadmill machine, and you are asked to

Your blood pressure, ECG, and heart rate will be monitored at every stage of the stress test. Adhesive Knobs called electrodes will be put onto your chest, shoulders, or abdomen to capture the electrical activity of your heart. These electrodes are connected to a computer on the other end. computer records electrical activity in the form of ECG from the information it gets through the electrodes. The sites on the chest and abdomen where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A gel may also be used to ensure a good quality ECG recording. The wires are connected to the ECG machine.

What should I expect after my treadmill test?

After the technician has finished your stress test, they’ll send the ECG graphs to a cardiologist for reporting.  Once the test results are back, your healthcare provider will share the results with you.

What are the risks of a TMT test?

TMT test is a very common and essential part of medical testing and screening. There’s very little risk to having a stress test. You may have slight tiredness or sweating during or after the test, but this usually resolves quickly. Few cases of heart attacks have been reported while having a stress test. Your doctor is always available in the place for rescue.

When can I expect stress test results?

In most cases, you should have your TMT test results back within 10 to 20 minutes, though it could take longer.

What do the results of a stress test mean?

Stress tests, usually provide the following information:

• The name of the test
• Your workload capacity
• Number of stages performed
• Your heart rate and blood pressure during various stages of the test
• Information that indicates if your result is normal or abnormal.

What are normal treadmill test results?

The normal  result for a stress treadmill test is as follows:

• You have achieved your target heart rate
• There are no ECG changes in the graph suggestive of decreased blood supply to the heart muscle (ischemia)
• You have not experienced chest pain or fainting during the test
• You have not developed abnormal heart rhythm during the test

If your results deviate from the normal, they may be classified as the intermediate probability of CAD, positive for CAD, or strongly positive for CAD.

 

Should I be concerned if I have an abnormal stress test results?

If your stress test results reveal that you have a positive test (positive for inducible ischemia), it means that you are likely to have coronary artery disease (coronary blockages)

A  Positive result for you may depend on many factors apart from coronary artery disease. Your heart specialist will take into consideration the following factors when interpreting your stress test results:

• Your age.
• Your risk factors for heart disease
• Other medical problems like low hemoglobin
• Your current medications.

 

Your doctor will determine the need for further tests such as a coronary angiogram or Ct coronary angiogram. If you have questions about your results, don’t be afraid to talk to your provider.

What are the next steps if stress test results are abnormal?

Since many factors contribute to positive test results, your doctor decides further course of action according to your complaints, risk factors, and other comorbidities.

If you have an abnormal stress treadmill test, your healthcare provider may recommend one or more of the following actions:

• Coronary angiogram
• CT angiogram
• Myocardial perfusion scan

He may put you on some medication

• Starting a cholesterol-lowering medication
• Blood-thinning medicine
• You will be encouraged to follow a healthy lifestyle such as changing your diet or starting an exercise routine.

 

When should I call my doctor?

If your complaints do not go away with medicine and lifestyle changes or if your complaints are increased in severity, contact your healthcare provider. Then you may need to undergo an angiogram  or angioplasty

A note from Dr. Malleswara Rao

Seeing an abnormal test result can be stressful. Know that having an abnormal stress test result does not always mean you have coronary artery disease. Also, know that having coronary artery disease does not always mean you need angioplasty or CABG surgery. While angioplasty or CABG can play a significant role in the management of coronary artery disease, even medicines can control coronary artery disease in some cases. Your healthcare provider will take many factors about your health and history into consideration when determining the next steps. Together you will decide on a plan that works best for you.

 

Is a Stress Test contraindicated for Your Condition?

If you are suffering from or experiencing the following things, you should not perform the stress test

• Have a heart attack less than 48 hours back
• Ongoing heart pain
• Myocarditis
• Pericarditis
• Aortic stenosis
• Mitral stenosis
• Uncontrolled hypertension

But what if you want to know about your coronary artery disease. Don’t worry. You can still have other tests like coronary angiogram to know about coronary artery disease.

Which is better: 2d echo test or tmt test?

Both are better in their own way. 2d echo test and tmt tests are complementary tests to each other but not substitutes for each other.

 

Conclusion: A stress test is a medical diagnostic test for studying the electrical activity of the heart during exercise