Stress test / Treadmill test

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1. Treadmill Test Khairul N izam A bdul R ahman 4262143008

2. What is Treadmill Test? Treadmill test is also called a stress test, exercise electrocardiogram, graded exercise test, or stress ECG. It is used to provide information about how the heart responds to exertion. It usually involves walking on a treadmill at increasing levels of difficulty, while electrocardiogram, heart rate, and blood pressure are monitored.

3. Why Need Treadmill Test? Treadmill test is use to Determine if there is adequate blood flow to heart during increasing levels of activity. Evaluate the effectiveness of heart medications to control angina and ischemia. Determine the likelihood of having coronary heart disease and the need for further evaluation. Check the effectiveness of procedures done to improve blood flow within the heart vessels in people with coronary heart disease. Identify abnormal heart rhythms. Help to develop a safe exercise program.

4. Contraindication Acute myocardial infarction (within 2 days) High-risk unstable angina Symptomatic severe aortic stenosis S ymptomatic heart failure Acute pulmonary embolus or pulmonary infarction Acute myocarditis or pericarditis Acute aortic dissection Electrolyte abnormalities Tachy or Brady arrhythmias Mental or physical impairment Hypertension (>200/100 at rest) Neuromuscular and musculoskeletal disorder exacerbated by exercise block

5. Technique Patients should be instructed not to drink, eat caffeinated beverages or smoke 3hour before testing & to wear comfortable shoes and clothes. Unusual physical exertion should be avoided Brief history & physical examination should be performed Should be instructed about risks and benefits Informed consent is taken 12 lead ECG is recorded with electrodes at the distal extremities Torso ECG is obtained in standing and sitting position If false + ve test is suspected, hyperventilation should be performed

6. Technique Area of electrode application should be rubbed with alcohol saturated pad to remove oil and rubbed with sand paper to reduce skin resistance to 5000ohms or less Cables should be light flexible and shielded Room temperature should be 18-24 C and humidity less than 60% Walking should be demonstrated to patient HR, BP & ECG should be recorded at the end of each stage. Minimum of 3 leads should be displayed continuously on the monitor A resuscitator cart, defibrillator and appropriate cardioactive drugs should be available in the TMT room.

7. When To Stop!? TMT might be prematurely stopped for any of the following: Moderate to severe angina Increasing chest pain Increasing nervous system symptoms (ataxia , dizziness) Signs of poor perfusion (cyanosis or pallor) Sustained ventricular tachycardia ST elevation (≥1.0 mm) ST depression (>2 mm) Drop in SBP of (≥ 10 mmHg) BP without ischemia Heart block or brady arrhythmias Technical difficulties in monitoring ECG or SBP Fatigue, shortness of breath, wheezing, leg cramps

8. Bruce Protocol Total of 1+6 (Seven 3 minute stages) – (3+18 min) Each minute exercise is approximately 1 MET Pretest plain walking + 6 Stages of graded exercise In each stage there is increase in speed and gradient Initial 1.7 mph with 10% gradient (upward inclination) Maximum 5.5 mph with 20% gradient

9. Bruce Protocol Stage Minutes % grade km/h MPH METS 1 3 10 2.7 1.7 5 2 6 12 4.0 2.5 7 3 9 14 5.4 3.4 10 4 12 16 6.7 4.2 13 5 15 18 8.0 5.0 15 6 18 20 8.8 5.5 18 7 21 22 9.6 6.0 20

10. What is MET? Metabolic Equivalent Term 1 MET = 3.5 ml O2 per kilogram of body weight per minute Actually differs with thyroid status, post exercise, obesity , disease states By convention just divide ml O2/Kg/min by 3.5 METs = Speed x [0.1 + (Grade x 1.8)] + 3.5 3.5 Calculated automatically by Device

11. Karvonen Method The Karvonen method factors in resting heart rate ( HRrest ) to calculate target heart rate (THR), using a range of 50–85%: THR = (( HRmax − HRrest ) × %Intensity) + HRrest Example for someone with a HRmax of 180 and a HRrest of 70: 50% intensity: ((180 − 70) × 0.50) + 70 = 125 bpm 85% intensity: ((180 − 70) × 0.85) + 70 = 163 bpm