TMT.pptx

Tmt

1. TMT(Treadmill Test) Sandra M

2. TMT( Treadmill Test) It is a non-invasive method for evaluate ISCHEMIC HEART DISEASE The patient usually exercise on a treadmill and is continuously monitored ‹#›

3. PROCEDURE The test consist of walking in monitor device ECG will be recorded through out the monitor BP is also monitored speed & grade changes according to the protocol ‹#›

4. INDICATIONS OF TMT Elicit abnormalities not present at rest Estimate functional capacity Estimate prognosis of CAD Likelyhood of coronary artery disease Extent of CAD Effect of CAD Evaluation&management of patients with wide variety of cardiovascular conditions including valvular heart disease,CHD,arrhythimias&peripheral arterial disease ‹#›

5. CONTRAINDICATIONS OF TMT ABSOLUTE Acute MI within2-3 days High risk unstable angina Uncontrolled arrythmia Symptomatic Severe AS Acute Endocarditis,Myocarditis or Pericarditis Decompensated Heart Failure Acute Pulmonary Embolism or Pulmonary Infarction Aortic dissection RELATIVE LMCA stenosis High degree AV block Electrolyte abnormalities Tachy/Brady arrythmia Mental /Physical in capability Hypertrophic Cardiomyopathy ‹#›

6. MASON- LIKER MODIFICATION Placement of electrode in TMT is called MASON-LIKER MODIFICATION RA&LA:Just below the clavicle on corresponding sides V1-V6:Chest electrodes are place same as in standard ecg placement LL&RL: Just below the rib cage on corresponding sides ‹#›

7. METs (Metabolic equivalent term) It is most significant in TMT METs is a term commonly used clinically to express the oxygen requirment of the work rate during an excercise test on a treadmill One METs is equated with the resting metabolic rate(~3.5ml of O2/kg body weight x min) METs=[speed ×[0.1+(Grade×1.8)]+3.5] /3.5 ‹#›

8. Clinical Significance of METs For Maximum Excercise METs ACTIVITY 1METs On Sitting 2-4 METs Light work around the house Walking at 3-4 mph >4-<10 METs Short running Scrabbing floor moving furnitures >10 METs Running>6-7mph Heavy labour Swimming Foot ball ‹#›

9. MYOCARDIAL OXYGEN DEMAND It is the amount of oxygen that the heart require to maintain optimal function Factors influence myocardial oxygen demand 1.Heart rate 2.Blood pressue 3.LV contractility 4.LV wall stress( IV pressure/Wall thikness/Cavity size) ‹#›

10. DUKE SCORE IN TMT Duke score is one of the tool for predicting the risk of ischemia or infraction in myocardium The calculation is done based on the informations obtained from an excercise test Duke score=Excercise time-(5 ×ST depression)-(4×angina score) (where 0= no angina,1=non-limiting angina, 2=excercise limiting angina) A duke score >5 indicates low risk for cardiovascular events ‹#›

11. TMT PROTOCOLS BRUCE PROTOCOL MODIFIDE BRUCE PROTOCOL ACIP PROTOCOL MODIFIDE ACIP PROTOCOL CORNELS PROTOCOL NAUGHTON& WEBER PROTOCOL ‹#›

12. BRUCE PROTOCOL It is the most commenly used protocol There are 7stages, most individuals are unable to complete all of the stages Each stage has 3 min duration ,the treadmill speed &incline is increased every 3 min ‹#›

13. MODIFIED BRUCE PROTOCOL This protocol is most often used in older individuals or those whose excercise capacity is limited by cardiac disease It has 2 warm up stages,each lasting 3min The first stage is at 1.7mph and 0%&the second is at 1.7mph and5% ‹#›

14. ACIP(Asymptomatic cardiac ischemia pilot) PROTOCOL Developed to test patients with established CAD The ACIP Trial use 2 min stages with 1.5MET increment between stages after 1-2 warm up stages with 1MET increment Result in a linear increase in heart rate&distributing the time to occurrence of ST segment depression over a wider range of heart failure&exercise time than protocols with more abrupt increment in work load between stages ‹#›

15. MODIFIED ACIP PROTOCOL The modified ACIP protocol produce a similar aerobic demand as the standard ACIP protocol for each minute of excercise Well suited for short or older individuals who can’t keep up with a walking speed of 3mph ‹#›

16. CORNELS PROTOCOL The protocol is good for a wider range of fitness level depending on starting grade Allow for gradual increase in grade &speed Started at 0%,5%,10% grade depending on fitness level ‹#›

17. NAUGHTON &WEBER PROTOCOL This protocol is use 1-3 minute stages with 1METs increment These protocol may be more suitable for patients with limited excercise tolerance.Such as patients with compensated congestive heart failure ‹#›

18. NORMAL RESPONSE TO TMT HR increases BP increases Cardiac output increases Oxygen consumption increases Total peripheral resistance decreases ‹#›

19. ABNORMAL RESPONSE TO TMT HR fails to rise above 120 or unstable to attain the HR of 85% of max Physicaly unstable to complete test Marked hypertention >260/115mmHg Chest pain and unusual shortness of breath ‹#›

20. NORMAL ECG CHANGES DURING TMT QRS complex decreases in size PR,QRS,QT shortnes J point decreases resulting in upsloping of ST segment ST segment returns to baseline by 80 milliseconds PR segment may down slope R amplitude may decrease at rates >130 P amplitude increases T wave decreases ‹#›

21. ABNORMAL ECG CHANGES DURING TMT Horizontal or down sloping ST segment ST segment depression or elevation ST segment does not return to baseline by 80milliseconds U or T wave inversion Dysrhythamias- rate dependent blocks above first degree,atrial flutter/fibrilation ‹#›

22. Emergeny Medicines Used In TMT Atropine: I t increase heart rate,which improve hemodynamic stability Adrenalin: To treat cardiac arrest and superficial bleeding Metalar : To treat high BP and to prevent symptoms of angina, to reduce risk of death rate after a heart attack Lasix: To treate acute and chronic heart failure Emset: To prevent nausea and vomitting Dobutamine : Used to treat acute &potentially reversible heart failure ‹#›

23. INDICATIONS TO STOP TMT ABSOLUTE RELATIVE Drop in systole BP>30mmHg Drop in systolic BP>10 mmHg Moderate-severe angina ST depression>3mm Increasing nervous system disorder Persisting SVT Patient desire to stop Increasing chest pain Pre -signs to poor perfusion ST elevation >1mm Sustained VT Fatigue, shortness of breath ‹#›

24. NEGATIVE TMT A negative TMT is declared when the patient can reach target heart rate without showing any ECG changes 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% ‹#›

25. POSITIVE TMT ST segment depression or elevation of 1mm or more is present in stress test ECG we can declare it as a positive TMT 1.Mildly positive 2.Moderately positive 3.Strongly positive ‹#›

26. TYPES OF POSITIVE TMT 1)mildly positive horizontal ST depression of 1-1.5 mm Slowly rising junctional depression,which remain depressed 1.5mm or more than 80ms after the J point 2)moderately positive horizontal ST depression of 1.5-2.5mm 3)strongly positive flat ST depression of 2.5mm or more horizontal or down sloping ST depression appearing in first stage of excercise &remaining for more than 8minutes into recovery ‹#›

27. INCONCLUSIVE TMT An inconclusive test result is usually due to non-diagnostic ECG changes When the test is terminated early due to exhaustion Before maximum HR or workload is reached ‹#›

28. THANK YOU ‹#›

29. ‹#› Thank you….