In India, 1 in 4 deaths are caused by cardiac complications. The symptoms of it - chest discomfort, breathlessness while climbing stairs, or fatigue - are deceptively simple and are dismissed as age or stress-related issues. Yet these symptoms may indicate underlying coronary artery disease.
Coronary artery
disease is one of the leading causes of mortality globally. It becomes
imperative to diagnose cardiac issues early not only to prevent cardiac arrests
and other complications but also improve quality of life. One of the tests a
medical professional might prescribe at an early diagnostic stage is a
Treadmill Test.
What
is treadmill test?
A Treadmill Test (TMT),
or cardiac stress test, is a diagnostic procedure that evaluates the heart's
response to stress. In cardiac diagnostic investigation, TMT carries much
significance. Beyond ECG and echo, which are helpful for assessing cardiac
arrhythmia as well as appearance, a TMT checks whether a person’s heart is
getting enough blood and oxygen during movement, as blockages don’t show up
during rest. Apart from this, a TMT also measures
- Neurocardiac Reflexes
- Cardiac Reserve
- Ischemia
- Chronotropic Incompetence
Why is it needed
A TMT not only
catches the signs accurately but it also does it early. Development in cardiac
issues may not be identified until the patient’s condition is serious. To
prevent this scenario, a cardiologist may prescribe TMT for a patient if they
experience:
·
Heaviness in the
chest while walking fast
·
Fatigue after a
mild activity
·
Breathless while
carrying out daily chores
·
Family history of
cardiac issues
·
High blood
pressure or cholesterol levels
How is the test carried out?
During the test, the
patient walks on a treadmill, and every few minutes, the speed and incline
increase. Sensors similar to that of ECG leaders, are placed on the chest to
track heart’s rate, rhythm, and electrical activity. If the patient experiences
discomfort, chest ache, dizziness, or any other issues, the test will be ceased.
If not, the test continues until the person’s target heart rate is reached.
In a TMT, METs or Metabolic Equivalents of Task, measures the energy expenditure and
functional capacity of the heart during physical exertion.
Understanding TMT
MET Score Ranges and Fitness Levels
During a TMT, the
highest level of work you reach shows your overall cardiovascular fitness and
prognosis:
·
Less than 5 METs
(< 5 METs): Poor functional
capacity; higher risk of heart-related events.
- 5
to 8 METs: Fair
fitness level.
- 9
to 11 METs: Good
fitness level.
- 12
METs or more (> 12 METs):
Excellent functional capacity.
As a rule of
thumb, a higher value of MET can be understood as a sign of a healthy heart.
Achieving a score of 10 METs or
higher is generally associated with a very low risk of cardiac death and a
strong 5-year survival rate (around 95%), even if minor ECG changes are
present.
Management
and Diagnostic Roadmap After a Positive Stress Test
A positive
Treadmill Test (TMT) suggests that the heart muscle is not getting enough
oxygen-rich blood under physical stress (inducible ischemia), which often
prompts doctors to recommend a Coronary Angiogram (CAG) to look for physical
blockages in the heart's blood vessels.
Coronary and CT Coronary angiogram
A coronary
angiogram is a diagnostic procedure which helps in identifying blocks in the
arteries which supply oxygenated blood to the heart muscle. The test can show
narrow blockages in the arteries that usually rise from atherosclerosis. Healthy
functioning of coronary arteries is important as they carry blood to the
heart’s muscle. A blocked coronary artery can lead to a heart attack.
A cardiologist
may recommend a coronary angiogram if:
- Stress test
or electrocardiogram (EKG) was abnormal
- The patient has heart valve
disease, heart failure or a history of a heart attack
- There is an upcoming surgery, and
the risk of having coronary artery disease is high
- The patient experiences angina
- There is unusual chest discomfort
or shortness of breath
A CT angiogram is
a non-invasive test that uses a CT scanner and contrast dye which is given via
a vein in the CT room to create detailed images of the coronary arteries. Unlike
traditional invasive coronary angiography, this method does not require
inserting a catheter into the arteries of the heart.
A CT coronary
angiogram is particularly helpful in ruling out significant coronary artery
disease in patients with low to intermediate risk. Its primary purpose is to
diagnose the following conditions:
- Irregular bulges, aneurysms, and
wide bulges in the blood vessels.
- Coronary artery disease.
- Pulmonary embolism.
- Fatty plaque deposits inside the
blood vessels
Is a coronary
angiogram recommended after a positive TMT?
While a coronary angiogram typically follows a positive
cardiac stress test (TMT), clinical evaluation must carefully assess whether
the patient successfully attained Stage 3 of the Bruce protocol. A diagnostic
coronary angiogram or therapeutic percutaneous coronary intervention (PCI) is
generally unwarranted if the patient's functional capacity exceeds 10 METs.
Long-term cardiovascular health and myocardial perfusion can
be achieved through the following targeted lifestyle modifications focused on
progressively enhancing cardiorespiratory fitness:
·
Structured Aerobic Exercise (Cardiorespiratory
Conditioning)
·
Weight
Management
·
Smoking Cessation & Tobacco Abstinence
·
Blood Pressure & Metabolic Control
·
Stress Management & Sleep Hygiene
In the case that cardiac stress test is positive and the patients
have refractory angina or have high-risk ischemia despite not meeting criteria
for or responding to revascularization, an EECP can be considered.
EECP (Enhanced External Counter
Pulsation) works by applying sequenced, pressure-controlled inflation to cuffs
wrapped around the calves, thighs, and lower body, timed precisely with the
cardiac cycle. The process increases diastolic blood flow and raises shear
stress along artery walls.
It has been postulated that
cardiac benefits of EECP are:
- Increased
VEGF activity, supporting the growth of new collateral blood vessels
- Improved
nitric oxide synthase activity, which enhances endothelial function
- Lower
endothelin-1 levels, reducing arterial constriction
- Reduced
smooth muscle cell proliferation, slowing arterial thickening
Conclusion
Early diagnosis
of cardiac conditions is imperative for identifying potential threats to
cardiovascular health. Physicians often prescribe multiple assessments,
beginning with a cardiac stress test or TMT. If the test is positive but the
patient maintains a functional capacity of at least 10 METs, management can
safely rely exclusively on medications and lifestyle modifications to improve
cardiac health.
Heal Your Heart, one of India's
reputed EECP treatment centers, recognises EECP therapy as an effective tool in
cardiac rehabilitation.
Led by Dr. S. Ramasamy, an
internationally renowned non-invasive cardiac care expert, Heal Your Heart was
founded with a clear vision – to offer patients a scientifically backed,
drug-free, surgery-free path to cardiovascular health. Dr. Ramasamy's decades
of specialization in EECP therapy have positioned the center as a trusted name
in evidence-based cardiac care.
For More Details About EECP Call :
9003070065 / 9003070064.
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