TMT is the abbreviation for Treadmill Test. The TMT Testing takes into account, the measurement of the blood circulation inside the body (blood pressure) when a patient walks/runs on a treadmill. TMT Testing helps to determine the impact which a physical stress can have on your heart. The test is conducted to find out how efficiently your heart responds when you’re made to exercise in a cloistered environment. The test is performed on OPD basis and requires no hospitalization. Why TMT? A TMT is performed to ascertain the following conditions. • To identify a congenital heart problem like Coronary Artery Disease (CAD) wherein blood vessels/arteries get clogged, diseased or damaged • To determine the functioning of your heart post a heart-attack or angioplasty • To detect repressed heart conditions like shallow breathing, dizziness, chest discomfort and abrupt bodily weaknesses • To monitor the efficacy of medications applied to cure diseases such as angina and ischemia • To discern any abnormal heartbeat rate because of exertion caused by exercise Who Should Undergo? A treadmill stress test is helpful for patients who: • Are suspected of having a cardiovascular issue due to the presence of some symptoms • Have a family history of chronic heart diseases • Chronic or long-time smokers • Are taking heart medications • Have an existing heart condition • Have hypertension, high cholesterol problems, and diabetes What it includes? The cardiac stress test involves several elements, which can help reveal a blockage in several ways: • Electrocardiogram (ECG): These same effects alter not only the heart rate but the heart rhythm as well. With CAD, the changes are characteristic and may be identified with an ECG. • Blood oxygen level monitoring: When the blood flow is obstructed (a condition known as ischemia), the amount of oxygen delivered to the heart and carried from the lungs is decreased. • Pulse and blood pressure monitoring: When the blood flow is partially obstructed by plaque, the heart has to work harder to pump blood through the narrowed vessels. What are the Risks? • an allergic reaction to the dye, in a nuclear stress test • abnormal heart rhythms, but these usually end when the test does • Unstable angina not yet stabilized with medication • flushing or chest pain

2D Echocardiography or 2D Echo of heart is a test in which ultrasound technique is used to take pictures of heart. It displays a cross sectional ‘slice’ of the beating heart, showing chambers, valves and the major blood vessels of heart. ‘Doppler’ is a special element of this ultrasound exam that assesses flow of blood in the heart. How is 2D Echo done? Patient is made to change in a front open robe and a colourless gel is applied to the chest area. Then he is asked to lay on his left side as the technician moves the transducer across the various parts of his chest to get specific/desired views of the heart. Instructions may also be given to the patient to breathe slowly or to hold it. This helps in getting superior quality pictures. What it detects? Echocardiography is a significant tool in providing the physician important information about heart on the following: • Size of the chambers, volume and the thickness of the walls • Pumping function, if it is normal or reduced to a mild/severe degree • Valve function – structure, thickness and movement of heart’s valves • Volume status as low blood pressure may occur as a result of poor heart function • Pericardial effusion (fluid in the pericardium – the sac that surrounds the heart), congenital heart disease, blood clots or tumours, abnormal elevation of pressure within the lungs etc. How safe is echocardiography? It is absolutely safe. There are no known risks of the ultrasound in this type of testing. Stress, modern lifestyle and many other factors have adverse effects on the heart. Hence, routine analysis of the heart health is important. 2D echocardiography is a screening test that produces live heart images. It allows your doctor to monitor the functioning of your heart and its valves.

Echocardiography is a test that uses sound waves to produce live images of your heart. The image is an echocardiogram. This test allows your doctor to monitor how your heart and its valves are functioning. The images can help them spot: • blood clots in the heart • fluid in the sac around the heart • problems with the aorta, which is the main artery connected to the heart During the procedure, a transducer (like a microphone) sends out sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or “echo” off of the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves. Why do people need an echo test? Your doctor may use an echo test to look at your heart’s structure and check how well your heart functions. The test helps your doctor find out: • The size and shape of your heart, and the size, thickness and movement of your heart’s walls. • How your heart moves. • The heart’s pumping strength. • If the heart valves are working correctly. • If blood is leaking backwards through your heart valves (regurgitation). • If the heart valves are too narrow (stenosis). • If there is a tumor or infectious growth around your heart valves. What are the types of echocardiography? There are several different types of echocardiograms. • Transthoracic echocardiography: This is the most common type of echocardiography. It’s painless and noninvasive. A device called a transducer will be placed on your chest over your heart. The transducer sends ultrasound waves through your chest toward your heart. A computer interprets the sound waves as they bounce back to the transducer. This produces the live images that are shown on a monitor. • Transesophageal echocardiography: If a transthoracic echocardiogram doesn’t produce definitive images, your doctor may recommend a transesophageal echocardiogram. In this procedure, the doctor guides a much smaller transducer down your throat through a thin, flexible tube in your mouth. They will numb your throat to make this procedure easier. This tube is guided through your esophagus, the tube that connects your throat to your stomach. • Stress echocardiogram: A stress echocardiogram uses traditional transthoracic echocardiography. However, the procedure is done after you’ve exercised or taken medication to make your heart beat faster. This allows your doctor to test how your heart performs under stress. • Three-dimensional echocardiography: A three-dimensional (3-D) echocardiogram uses either transesophageal or transthoracic echocardiography to create a 3-D image of your heart. This involves multiple images from different angles. It’s used prior to heart valve surgery. It’s also used to diagnose heart problems in children. • Fetal echocardiography: Fetal echocardiography is used on expectant mothers sometime during weeks 18 to 22 of pregnancy. The transducer is placed over the woman’s belly to check for heart problems in the fetus. The test is considered safe for an unborn child because it doesn’t use radiation, unlike an X-ray.

An arrhythmia describes an irregular heartbeat – the heart may beat too fast, too slowly, too early, or irregularly. Arrhythmias occur when the electrical signals to the heart that coordinate heartbeats are not working properly. For instance, some people experience irregular heartbeats, which may feel like a racing heart or fluttering. Many heart arrhythmias are harmless; however, if they are particularly abnormal, or result from a weak or damaged heart, arrhythmias can cause serious and even potentially fatal symptoms. Arrhythmias are broken down into: • Slow heartbeat: bradycardia. • Fast heartbeat: tachycardia. • Irregular heartbeat: flutter or fibrillation. • Early heartbeat: premature contraction. What are the causes of arrhythmia? Any interruption to the electrical impulses that cause the heart to contract can result in arrhythmia. For a person with a healthy heart, they should have a heart rate of between 60-100 beats per minute when resting. The more fit a person is, the lower their resting heart rate. Olympic athletes, for example, will usually have a resting heart rate of under 60 beats per minute because their hearts are very efficient. A number of factors can cause the heart to work incorrectly, they include: • alcohol abuse • diabetes • drug abuse • excessive coffee consumption • heart disease like congestive heart failure • hypertension (high blood pressure) What are symptoms of arrhythmia? Some patients have no symptoms, but a doctor might detect an arrhythmia during a routine examination or on an EKG. Symptoms are depend on the type of arrhythmia. Some of them common are; • dizziness • chest pain • sudden weakness • shortness of breath • diaphoresis, or sweating How are arrhythmias diagnosed? Tests used to diagnose an arrhythmia or determine its cause include: • Electrocardiogram • Holter monitor • Event monitor • Stress test • Echocardiogram • Cardiac catheterization What are the types of arrhythmia? There are several types of arrhythmia: • Atrial fibrillation: This is irregular beating of the atrial chambers – nearly always too fast. Atrial fibrillation is common and mainly affects older patients. Instead of producing a single, strong contraction, the chamber fibrillates (quivers). • Atrial flutter: While fibrillation consists of many random and different quivers in the atrium, atrial flutter is usually from one area in the atrium that is not conducting properly, so the abnormal heart conduction has a consistent pattern. Neither are ideal for pumping blood through the heart. • Supraventricular tachycardia (SVT): A regular, abnormally rapid heartbeat. The patient experiences a burst of accelerated heartbeats that can last from a few seconds to a few hours. Typically, a patient with SVT will have a heart rate of 160-200 beats per minute. Atrial fibrillation and flutter are classified under SVTs. • Ventricular tachycardia: Abnormal electrical impulses that start in the ventricles and cause an abnormally fast heartbeat. This often happens if the heart has a scar from a previous heart attack. Usually, the ventricle will contract more than 200 times a minute.