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.

Angioplasty and stent placement are common procedures to open arteries in the heart that are clogged. These procedures are formally known as coronary angioplasty or percutaneous coronary intervention. Angioplasty involves the use of a tiny balloon to widen the artery. A stent is a tiny wire-mesh tube that your doctor inserts into the artery. The stent stays in place to prevent the artery from closing. A cardiologist typically performs both procedures at the same time. Why it's done? Angioplasty is used to treat the buildup of fatty plaques in your heart’s blood vessels. This buildup is a type of heart disease known as atherosclerosis. Angioplasty may be a treatment option for you if: • You have tried medications or lifestyle changes but these have not improved your heart health. • You have chest pain (angina) that is worsening. • You have a heart attack. Angioplasty can quickly open a blocked artery, reducing damage to your heart. What are the benefits of a coronary angioplasty? In most cases, the blood flow through the coronary arteries improves after an angioplasty. Many people find their symptoms get significantly better and they’re able to do more than they could before the procedure. If you’ve had a heart attack, an angioplasty can increase your chances of surviving more than clot-busting medication (thrombolysis). The procedure can also reduce your chances of having another heart attack in the future. How safe is a coronary angioplasty? A coronary angioplasty is 1 of the most common types of treatment for the heart. Coronary angioplasties are most commonly performed in people aged 65 or older, as they’re more likely to have heart disease. As the procedure doesn’t involve making major incisions in the body, it’s usually carried out safely in most people. Doctors refer to this as a minimally invasive form of treatment. The risk of serious complications from a coronary angioplasty is generally small, but this depends on factors such as: • your age • your general health • whether you’ve had a heart attack

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. High blood pressure is now classified as a systolic blood pressure greater than 130 and diastolic over 80. To prevent high blood pressure, everyone should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking, and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 130/80 in people older than age 65 and those with risk factors such as diabetes and high cholesterol. Treating high blood pressure involves lifestyle changes and possibly drug therapy. Lifestyle Changes to Treat High Blood Pressure - A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes: • Losing weight if you are overweight or obese • Quitting smoking • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat) • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week) • Limiting alcohol Symptoms of high blood pressure - Most people who have high blood pressure do not have symptoms. This is why it’s sometimes called “the silent killer.” It is very important to have your blood pressure checked regularly. Some people experience headaches, nosebleeds, or shortness of breath with high blood pressure. What causes high blood pressure? Food, medicine, lifestyle, age, and genetics can cause high blood pressure. Your doctor can help you find out what might be causing yours. Common factors that can lead to high blood pressure include: • A diet high in salt, fat, and/or cholesterol. • Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol. • Family history, especially if your parents or other close relatives have high blood pressure. • Lack of physical activity. • Some birth control medicines. • Stress • Tobacco use or drinking too much alcohol.

If your heart seems to skip a beat, race, or work a bit too slow, you could have a condition known as arrhythmia. Your doctor might suggest you wear a device called a Holter monitor. A Holter monitor is a battery-operated portable device that measures and records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used. The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The Holter monitor and other devices that record your ECG as you go about your daily activities are called ambulatory electrocardiograms. A doctor may ask for Holter monitoring if a person has symptoms such as: • a fast or slow heartbeat • dizziness • weakness or fatigue • chest pain Why might I need a Holter monitor? Some reasons for your healthcare provider to request a Holter monitor recording or event monitor recording include: • To evaluate chest pain that can’t be reproduced with exercise testing • To evaluate other signs and symptoms that may be heart-related, such as tiredness, shortness of breath, dizziness, or fainting • To identify irregular heartbeats or palpitations • To see how well a pacemaker is working • To determine how well treatment for complex arrhythmias is working What are the risks of a Holter monitor? The Holter monitor is an easy way to assess the heart’s function. Risks associated with the Holter monitor are rare. It can be hard to keep the electrodes stuck to your skin, and extra tape may be needed. It may be uncomfortable when the sticky electrodes and tape are taken off. If the electrodes are on for a long time, they may cause tissue breakdown or skin irritation at the application site.

A coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries (the main blood vessels supplying the heart). The term “angioplasty” means using a balloon to stretch open a narrowed or blocked artery. However, most modern angioplasty procedures also involve inserting a short wire-mesh tube, called a stent, into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely. Coronary angioplasty is sometimes known as percutaneous transluminal coronary angioplasty (PTCA). The combination of coronary angioplasty with stenting is usually referred to as percutaneous coronary intervention (PCI). What are the types of Angioplasty? There are different types of coronary angioplasty procedures. Each one decreases blockage in a different way. • Balloon angioplasty – A small balloon is inflated inside the artery to “crack” the blockage and push it against the wall of the artery • Atherectomy – The blocked area inside the artery is “shaved” away by a tiny device on the end of a catheter • Stent – A tiny coil made of metal is expanded inside the artery and is left in place to keep the artery open. This is the most common procedure when performing a coronary angioplasty. When a coronary angioplasty is used? Like all organs in the body, the heart needs a constant supply of blood. This is supplied by the coronary arteries. In older people, these arteries can become narrowed and hardened (known as atherosclerosis), which can cause coronary heart disease. If the flow of blood to the heart becomes restricted, it can lead to chest pain known as angina, which is usually triggered by physical activity or stress. While angina can often be treated with medication, a coronary angioplasty may be required to restore the blood supply to the heart in severe cases where medication is ineffective. Coronary angioplasties are also often used as an emergency treatment after a heart attack. What are the benefits of a coronary angioplasty? In most cases, the blood flow through the coronary arteries improves after an angioplasty. Many people find their symptoms get significantly better and they’re able to do more than they could before the procedure. If you’ve had a heart attack, an angioplasty can increase your chances of surviving more than clot-busting medication (thrombolysis). The procedure can also reduce your chances of having another heart attack in the future. How safe is a coronary angioplasty? A coronary angioplasty is 1 of the most common types of treatment for the heart. Coronary angioplasties are most commonly performed in people aged 65 or older, as they’re more likely to have heart disease. As the procedure doesn’t involve making major incisions in the body, it’s usually carried out safely in most people. Doctors refer to this as a minimally invasive form of treatment. The risk of serious complications from a coronary angioplasty is generally small, but this depends on factors such as: • your age • your general health • whether you’ve had a heart attack

A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart. A pacemaker may be recommended to ensure that the heartbeat does not slow to a dangerously low rate. The pacemaker sends electrical pulses to your heart to keep it beating regularly and not too slowly. Having a pacemaker can significantly improve your quality of life if you have problems with a slow heart rate. The device can be lifesaving for some people. Types of pacemakers - Your doctor will decide what type of pacemaker you need based on your heart condition. Your doctor also determines the minimum rate (lowest heart rate) to set your pacemaker. • Leadless Pacemaker – Self-contained device without connecting leads (wires) and generator • Biventricular Pacemaker – also called cardiac resynchronization therapy (CRT) Why do I need a pacemaker? The heart is essentially a pump made of muscle, which is controlled by electrical signals. These signals can become disrupted for several reasons, which can lead to a number of potentially dangerous heart conditions, such as: • an abnormally slow heartbeat (bradycardia) • an abnormally fast heartbeat (tachycardia) • heart block (where your heart beats irregularly because the electrical signals that control your heartbeat aren’t transmitted properly) • cardiac arrest (when a problem with the heart’s electrical signals cause the heart to stop beating altogether) How is a pacemaker fitted? Having a pacemaker implanted is a relatively straightforward process. • It’s usually carried out under local anaesthetic, which means you’ll be awake during the procedure. • The generator is usually placed under the skin near the collarbone on the left side of the chest. The generator is attached to a wire that’s guided through a blood vessel to the heart. • The procedure usually takes about an hour, and most people are able to leave hospital on the same day or a day after surgery. What are the risks of the procedure? Possible risks of pacemaker include, but are not limited to, the following: • Bleeding from the incision or catheter insertion site • Damage to the vessel at the catheter insertion site • Infection of the incision or catheter site • Pneumothorax. If the nearby lung is inadvertently punctured during the procedure, leaking air becomes trapped in the pleural space (outside the lung but within the chest wall); this can cause breathing difficulties and in extreme cases may cause the lung to collapse.

An electrophysiological study (EP study) is a test used to evaluate your heart’s electrical system and to check for abnormal heart rhythms. Natural electrical impulses coordinate contractions of the different parts of the heart. This helps keep blood flowing the way it should. This movement of the heart creates the heartbeat, or heart rhythm. During an EP study, your doctor inserts small, thin wire electrodes into a vein in the groin (or neck, in some cases). He or she will then thread the wire electrodes through the vein and into the heart. To do this, he or she uses a special type of X-ray “movie,” called fluoroscopy. Once in the heart, the electrodes measures the heart’s electrical signals. Electrical signals are also sent through the electrodes to stimulate the heart tissue to try to cause the abnormal heart rhythm. This is done so that it can be evaluated and its cause can be found. It may also be done to help evaluate how well a medicine is working. Why might I need an electrophysiological study? Your healthcare provider may advise an EP study for these reasons: • To evaluate symptoms such as dizziness, fainting, weakness, palpitation, or others to see if they might be caused by a rhythm problem. This may be done when other tests have not been clear and your doctor strongly suspects you have a heart rhythm problem • EP studies can be used to get information related to abnormally fast or slow heart rhythms To find the source of a heart rhythm problem with the intent to do ablation once the source is identified • To see how well medicine(s) given to treat a rhythm problem are working What are the risks of an EP Study? Possible risks of an EP study include: • Bleeding and bruising at the site where the catheter(s) is put into a vein • Damage to the vessel that the catheter is put into • Formation of blood clots at the end of the catheter(s) that break off and travel into a blood vessel • Rarely, infection of the catheter site(s) • Rarely, perforation (a hole) of the heart • Rarely, damage to the heart’s conduction system

An atrial septal defect (ASD) is an opening or hole in the wall that separates the two upper chambers of the heart. This wall is called the atrial septum. The hole causes oxygen-rich blood to leak from the left side of the heart to the right side. This causes extra work for the right side of the heart, since more blood than necessary is flowing through the right ventricle to the lungs. If the ASD is small enough, it can be closed with a special device. The procedure is done in the heart catheterization lab. What causes it? Every child is born with an opening between the upper heart chambers. It’s a normal fetal opening that allows blood to detour away from the lungs before birth. After birth, the opening is no longer needed and usually closes or becomes very small within several weeks or months. Sometimes the opening is larger than normal and doesn’t close after birth. In most children the cause isn’t known. Some children can have other heart defects along with ASD. How does it affect the heart? Normally, the left side of the heart only pumps blood to the body, and the right side of the heart only pumps blood to the lungs. In a child with ASD, blood can travel across the hole from the left upper heart chamber (left atrium) to the right upper chamber (right atrium) and out into the lung arteries. If the ASD is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lung arteries can become gradually damaged. What are the symptoms? Many babies born with atrial septal defects have no signs or symptoms. Signs or symptoms can begin in adulthood. Atrial septal defect signs and symptoms can include: • Shortness of breath, especially when exercising • Fatigue • Swelling of legs, feet or abdomen • Heart palpitations or skipped beats • Stroke • Heart murmur, a whooshing sound that can be heard through a stethoscope Can the ASD be repaired? If the opening is small, it doesn’t make the heart and lungs work harder. Surgery and other treatments may not be needed. Small ASDs that are discovered in infants often close or narrow on their own. There isn’t any medicine that will make the ASD get smaller or close any faster than it might do naturally. If the ASD is large, it can be closed with open-heart surgery, or by cardiac catheterization using a device inserted into the opening to plug it. Sometimes, if the ASD is an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart (pulmonary veins), the ASD can’t be closed with the catheter technique. Then surgery is needed. Procedure - The non-surgical closure of atrial septal defects (ASD) involves the following steps: • A tiny cut is made in the groin area. • A thin tube (catheter) is inserted into a blood vessel and guided to the heart. • An ASD closure device is attached to the catheter and advanced to the heart and through the defect, under the guidance of X-ray and intra-cardiac echocardiogram. • The closure device is then placed across the ASD opening and the defect is closed. Eventually, heart tissue grows around the implant and becomes part of the heart tissue.

How do heart valves work? Blood passes through a valve before leaving each chamber of the heart. There are four valves within your heart. The heart valves make sure blood flows in only one direction through your heart. The mitral valve is located between the left upper and lower chambers of the heart. It has two leaflets that open and close similar to a double door. What is mitral stenosis? Stenosis means narrowing of an opening, such as a heart valve. Stenosis of the mitral valve limits the forward flow of blood from the left atrium to the left ventricle. This may cause a back-up of blood and fluid in the lungs. Mitral stenosis most commonly develops many years after a person has had rheumatic fever, although many patients diagnosed with mitral stenosis don’t recall ever having the illness. What are the symptoms? Many of the symptoms of mitral stenosis, such as shortness of breath and fatigue, result from a back-up of blood in the lungs. Other symptoms of mitral stenosis may include quick weight gain; weakness; dizziness; swelling in the ankles, feet and/or abdomen (edema); and/or heart palpitations (irregular heartbeat). What causes mitral stenosis? Mitral stenosis most commonly develops many years after a person has had rheumatic fever, although many patients diagnosed with mitral stenosis don’t recall ever having the illness. During rheumatic fever, the valve becomes inflamed. Over time, the leaflets of the inflamed valve stick together and become scarred, rigid and thickened, limiting its ability to open completely. How is mitral valve stenosis treated? Valve stenosis can sometimes be treated with medications if the symptoms are mild. When medications do not work to control symptoms, balloon valvotomy or surgical valve repair or replacement is performed. Balloon valvotomy successfully opens the narrowed valve and improves the overall function of the heart. If balloon valvotomy cannot be performed, surgical valve repair or replacement may be options. Valve repair may be performed to separate fused valve leaflets, sew torn leaflets or reshape parts of the valve.

A coronary angiogram is a diagnostic image, which uses dye and special X-rays to show the inside of your coronary (heart) arteries. These images are used to identify arterial narrowings that may be responsible for chest pain and future heart attacks. An angiography is the procedure, which uses special imaging techniques to produce coronary angiograms. To prepare for imagining, a very small tube (catheter) is inserted into a blood vessel in either the patient’s groin or arm. The tip of the tube is positioned at the beginning of the arteries supplying the heart, and a special fluid or dye is injected. This special fluid is visible by X-ray, which details the narrowing, occlusions, and other abnormalities of specific arteries. These images obtained are called angiograms. Why it's done? Your doctor may recommend that you have a coronary angiogram if you have: • Symptoms of coronary artery disease, such as chest pain (angina) • Pain in your chest, jaw, neck or arm that can’t be explained by other tests • New or increasing chest pain (unstable angina) • A heart defect you were born with (congenital heart disease) • Abnormal results on a noninvasive heart stress test • Other blood vessel problems or a chest injury • A heart valve problem that requires surgery What are risks? As with most procedures done on your heart and blood vessels, a coronary angiogram has some risks, such as radiation exposure from the X-rays used. Major complications are rare, though. Potential risks and complications include: • Heart attack • Stroke • Injury to the catheterized artery • Irregular heart rhythms (arrhythmias) • Allergic reactions to the dye or medications used during the procedure • Kidney damage