'irregular heartbeat'

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

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.

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 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

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