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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.

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 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.