Exercise ECG aka “TMT test”

When not to do?

Treadmill and cardiology have an evergreen affair.Treadmill is known to give the user not just an exemplary cardiac fitness ,but diagnose serious heart diseases.But what if treadmill can lead to death!! yes it can sometimes…

Exercise ecg testing is quite popular in clinical cardiology for more than 50 years.It can be a “stand alone test ” in appropriately selected patients.When properly done risk for mortality is less than 1 in 10,000 tests.

Exercise ecg can be potentially hazardous in some situations aka absolute contraindications.It include following but not limited to following conditions

  1. Acute myocardial infarction or unstable angina
  2. acute myo or pericarditis
  3. left main coronary artery stenosis
  4. second degree or third degree AV block
  5. rapid arrythmias
  6. severe valvular stenosis
  7. acute pulmonary embolism
  8. acute non cardiac illness
  9. patients with locomotor problems
  10. Heart failure

Some other scenarios where risk benefit ratio needs to be considered.Such relative contraindications include but not limited to:

  • HCM
  • significant AV blocks
  • Recent arrhythmias
  • Moderate valvular stenosis
  • Severe (> 3 mm) ST segment depression at rest
  • Severe (> 200/110 mm) arterial hypertension

American Society of Nuclear Cardiology recommend, pharmacologic stress is meaningful only if the patient is unable to achieve ≥ 85% MPHR and five METs

Last but not the least a simple stethoscope auscultation may bring out harsh ejection systolic murmur of aortic stenosis which may prevent a mishap@treadmill.

Inspired by Ref Hurst cardiology 14 th ed

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