TREADMILL TEST OR EXERCISE STRESS TEST

What is the Treadmill Test?
• Treadmill test is also called a stress test, exercise
electrocardiogram, graded exercise test, or stress ECG.
It is used to provide information about how the heart
responds to exertion. It usually involves walking on a
treadmill at increasing levels of difficulty, while
electrocardiogram, heart rate, and blood pressure are
monitored.

Why Need a Treadmill Test?
The treadmill test is used to
• Determine if there is adequate blood flow to the heart during
increasing levels of activity.
• Evaluate the effectiveness of heart medications to control angina
and ischemia.
• Determine the likelihood of having coronary heart disease and the
need for further evaluation.
• Check the effectiveness of procedures done to improve blood flow
within the heart vessels in people with coronary heart disease.
• Identify abnormal heart rhythms.
• Help to develop a safe exercise program
Contraindication
• Acute myocardial infarction (within 2 days)
• High-risk unstable angina
• Symptomatic severe aortic stenosis
• Symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Acute aortic dissection
• Electrolyte abnormalities
• Tachy or Bradyarrhythmias
• Mental or physical impairment
• Hypertension (>200/100 at rest)
• Neuromuscular and musculoskeletal disorder exacerbated by exercise
Technique
1. Patients should be instructed not to drink, eat caffeinated
beverages or smoke 3hour before testing & to wear
comfortable shoes and clothes.
2. Unusual physical exertion should be avoided
3. Brief history & physical examination should be performed
4. Should be instructed about risks and benefits
5. Informed consent is taken
6. 12 lead ECG is recorded with electrodes at the distal
extremities
7. Torso ECG is obtained in standing and sitting position
8. If false +ve test is suspected, hyperventilation should be
performed technique
9. Area of electrode application should be rubbed with
alcohol saturated pad to remove oil and rubbed with sand
paper to reduce skin resistance to 5000ohms or less
10. Cables should be light flexible and shielded
11. The room temperature should be 18-24 C and humidity less
than 60%
12. Walking should be demonstrated to the patient
13. HR, BP & ECG should be recorded at the end of each
stage.
14. Minimum of 3 leads should be displayed continuously on
the monitor
15. A resuscitator cart, defibrillator, and appropriate
cardioactive drugs should be available in the TMT room.
When To Stop!?
TMT might be prematurely stopped for any of the following:
• Moderate to severe angina
• Increasing chest pain
• Increasing nervous system symptoms (ataxia, dizziness)
• Signs of poor perfusion (cyanosis or pallor)
• Sustained ventricular tachycardia
• ST elevation (≥1.0 mm)
• ST depression (>2 mm)
• Drop-in SBP of (≥10 mmHg) BP without ischemia
• Heart block or bradyarrhythmias
• Technical difficulties in monitoring ECG or SBP
• Fatigue, shortness of breath, wheezing, leg cramps
Bruce Protocol
• Total of 1+6 (Seven 3 minute stages) – (3+18 min)
• Each minute exercise is approximately 1 MET
• Pretest plain walking + 6 Stages of graded
exercise
• In each stage there is an increase in speed and
gradient
• Initial 1.7 mph with 10% gradient (upward
inclination)
• Maximum 5.5 mph with 20% gradient
Thanks, And Regards
Dr.Jaishree Tiwari

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