Exercise ECGthalimageprepost

It is a test which repeated ECG is taken time to time when the patient is under exercise stress. It is usually done to detect or assess coronary artery diseases and arrhythmia while the patient on different stages of exertion. Test also involves measuring blood pressure heart rate regularly while on the treadmill and recovery

Stages Spead elevation HR BP remarks
0 1 0      
1 1.7 100      
2 2.5 120      
3 3.4 140      
4 4.2 160      
Recovery –1mi          
3 min          
5 min          
7 min          

Exercise ECG is usually done for intermediate risk category patients as it may give false positive for low risk patient which may lead to unnecessary anxiety. High risk patient will be undergone on angiogram straight away.

Target heart rate during the procedure is 85% increase ( 220 –  age ). When the patient have WPW syndrome , LBBB, LV hypertrophy or patient is on digoxin interpretation become difficult.

Patient need to take usual medications and should not exercise before the procedure. Should not take caffeine or smoke but need not to be in fasting.

Stress Echo

Echocardiogram done while the  patient being on stress.

Most people will walk on a treadmill . Slowly (about every 3 minutes), you will be asked to walk  faster and on an incline. It is like being asked to walk fast or jog up a hill. Once the target heart rate achieved or too tired the echo cardiogram is performed. If the patient is not able to exercise he will be dopamine which will faster the heart rate.

Advantages of this test are ability to localize the lesion and  useful in patients who are not suitable for exercise ECG.

Coronary Angiogram

Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.

Before the procedure mild sedative is given to relax and The cardiologist passes a thin hollow tube, called a catheter, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter. Once the catheter in place   Series of X ray images are taken as a video clip. Doctor can see if there is a blockage or stenosis.

It carries a 1:1000 motility rate and   acute complications are anaphylaxis , Stroke, MI, injury to arteries  and renal failure. It is very specific and can give false negative rarely when there is a vulnerable plaque which may break down later. Such situation has to be treated with high dose statins and antiplatelet.

Exercise thallium test

A thallium stress test is a nuclear imaging test that shows how well blood flows into the heart while you’re exercising or at rest. Radioisotope thallium is injected through a vein and gama camera get pictures. The doctor can detect if any issues in heart muscles having  including perfusion, past scaring and size of the heart.

It is a noninvasive procedure and it is also done while the patient is under exercise stress or drug induced stress.

CT angiogram

Computed tomography angiography (CTA) uses an injection of iodine-rich contrast material and CT scanning to help diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages.

Automatic injection of contrast material in a required rate is in place. During CT angiography of the coronary arteries or aorta in the chest, electrocardiogram (ECG) leads (sticky patches) will be placed on the patient’s chest to record heart rhythm during scanning. Depending upon how fast and regular patients heart beats, your heart rate may be temporarily slowed down for the duration of the exam with medication to obtain motion free images of the heart. If heart rate medication is given, you will be monitored during and for a brief period after the procedure. It is a noninvasive low risk procedure which give more information.

 

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