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TMT, HOLTER, HUTT: WHAT SHOULD I KNOW?

TMT, HOLTER, HUTT: WHAT SHOULD I KNOW?. DR. AMEYA UDYAVAR MADRAS MEDICAL MISSION. www.anaesthesia.co.in anaesthesia.co.in@gmail.com. 1. TMT. TMT. Is a means of evaluating the circulatory response to physical stress [exercise] Heart rate Blood pressure ST changes

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TMT, HOLTER, HUTT: WHAT SHOULD I KNOW?

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  1. TMT, HOLTER, HUTT:WHAT SHOULD I KNOW? DR. AMEYA UDYAVAR MADRAS MEDICAL MISSION www.anaesthesia.co.in anaesthesia.co.in@gmail.com

  2. 1. TMT

  3. TMT • Is a means of evaluating the circulatory response to physical stress [exercise] • Heart rate • Blood pressure • ST changes • Arrhythmias [heart rhythm]

  4. INDICATIONS • Evaluate patients with chest pain • Assess severity of CAD and prognosis • For rehabilitation of patients with MI • To assess efficacy of Rx in CAD • To screen high risk asymptomatic individuals

  5. CONTRAINDICATIONS • Acute MI/ ACS • Uncontrolled arrhythmias • Uncontrolled valvular heart disease • CHF • Uncontrolled HTN • Myocarditis, endocarditis

  6. PRECAUTIONS • Carried out in the presence of physician • Explain the procedure • Informed written consent • NBM at least 3-4 hours • No coffee, tea • Medications to be noted

  7. PRECAUTIONS • Wear loose comfortable shoes • Have their chest saved • ALWAYS ASK FOR HISTORY OF RECENT/ WORSENING ANGINA • Always demonstrate to the patient. • Reassure and clear all his doubts

  8. treadmill

  9. CPU with the monitor

  10. Test being conducted

  11. Electrodes attachment

  12. precautions • Oxygen provision • Emergency drugs • Easy access to the CCU • Physician available

  13. Things to observe • Heart rate • Blood pressure • Chest pain, dyspnea • Arrhythmias • ST changes

  14. TMT PROTOCOLS

  15. ST CHANGES- post J 80 msec

  16. ST CHANGES

  17. REASONS FOR DISCONTINUING THE TEST • CLINICAL: chest pain, severe dyspnea, syncope, fatigue, leg claudication, fall in BP or HR, pts desire to stop • ECG DETERMINANTS: ST depression 1 mm or more, ST elevation 1 mm or more, VT, Heart blocks, other arrhythmias

  18. POST TEST • Help to sit on the chair • Monitor HR and BP for 10 min • Avoid heavy exertion immediately after the test • Report preparation

  19. REPORT PREPARATION • Patients identity • TMT protocol and stages • HR response • BP response • ST changes • Arrhythmias • METS achieved

  20. 2. HOLTER TEST

  21. HOLTER MONITORING • 24 hours ambulatory ECG monitoring provides a record of patients heart rate and rhythm while the patient is engaged in the activities of daily living

  22. INDICATIONS • Identify and record cardiac arrhythmias • Correlate these arrhythmias with symptoms • Assess efficacy of medications • Evaluate pacemaker malfunction • Detect ST segment changes

  23. COMPONENTS • Chest electrodes • Patients diary • Recoding apparatus • Holter monitor scanner

  24. Recording apparatus

  25. Electrode position

  26. Belt or vest

  27. PROCEDURE • Explain the procedure, prepare the chest • Apply jelly and then the electrodes • Fix the connecting wires with a stress loop • Recorder fastened to the waist, note time • tell patient to record all activities and symptoms • Do not meddle with electrodes or wet them

  28. ANALYSIS

  29. EXAMPLES

  30. EXAMPLES

  31. 3. HUTT

  32. INDICATIONS • to study the heart rate and blood pressure adaptations to changes in position • as a technique for evaluation of orthostatic hypotension • as a method to study hemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction and hypertension

  33. SYNCOPE • 80%- vasovagal/ neurocardiogenic • Orthosatic hypotension • Cardiac causes • arrhythmias

  34. Tilt table

  35. NECESSARY EQUIPMENT

  36. PROCEDURE • Laboratory- Quiet, dim lighting, comfortable temperature • 20–45-min supine equilibration period • Fasting overnight or for several hours before procedure • Recordings with minimum of three ECG leads continuously recording • Beat-to-beat blood pressure recordings using the least intrusive means (may not be feasible in children) • Table with Foot-board support • Smooth, rapid transitions (up and down)

  37. PROCEDURE • Tilt angle: 60 to 80 degree acceptable • 70 degree becoming most common • Tilt duration [a] Initial drug-free tilt 30–45 min, [b] Pharmacologic provocation—depends on agent • Pharmacologic with Isoproterenol (infusion preferred), Nitroglycerin, Edrophonium • Supervision with Nurse or laboratory technician experienced in tilt table technique with Physician in attendance or in proximity and immediately available

  38. Cardio-inhibitory response

  39. Vaso-depressor response

  40. CONCLUSIONS • THESE ARE IMPORTANT NONINVASIVE DIAGNOSTIC TESTS • IF CONDUCTED WITHOUT FOLLOWING THE NECESSARY INSTRUCTIONS AND PRECAUTIONS, THE PURPOSE OF THE TEST MAY BE NULLIFIED.

  41. THANK YOU www.anaesthesia.co.in anaesthesia.co.in@gmail.com

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