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An electrocardiogram (ECG) is a medical test that records the electrical activity of your heart through small electrode patches that a technician attaches to the skin of your chest, arms, and legs. Physical relaxation for a few minutes before the recording is made is important, as this allows the electrode connections to stabilize and the recordings made will be more reliable.
An abnormal ECG will tell us about the heart enlargement, major heart attack, irregular heart rhythm etc. In few patients with heart blocks and heart attack ECG may be completely normal. Hence in patients with chest pain and breathing difficulty further detailed evaluation may be required in the form of ECHO and TMT.
The echocardiogram is an ultrasound of the heart that provides live information about the structure and function of the heart. It is a painless procedure. There is no need to be on fasting for ECHO.
Echocardiogram will show very clearly about the heart size and heart function. It will show us the cardiac valves, chambers and flow of blood within the heart. It also helps us to identify Congenital heart diseases (heart diseases from birth).It can detect major heart attack very clearly by identifying variation in heart’s pumping capacity. Sometimes silent heart attacks (major heart attack happening without chest pain) also will be detected by Echo especially in diabetic patients and elderly people.
Echo can detect only when the artery supplying the heart is totally blocked or near total blocked ECHO may be normal even when there is more than 70 to 80%blockage.
How TMT is done?
During a standard exercise test, you walk on a treadmill at progressively faster speeds while health care providers monitor your heart’s electrical activity, your heart rate, and your blood pressure. Throughout the test, the speed and incline of the treadmill increase gradually. The actual test takes only around 15 minutes.
Stress tests can detect when arteries have 70 percent or more blockage. But normal results from a stress test do not rule out the possibility of a future heart attack. This is because a small plaque can still rupture, form clots, and block an artery completely. A normal test result indicates there is sufficient and unrestricted blood flow to your heart, both during periods of rest and exercise. … An abnormal result, which means your heart’s blood flow is insufficient, may occur only during the exercise phase of your stress test
A Holter monitor is a small, wearable battery-operated portable device. It measures and records your heart’s rate and rhythm (ECG) continuously for 24 to 48 hours or even longer
If you have symptoms like an irregular or fast heart beat or unexplained giddiness or loss of consciousness, first ECG will be done. However, sometimes an ECG doesn’t detect any abnormalities in your heart rhythm because you’re hooked up to the machine for only a short time. But a Holter monitor being a continuous monitoring system will be able to detect irregularities in your heart rhythm that an ECG fails to pickup.
The 24-hour ambulatory BP monitor is a small portable device connected to the arm cuff with tubing that measure blood pressure every 15 to 30 minutes. After 24 hours, the patient returns, and the data is downloaded.
The BP measured in the clinic may not reflect the true BP levels. When Clinic BP levels are elevated, 24-h ABPM should be done to confirm the diagnosis of Hypertension. Accurate BP monitoring is essential for blood pressure evaluation and management
Ambulatory blood pressure monitoring allows many blood pressure (BP) readings to be recorded over a 24-hour period
The most useful information includes
In normal persons BP should slightly fall while sleeping. If this fall doesn’t happen or if there is a paradoxical rise in BP while sleeping there will be an increased risk of heart attack. The ABPM’s unique ability to evaluate BP at night while sleeping makes it a superior instrument for BP management and in prediction of heart attack risk.
The ABPM should be done on a normal workday rather than a rest day to obtain a typical BP profile. The readings should be taken every 20–30 min during the day and every 30–60 min at night to avoid interfering with activity or sleep.
Uses of ABPM – 24 hrs ambulatory BP monitoring is recommended for the screening and evaluation of