The document discusses the treadmill test, which involves walking on a treadmill at increasing difficulty levels while monitoring electrocardiogram, heart rate, and blood pressure. It is used to evaluate how the heart responds to exertion and determine things like blood flow adequacy and likelihood of heart disease. Contraindications and techniques for administering the test are provided, along with details on the Bruce protocol and MET and Karvonen methods for calculating exercise intensity.

1. Treadmill Test
Khairul Nizam Abdul Rahman
4262143008

2. What is 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.

3. Why Need Treadmill Test?
Treadmill test is use to
• Determine if there is adequate blood flow to 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.

4. 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 Brady arrhythmias
• Mental or physical impairment
• Hypertension (>200/100 at rest)
• Neuromuscular and musculoskeletal disorder exacerbated by exercise
 block

5. 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

6. 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. Room temperature should be 18-24 C and humidity less
than 60%
12. Walking should be demonstrated to 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.

7. 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 brady arrhythmias
• Technical difficulties in monitoring ECG or SBP
• Fatigue, shortness of breath, wheezing, leg cramps

8. 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 increase in speed and
gradient
• Initial 1.7 mph with 10% gradient (upward
inclination)
• Maximum 5.5 mph with 20% gradient

9. Bruce Protocol
Stage Minutes % grade km/h MPH METS
1 3 10 2.7 1.7 5
2 6 12 4.0 2.5 7
3 9 14 5.4 3.4 10
4 12 16 6.7 4.2 13
5 15 18 8.0 5.0 15
6 18 20 8.8 5.5 18
7 21 22 9.6 6.0 20

10. What is MET?
• Metabolic Equivalent Term
• 1 MET = 3.5 ml O2 per kilogram of body weight
per minute
• Actually differs with thyroid status, post exercise,
obesity, disease states
• By convention just divide ml O2/Kg/min by 3.5
METs = Speed x [0.1 + (Grade x 1.8)] + 3.5
3.5
• Calculated automatically by Device

11. Karvonen Method
• The Karvonen method factors in resting heart
rate (HRrest) to calculate target heart rate (THR),
using a range of 50–85%:
• THR = ((HRmax − HRrest) × %Intensity) + HRrest
• Example for someone with a HRmax of 180 and a
HRrest of 70:
• 50% intensity: ((180 − 70) × 0.50) + 70 = 125 bpm
• 85% intensity: ((180 − 70) × 0.85) + 70 = 163 bpm