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Treadmill stress tests (TMT) are a standard medical procedure to assess an individual’s heart function during exercise.
This test involves walking or running on a treadmill while monitoring your heart rate and other vital signs.
While a treadmill stress test is generally safe for most people, some individuals should not have one or may require extra evaluation before the test.
Additionally, some medical conditions or medications may affect an individual’s ability to exercise or increase their risk of complications during the test.
The American College of Cardiology (ACC) and the American Heart Association (AHA) Task Force Guidelines for Exercise Testing are what doctors may choose to follow when deciding if a patient is fit to undergo a TMT test.
During a thorough evaluation, your doctor will consider several factors, such as your age, medical history, current medications, and any symptoms you may be experiencing, to determine if a treadmill stress test is appropriate for you.
If you have chronic illnesses such as obesity, cholesterol, diabetes, and hypertension – or hereditary factors – they can all combine and have a multiplicative effect on the heart.
It’s imperative to let your doctor know about your current ailments – whether you have high blood sugar level symptoms or high blood pressure, what are your medications and diet to reduce cholesterol, and how you manage obesity and overweight.
Treadmill stress tests are generally safe for most people, but some individuals should avoid undergoing this test or may require additional evaluation before the test.
The doctor may preclude those from taking the test if they fall under any of these categories:
For those having a fever or an acute illness such as a respiratory infection, postponing the stress test until they have recovered is best.
Individuals with specific medical conditions, such as unstable angina or uncontrolled hypertension, may not be suitable for a treadmill stress test.
Those with injuries or limb impairments that limit their ability to exercise or walk may not be able to complete the treadmill stress test.
The treadmill stress test may not be appropriate for pregnant women (especially after the first trimester) as it may pose a risk to the developing fetus.
According to Cleveland Clinic, the doctor may recommend other tests instead of a treadmill stress test for persons with a high heart attack or stroke risk.
If a person takes medications, such as beta-blockers, that slow down the heart rate or affect the blood pressure response to exercise, the doctor may need to adjust the medication or perform alternative tests.
The treadmill stress test may not accurately assess heart function for those with an irregular heartbeat, such as atrial fibrillation. The doctor may recommend other tests, such as a non-treadmill stress echocardiogram or nuclear stress test.
For people who have had a stroke or mini-stroke (which, according to Healthline, is also called a transient ischemic attack), the doctor may need to evaluate the risk of their having another stroke during the treadmill stress test.
Individuals with severe obesity may be unable to complete the treadmill stress test due to physical limitations or the risk of injury.
Individuals with severe lung diseases like COPD may be unable to do the treadmill stress test due to difficulty breathing during exercise. Also, according to S Bernard et al., in their medical paper in PubMed, “Peripheral muscle weakness is commonly found in patients with chronic obstructive pulmonary disease (COPD) and may play a role in reducing exercise capacity.”
For persons having severe arthritis or joint pain, it may be difficult to walk on the treadmill, and the test may not accurately assess heart function. The doctor may recommend other tests, such as a pharmacologic stress test.
For people with severe PAD, walking on the treadmill may be difficult, and the test may not accurately assess heart function. The doctor may recommend other tests, such as an exercise stress test with ankle-brachial index measurement or a pharmacologic stress test.
For individuals with a history of heart failure, the doctor may need to evaluate heart function and decide if a treadmill stress test is safe.
For some people with certain electrolyte imbalances, such as low potassium or magnesium levels, their condition may affect their heart function during the test. The doctor may need to correct the imbalance before the test.
For those with significant chest discomfort or shortness of breath at rest, the doctor may need to evaluate the cause of these symptoms before recommending a treadmill stress test.
People with uncontrolled diabetes may be required to be evaluated by their doctors for blood sugar levels before and during the test to ensure their safety.
For persons with pacemakers or implantable defibrillators, the doctor may need to adjust the device settings or perform alternative testing methods to ensure safety during the test.
Physical exertion during a treadmill stress test may trigger an asthma attack for people with severe asthma. The doctor may recommend alternative testing methods, such as a pharmacologic stress test.
For people who have recently had surgery or a significant injury, the doctor may need to evaluate physical readiness for the test and may recommend postponing it until they fully recover.
The doctor may recommend alternative testing methods to evaluate heart function for patients with severe valvular heart disease, such as severe aortic stenosis or mitral stenosis.
If a person has a history of fainting or syncope, the doctor may need to evaluate the cause of these symptoms and determine if a treadmill stress test is safe.
For people with a history of pulmonary embolism, the doctor may need to evaluate their risk of having another pulmonary embolism during the treadmill stress test.
According to P J Best et al., in their medical paper in Annals of Internal Medicine, for those having an aortic aneurysm, the doctor may need to evaluate the size and location of the aneurysm and determine if a treadmill stress test is safe.
For people with severe liver or kidney disease, the doctor may need to evaluate their health status and determine if a treadmill stress test is recommended.
There are many alternatives your doctor may have recourse to if you cannot have a treadmill stress test. It’s best to leave the decision of a TMT to your doctor, who can best weigh the benefits versus the risks to your body and your heart. Stay heart-healthy. Be a Zinda Dil.
