Treadmill exercise test (TMT) ECG series

Treadmill exercise test (TMT) ECG series

Treadmill exercise test pretest ECG
Treadmill exercise test pretest ECG

The pretest ECG of a treadmill exercise test series shows a bit of artefacts especially in leads II and III. The pretest heart rate is about 100/min, possibly due to apprehension.

Treadmill test Stage 1 ECG
Treadmill test Stage 1 ECG

ECG recording in stage 1 of the Bruce protocol of treadmill exercise test. The heart rate has increased and there are not many artefacts and no significant ST segment shift is evident.

Treadmill test ECG at peak exercise
Treadmill test ECG at peak exercise

The recording at the peak exercise shows significant horizontal ST segment depression in inferior and lateral leads at a fast heart rate. But the significant level of artefacts in the raw rhythm strip make us suspect whether the ST segment depression could be artifactual due to computerized averaging in the computer synthesized rhythm.

Treadmill test early recovery ECG
Treadmill test early recovery ECG

The recording in early phase of recovery at 1 minute shows very little ST segment depression, making us suspect further whether the earlier recording was really due to myocardial ischemia. But the ST segment is downsloping in inferior leads.

Treadmill test recovery phase ECG at 3 min
Treadmill test recovery phase ECG at 3 min

ECG at 3 minutes of recovery shows further worsening of ST segment depression in inferior and lateral leads, establishing the presence of significant myocardial ischemia.

TMT recovery phase ECG at 6 minutes
TMT recovery phase ECG at 6 minutes

TMT recovery phase ECG at 6 minutes showing the persistence of downsloping ST segment depression. This calls for further evaluation including coronary angiography and revascularization if feasible. Moreover, ECG recording has to be continued till the ST segment shift resolves.

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