Treadmill & holter monitoring used to screen heart diseases

Normally, treadmills are associated with workouts but the one at the Cardiology Department at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is used to screen and confirm heart patients.

When patients visit the Out Patient Department (OPD) with complaints of chest pain, it is difficult to know the cause otherwise, said the cardiologist at JDWNRH, Dr. Mahesh Gurung. “We bring the patient to the TMT to do the test which screens and confirms if a patient is suffering from a heart problem,” he said.

He also said that TMT can be used for risk-stratify the patients which means that the treadmill test can monitor how stable the patient is after a course of treatment is prescribed.

TMT, also known as Real Time ECG (electrocardiogram) is used while going for executive check-ups as well. Bhutanese people who go to Thailand for medical checkup has to undergo it as well.

During the TMT, a patient is attached with an electrode lead or patch and is asked to start walking on the treadmill. After every three minutes, the machine will increase in inclination and also in speed.

“As the heart rate increases, there will an increase in demand for oxygen. So this test tells us if there is adequate supply of oxygen or if there is anything obstructing the supply as we will see electrical changes in the ECG or the patient will start showing some symptoms,” said Dr. Mahesh Gurung.

He said that the number of patients coming in for screening have been increasing over the years. A total of about 45 patients were screened and confirmed with heart disease from 2013 to 2016 and in just three months this year, there were eight.

In October last year, JDWNRH also restarted holter monitoring test which was idle for the last three years since the holter monitor machine broke down.

A holter monitoring is a continuous test to record hearts’ rate and rhythm for 24 hours. The holter monitor is worn for 12-48 hours as the patient goes about doing his normal daily routine.

“It is mostly done in patients who come with abnormal palpitation or transcend loss of consciousness or syncope symptom,” said Dr. Mahesh Gurung. He also said that the holter monitor saves all the data which is later evaluated to see if there are any abnormal rhythms or missed beats.

A holter monitor cost about Nu 1.3mn. Dr. Mahesh Gurung said that JDWNRH currently has only one holter monitor; however, Japan International Cooperation Agency is planning to donate one more. “As it depends on the number of cases that comes in, ideally two devices is enough for our population,” he said.

Since resuming the facility from October till December 2017, eight cases of high palpitation which required holter monitoring were detected. However, in just three months this year, there were more than 11 cases of palpitation and abnormal electrical activities.

Lucky Wangmo from Thimphu