What to do after TMT Test ?

After a Treadmill Test (TMT), angiography is typically recommended for patients in the following scenarios:

1. Positive TMT with High-Risk Features:

   • Significant ST-segment depression/elevation (>2 mm).

   • Symptoms during the test (e.g., chest pain, shortness of breath).

   • Hypotension (drop in blood pressure) during exercise.

   • Ventricular arrhythmias or exercise-induced ischemia.

2. Inconclusive TMT with Persistent Symptoms:

   • Equivocal TMT results but ongoing symptoms (e.g., angina, fatigue).

   • High clinical suspicion of coronary artery disease (CAD) despite unclear TMT.

3. High Pre-Test Probability of CAD:

   • Patients with risk factors (diabetes, hypertension, smoking, family history) and abnormal TMT.

   • Asymptomatic patients with strongly positive TMT and multiple risk factors.

4. Prior History of CAD:

   • Worsening symptoms (e.g., unstable angina) in patients with known CAD.

   • Evaluation for revascularization (e.g., stent/bypass surgery candidates).

5. Low Exercise Capacity:

   • Inability to reach target heart rate due to physical limitations, with suspected ischemia.

Note: The decision also depends on clinical judgment, patient preferences, and may involve additional tests (e.g., CT angiography, stress echocardiography) before proceeding to invasive angiography. Always consult a cardiologist for individualized assessment.