TMT recommendation after normal ECG and echo
Dr Joshi, if the ECG and 2D echo reports are normal, do you still recommend TMT?
If you’re low risk and have no concerning symptoms, a normal ECG and 2D echo are usually enough, and I wouldn’t add a TMT just to “check.” Echo looks at structure/pumping; ECG looks at rhythm. A TMT (treadmill test) is mainly for exercise-induced ischemia (reduced blood flow) or to assess exercise capacity. I’d consider a TMT if: 1) you have chest pressure, breathlessness, or jaw/arm discomfort with exertion, 2) multiple risk factors (diabetes, high LDL/ApoB, strong family history, smokers), 3) abnormal exercise tolerance or equivocal symptoms, 4) to clear you for vigorous sports or physically demanding jobs. For plaque risk without symptoms, a coronary calcium score (CAC) can be more informative than TMT.