Diagnostic Tests: ECG, 2D Echo with GLS & TMT

If you have been advised to have a heart test, it helps to know what the test is looking for and what will happen during it. At Sheth Heart Clinic in Bopal, Ahmedabad, you can have a heart tracing, heart ultrasound and treadmill test at the same location as your consultation.

Dr. Kulin Sheth personally performs and interprets echocardiograms, including global longitudinal strain assessment where appropriate. He considers test findings alongside your symptoms, examination and previous reports when advising you about the next step.

You do not automatically need every test. The choice depends on the question being investigated. If you are unsure which test is appropriate, a cardiologist consultation can help establish that first.

An electrocardiogram, usually called an ECG, records the electrical signals that control your heartbeat.

• Why it may be useful: assessing a racing or irregular heartbeat, chest symptoms, or changes associated with certain heart conditions.
• What happens: you lie still while electrodes are placed on your chest and limbs. The recording takes only a short time, with extra time for positioning and skin preparation.
• What it feels like: the machine records signals; it does not send an electric shock into your body. Skin preparation or removal of adhesive electrodes may cause minor irritation.
• Preparation: fasting is not required. Bring earlier tracings if available so changes can be compared.

An ECG is a brief snapshot. An intermittent rhythm problem may not occur during the recording, and longer monitoring may be needed for selected patients with palpitations or rhythm concerns.

A normal ECG alone does not rule out a heart attack or every coronary blockage. Ongoing concerning symptoms need clinical assessment, which may include repeat ECGs and blood tests rather than reassurance from one normal tracing.

A two-dimensional echocardiogram, or 2D echo, uses sound waves to produce moving images of the heart. The usual scan is performed from outside the chest, without radiation.

At Sheth Heart Clinic, Dr. Kulin Sheth personally performs the scan and interprets the findings.

What does an echo assess?

• The size and structure of the heart’s chambers.
• How well the heart muscle contracts and relaxes.
• Ejection fraction: the proportion of blood pumped out of the main pumping chamber with each beat. This is one part of assessing heart function.
• Whether valves are narrowed or leaking.
• Other relevant findings, such as fluid around the heart.

Echo may help investigate breathlessness, a heart murmur or suspected heart failure, and assess or monitor heart valve disease.

What happens during the scan?

• You lie on a couch, often turned onto your left side.
• Gel is applied and a handheld probe is moved over the chest.
• You may be asked to change position or briefly adjust your breathing.
• You may feel pressure from the probe. Tell Dr. Kulin if you are uncomfortable.

Allow time for the examination and discussion; the time required varies with the findings and image quality.

Does echo show heart blockages?

A routine resting echo does not directly map narrowing inside the coronary arteries. It may show effects on heart-muscle movement, but a normal echo does not exclude coronary artery disease. Image quality also varies between patients.

“Doctor, pumping normal chhe, toh aa extra measurement sha mate?”

If pumping looks normal, why take an extra measurement?

Global longitudinal strain (GLS) measures how much the heart muscle shortens along its length when it contracts. It can provide additional information beyond ejection fraction and may identify subtler changes in selected situations.

• GLS is calculated from suitable echo images. It does not require a separate injection or scan procedure.
• It can help assess and monitor selected heart-muscle conditions or treatment-related changes.
• Its usefulness depends on the clinical question and image quality.
• Blood pressure, measurement technique and equipment can affect results. Comparisons need careful interpretation.

Dr. Kulin Sheth interprets GLS alongside the rest of the echocardiogram. A single strain value is not a diagnosis, and GLS is not a substitute for coronary artery testing when that is needed.

A treadmill test, or TMT, checks how your heart responds as exercise becomes more demanding. It can help assess exercise-related symptoms, exercise capacity and signs suggesting reduced blood supply to the heart muscle.

What happens during a TMT?

• Electrodes record your ECG and a cuff measures blood pressure.
• You begin walking, with the speed and incline increasing in stages.
• The supervising team monitors the tracing, blood pressure and how you feel.
• Tell the team immediately about chest discomfort, dizziness, unusual breathlessness or difficulty continuing.
• Monitoring continues during recovery after exercise stops.

You can ask to stop. The team may also stop the test because of symptoms, monitoring changes, fatigue or other clinical reasons. Reaching a particular heart rate is not the only consideration.

Is a treadmill test suitable for everyone?

No. Your symptoms, ability to exercise, resting ECG and other health conditions affect suitability. Tell the team about knee or back problems, difficulty walking, recent illness or worsening symptoms before the test.

For some patients, another assessment, such as stress imaging or coronary computed tomography angiography, which uses a CT scan to examine the heart arteries, may answer the question better. The choice is individual and may require referral.

The test is supervised because exercise can provoke symptoms, abnormal heart rhythms or blood pressure changes. Serious complications are uncommon, but the risk is not zero; suitability is assessed beforehand.

What does the result mean?

• Positive: changes suggest possible reduced blood supply during exercise. This does not automatically mean you need angioplasty or a stent.
• Negative: the test did not show the changes being assessed at the workload achieved. It does not exclude every blockage or all future heart risk.
• Inconclusive: exercise or recording limitations prevent a clear answer. Further assessment depends on your symptoms and overall risk.

A TMT does not show the exact location or degree of a coronary narrowing.

For any test, bring your prescription, medicine list, previous reports and relevant discharge summaries.

ECG and standard chest-surface echo do not require fasting. Obtain specific food instructions when booking a TMT or blood test.

Do not stop prescribed medicines on your own. Some medicines affect exercise-test interpretation, but whether to adjust them depends on the purpose of the test and your health.

Examination times vary. Ask the clinic how much time to allow for preparation, the test, recovery where needed and consultation, rather than planning only for the recording itself.

Sheth Heart Clinic offers outpatient consultation, ECG, 2D echo with GLS and TMT, with laboratory sample collection through local pathology partners. Necessary services can be coordinated to reduce separate trips, subject to preparation and availability.

Dr. Kulin Sheth explains how the findings relate to your symptoms and whether medicines, monitoring or further assessment are appropriate. If you have an outside report or conflicting advice, you can seek a second opinion with the original reports and available images. Repeat testing is considered when it would add useful information.

Evening consultations are available until 8:30 PM. Confirm the availability and preparation for your particular test when booking.

When to seek emergency care instead

Do not book a routine ECG, echo or treadmill test as a substitute for emergency assessment if you have:

• New or persistent chest pressure or discomfort, especially with sweating, nausea, breathlessness or pain spreading to the arm, jaw or back.
• Severe breathlessness, collapse or loss of consciousness.
• A racing heartbeat with chest discomfort, fainting or severe breathlessness.

Seek emergency care promptly. Do not wait for a WhatsApp reply or drive yourself if a serious emergency is suspected. Our chest pain and heart attack guidance explains the warning signs further.