Exercise ECG testing: Performing the test and interpreting the ECG results
- Panithaya Chareonthaitawee, MD
Panithaya Chareonthaitawee, MD
- Associate Professor of Medicine
- Mayo Clinic College of Medicine
- J. Wells Askew, MD
J. Wells Askew, MD
- Assistant Professor of Medicine
- Mayo Clinic College of Medicine
- Section Editors
- Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
- Section Editor — Coronary Heart Disease
- Professor of Cardiovascular Science
- Director, Cardiovascular and Cell Sciences Research Institute
- St. George's, University of London
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
The exercise electrocardiogram (ECG) is a well-validated procedure for establishing the diagnosis and prognosis of coronary heart disease, as well as assessing exercise capacity (ie, functional capacity). The exercise ECG indirectly detects myocardial ischemia, which is the physiologic consequence of a mismatch between myocardial oxygen delivery (coronary blood flow) and myocardial oxygen demand (myocardial work). (See "Angina pectoris: Chest pain caused by myocardial ischemia".)
A well-recognized sequence of events is precipitated by an imbalance between myocardial oxygen supply and demand (figure 1). This sequence helps explain why mechanical measures of ischemia obtained with echocardiographic or radionuclide imaging are more sensitive indicators than ECG measures; they occur at a lower intensity of ischemia, and thereby precede ECG changes. Similarly, silent ischemia that is identified electrocardiographically often occurs at a lower ischemic threshold than that needed for the symptomatic expression of ischemia.
This topic provides a brief overview of exercise ECG testing including methodology, indications, and contraindications, and discusses the ECG manifestations of exercise-induced ischemia. A discussion on how to select the optimal cardiac stress test in a given patient is presented elsewhere. (See "Selecting the optimal cardiac stress test".)
There are many patients in whom exercise ECG testing can be used for diagnostic or prognostic purposes, including those with:
●Symptoms suggesting myocardial ischemia
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- LIMITATIONS TO EXERCISE ECG TESTING
- TYPES OF EXERCISE
- Comparison of types of exercise
- Common exercise protocols
- - Bruce protocol
- - Modified Bruce protocol
- - Naughton protocol
- - Other treadmill protocols
- - Bicycle testing
- EXERCISE TEST PROCEDURE
- Pre-test instructions
- Patient interview and examination
- Establishing the target heart rate
- Blood pressure measurements
- Symptoms and perceived exertion
- Test endpoints
- - Patient-determined endpoints
- - Provider-determined endpoints
- - Protocol-determined endpoints
- Submaximal testing
- Recovery period
- Life-threatening complications
- Exercise test summary report
- ECG ABNORMALITIES DURING EXERCISE
- Electrophysiology of myocardial ischemia
- ST segment depression
- - Upsloping ST segment depression
- - Horizontal or downsloping ST segment depression
- - Resting ST segment depression
- ST segment elevation
- - ST segment elevation in aVR
- Bundle branch block
- ECG ABNORMALITIES DURING RECOVERY
- ST segment depression
- Frequent ventricular ectopy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS