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Exercise ECG testing: Performing the test and interpreting the ECG results

Panithaya Chareonthaitawee, MD
J. Wells Askew, MD
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Brian C Downey, MD, FACC


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 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 [1]:

Symptoms suggesting myocardial ischemia


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Literature review current through: Mar 2017. | This topic last updated: Mar 15, 2017.
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