Stress ECG (Exercise Electrocardiography)

Introduction

Stress ECG, also called an exercise electrocardiogram, is a test used to assess how the heart performs under physical stress. It helps detect coronary artery disease (CAD) and evaluate symptoms like chest pain or shortness of breath during exertion.

How It Works

  1. Preparation: Electrodes are placed on the chest, arms, and legs to record heart activity.
  2. Exercise Phase: The patient walks on a treadmill or pedals a stationary bike with gradually increasing intensity.
  3. Monitoring: Heart rate, blood pressure, and ECG readings are continuously monitored.
  4. Completion: The test stops if the patient reaches maximum exertion or experiences concerning symptoms.

When Is a Stress ECG Needed?

  • Suspected coronary artery disease (blocks in heart arteries).
  • Evaluation of chest pain to determine whether it is heart-related.
  • Assessment of heart function post-heart attack or heart procedures, such as stenting or bypass surgery.
  • Planning an exercise regime for patients with known heart conditions.
  • Monitoring treatment effectiveness in heart disease.

What Can a Stress ECG Detect?

  • Signs of reduced blood flow to the heart (ischemia)
  • Abnormal heart rhythms (arrhythmias)
  • Blood pressure response to exercise
  • Exercise capacity and heart recovery time

Interpretation of Results

  • Normal: No ECG changes or symptoms.
  • Abnormal: ECG changes such as ST-segment depression suggest reduced blood supply to the heart, possibly due to blocked arteries.

Risks and Limitations

  • Generally safe, but may cause dizziness, chest pain, or abnormal heart rhythms.
  • Cannot visualize the heart directly (unlike imaging-based stress tests like stress echocardiography or nuclear stress tests).
  • Not suitable for patients unable to exercise—alternatives include pharmacologic stress tests.

Conclusion

A stress ECG is a valuable, non-invasive test for diagnosing heart disease and assessing cardiovascular health. Discuss with your doctor whether this test is right for you.

Source recommendations

1. American Heart Association Guidelines for Exercise Testing

  1. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
  2. https://www.ahajournals.org/doi/abs/10.1161/cir.0b013e31829b5b44
  3. https://pubmed.ncbi.nlm.nih.gov/9207652/
  4. https://www.ahajournals.org/doi/10.1161/cir.0b013e31829b5b44
  5. https://professional.heart.org/en/science-news/supervision-of-exercise-testing-by-non-physicians-a-scientific-statement-from-the-american-heart

2. European Society of Cardiology Guidelines on the Management of Chronic Coronary Syndromes

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Chronic-Coronary-Syndromes
  2. https://academic.oup.com/eurheartj/article/45/36/3415/7743115
  3. https://pubmed.ncbi.nlm.nih.gov/31504439/
  4. https://academic.oup.com/eurheartj/article/41/3/407/5556137
  5. https://pubmed.ncbi.nlm.nih.gov/39210710/

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