The Exercise ECG Test

An exercise electrocardiogram (exercise ECG) helps to diagnose ischaemic heart disease, which is the common cause of angina and other heart problems. It can also help to assess the severity of ischaemic heart disease.

What is an exercise ECG?
An exercise ECG records the electrical activity of your heart whilst you exercise. This test is sometimes called an exercise stress test or exercise tolerance test.

How is an exercise ECG test done?
Small metal electrodes are stuck onto your chest (for men the technician may have to shave some hairs off the chest for good contact). Wires from the electrodes are connected to the ECG machine. You will then be asked to walk on a treadmill. The exercise starts at a very easy pace, and is gradually made more strenuous by increasing the speed and incline of the treadmill every 3 minutes. You will continue to be monitored for 10 - 15 minutes after exercising, or until your heart rate returns to its baseline.

Whilst you exercise, ECG tracings are made and you will also have your blood pressure measured from time to time. The whole test lasts about 30 minutes.

Why is an exercise ECG test done?
The exercise ECG test helps to diagnose and assess the severity of ischaemic heart disease (sometimes called coronary heart disease or coronary artery disease). This disease is due to narrowing of the coronary arteries. It can cause angina (chest pains) and other problems. So, if you develop chest pains you may be advised to have an exercise ECG to help to clarify the cause.

Many people with ischaemic heart disease have a normal ECG at rest. During exercise the heart beats faster and needs more oxygen. If one or more of your coronary arteries are narrowed, part or parts of the heart muscle do not get enough oxygen. This can cause the ECG tracing to become abnormal when you exercise. Therefore, if you have a 'positive' exercise ECG test (an abnormal reading) you are likely to have ischaemic heart disease.

If you already have ischaemic heart disease, the degree of abnormality on the exercise ECG tracing can give a good idea of the severity of the disease. Therefore, an exercise ECG test is often done to help to decide if you need further investigations or treatment.

Will I cope with the exercise required?
Most people manage to do the exercise ECG test. It can be hard work, but the level of exercise chosen aims to match your normal capabilities. At any stage you can tell the technicians doing the test if you feel it is too difficult, and the test will be stopped. The test will also be stopped if you develop unpleasant pains or if you become very tired, or short of breath.

What should I do to prepare for the test?
You should not have a heavy meal within one hour of the test. You must not smoke, or drink beverages containing caffeine or alcohol for 3 hours before the test. Otherwise, there is no special preparation needed. For the test, wear loose fitting clothes and shoes that are comfortable to walk in, ladies may feel more comfortable wearing trousers/slacks. Continue to take your usual medication unless advised otherwise by a doctor and bring along a list of your current medication. Please do not use bath oils or apply sun tan cream before your test.

Limitations for the exercise test
An exercise ECG is valuable test. However, it is not 100% accurate. Therefore, some people with a normal heart have 'abnormal' changes on their exercise ECG tracing. Also, some people with ischaemic heart disease have a normal exercise ECG with no abnormal changes on the tracing. Doctors are aware of this and use the results of the test in conjunction with other information such as your symptoms, results of other tests, etc.

Are there any risks when doing an exercise ECG?
An exercise ECG test is done without any problems in the vast majority of cases. If you do not have ischaemic heart disease then complications are very rare. However, serious complications occur in a small number of cases in people who have ischaemic heart disease. The risk is to develop a heart attack or a serious heart irregularity (arrythmia) during the test. One or other of these problems occurs in about 3 in 1000 tests done on people with ischaemic heart disease. Medical help is near to hand to deal with possible problems. However, if you have ischaemic heart disease, you have about a 3 in 10,000 risk of dying during an exercise ECG test.

You have to weigh up the pros and cons before deciding on having this test. The test can give very valuable information about your condition, but with a small risk of serious problems developing.