Exercise Stress Test

Exercise ECG (Treadmill)

What is an Exercise Stress Test?

An exercise stress test can be summarized as the continuous monitoring of the ECG while exercising in a way that gradually increases the workload on the heart, with recordings taken at regular intervals. It is one of the tests used to investigate heart and vascular diseases.

The exercise is performed on a treadmill or a bicycle at a certain speed and duration.

It is preferred because it is non-invasive, inexpensive, and has relatively low side effects.

The patient’s heart rate is increased by walking on a treadmill or pedaling on a stationary bike. The speed and incline of the treadmill are adjusted by the doctor to stress the heart. During this time, the ECG recordings taken from the patient are analyzed on the computer. Blood pressure, pulse changes, chest pain, and shortness of breath during exercise are also recorded. Abnormalities that may not appear on a resting ECG can be revealed with this test. The exercise stress test provides great advantages in the early diagnosis and detection of heart diseases.

It is performed during gradually increasing, strictly monitored standard physical activity. Its purpose is to determine whether the patient has coronary artery disease and to assess the severity of the disease using specific criteria.

Who Should Have an Exercise Stress Test?

The exercise stress test is most commonly performed to diagnose coronary artery disease (narrowing or blockage of the arteries supplying the heart) or to monitor patients already diagnosed with this condition.

In addition, it is also requested to determine exercise capacity, investigate blood pressure response to exercise, study rhythm and conduction disturbances triggered by exercise, and evaluate causes of fainting.

In summary, the reasons include:

To detect patients with coronary narrowing and assess the severity of disease,

To determine risk in patients who have had a heart attack,

To monitor treatment results,

To investigate blood pressure elevation during exercise,

To measure exercise capacity,

To diagnose exercise-induced arrhythmias.

It is an important diagnostic tool in evaluating chest pain and determining whether the pain originates from the heart.

How is an Exercise Stress Test Performed?

The decision to perform an exercise stress test is made after careful clinical evaluation and analysis of a resting ECG. All these assessments must be performed by the physician responsible for the test. Sometimes, even if the patient seems suitable, the physician may detect new clinical signs or ECG changes and conclude that the test could be risky.

In hospitals, the test is performed on a motorized treadmill under nurse or technician supervision. Electrodes are attached to the chest to record ECG, blood pressure and pulse are measured, and then the test begins. The treadmill starts slowly with little incline. Every three minutes, both the speed and incline increase according to the protocol. At the beginning, walking is sufficient, but in later stages, running may be required.

The goal is to gradually increase the heart’s workload until the maximum heart rate for the patient’s age (calculated as 220 – age) reaches 85%. The duration depends on age and exercise capacity, averaging about 8–10 minutes. Every 2 minutes, treadmill speed and incline increase. Heart rhythm is continuously monitored, and blood pressure is measured at each stage.

The recordings are analyzed for signs of coronary disease or rhythm disturbances. If findings suggest heart disease, or if any warning symptoms arise, the test is stopped early without proceeding to higher levels.

Equipment Used in the Exercise Stress Test:

Treadmill or bicycle: used for controlled walking or running.

ECG device: continuously records heart rhythm during the test.

Blood pressure monitor: measures blood pressure at intervals.

Electrodes: attached to the body to transmit signals to the ECG device.

Defibrillator, oxygen tank, and emergency medications are kept available in case of serious complications.

How Should You Prepare for the Test?

Some heart or blood pressure medications may need to be discontinued before the test, as instructed by your doctor.

Two hours of fasting is recommended before the test, and smoking should be avoided. Comfortable clothing (tracksuit or shorts) and sports shoes are recommended. Male patients should shave their chest.

What Happens During the Test?

If you experience any symptoms such as chest pain, shortness of breath, dizziness, palpitations, leg pain, or fatigue, notify the medical team immediately.

The test is terminated if you reach your target heart rate, become fatigued, develop limiting symptoms, or based on the physician’s judgment. After stopping, rhythm monitoring, ECG, and blood pressure are continued for at least 5 minutes.

What Do the Results Mean?

The results are evaluated based on ECG recordings, blood pressure changes, and the patient’s symptoms.

Patients may be classified as negative (no coronary disease detected) or positive (further testing such as coronary angiography is required).

In some cases, additional tests like nuclear imaging or CT coronary angiography may be necessary.

What Are the Risks?

Some side effects can occur, such as dizziness, nausea, fatigue, faintness, headache, or shortness of breath.

The most common arrhythmia is atrial fibrillation (9.5/10,000). Life-threatening arrhythmias such as VT (5.8/10,000) and VF (0.67/10,000) are rare. Heart attack may also rarely occur (1/2500). The risk of death is extremely low (1/25,000).

Before Coming to Your Treadmill Test Appointment:

– Eat a light meal 3 hours before the test.

– Bring your previous ECG records.

– Male patients should shave their chest.

– Female patients should wear two-piece clothing.

– Consult your doctor about which medications should be discontinued.

– Do not discontinue your blood pressure medications unless advised, as this may dangerously elevate your blood pressure and prevent the test from being performed.