Exercise ECG; ECG - exercise treadmill; EKG - exercise treadmill; Stress ECG; Exercise electrocardiography; Stress test - exercise treadmill; CAD - treadmill; Coronary artery disease - treadmill; Chest pain - treadmill; Angina - treadmill; Heart disease - treadmill
An exercise stress test is used to measure the effect of exercise on your heart.
This test is done at a medical center or health care provider's office.
The technician will place 10 flat, sticky patches called electrodes on your chest. These patches are attached to an ECG monitor that follows the electrical activity of your heart during the test.
You will walk on a treadmill or pedal on an exercise bicycle. Slowly (about every 3 minutes), you will be asked to walk (or pedal) faster and on an incline or with more resistance. It is like walking fast or jogging up a hill.
While you exercise, the activity of your heart is measured with an electrocardiogram (ECG). Your blood pressure readings are also taken.
The test continues until:
You will be monitored for 10 to 15 minutes after exercising, or until your heart rate returns to baseline. The total time of the test is around 60 minutes.
Wear comfortable shoes and loose clothing to allow you to exercise.
Ask your provider if you should take any of your regular medicines on the day of the test. Some medicines may interfere with test results. Never stop taking any medicine without first talking to your doctor.
Tell your doctor if you are taking sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and have taken a dose within the past 24 to 48 hours.
You must not eat, smoke, or drink beverages containing caffeine or alcohol for 3 hours (or more) before the test. In most cases, you will be asked to avoid caffeine for 24 hours before the test. This includes:
Electrodes (conductive patches) will be placed on your chest to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.
The blood pressure cuff on your arm will be inflated every few minutes. This produces a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before exercise starts.
You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill (or the pedaling resistance) will slowly be increased.
Sometimes, people experience some of the following symptoms during the test:
Reasons why an exercise stress test may be performed include:
There may be other reasons why your provider asks for this test.
A normal test will most often mean that you were able to exercise as long as or longer than most people of your age and sex. You also did not have symptoms or concerning changes in blood pressure or your ECG.
The meaning of your test results depends on the reason for the test, your age, and your history of heart and other medical problems.
It may be hard to interpret the results of an exercise-only stress test in some people.
Abnormal results may be due to:
When you have an abnormal exercise stress test, you may have other tests performed on your heart such as:
Stress tests are generally safe. Some people may have chest pain or may faint or collapse. A heart attack or dangerous irregular heart rhythm is rare.
People who are more likely to have such complications are often already known to have heart problems, so they are not given this test.
Balady GJ, Morise AP. Exercise electrocardiographic testing. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli MD, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 13.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929-1949. PMID: 25077860 pubmed.ncbi.nlm.nih.gov/25077860/.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA Guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935-2959. PMID: 24239921 pubmed.ncbi.nlm.nih.gov/24239921/.
Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 61.BACK TO TOP
Review Date: 7/30/2020
Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 09/28/2021.
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