Exercise Electrocardiogram

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Exercise Electrocardiogram

Exercise Electrocardiogram

Test Overview

An exercise electrocardiogram (EKG or ECG)
is a test that checks for changes in your heart while you exercise. Sometimes
EKG abnormalities can be seen only during exercise or while symptoms are
present. This test is sometimes called a "stress test" or a "treadmill test."
During an exercise EKG, you may either walk on a motor-driven treadmill or
pedal a stationary bicycle.

The
heart is a muscular pump made up of
four chambers. The two upper chambers are called atria, and the two lower
chambers are called ventricles. A natural electrical system causes the heart
muscle to contract and pump blood through the heart to the lungs and the rest
of the body.

An exercise EKG translates the
heart's electrical activity into line tracings on paper. The spikes and dips in
the line tracings are called waves.

A resting EKG is always done
before an exercise EKG test, and results of the resting EKG are compared to the
results of the exercise EKG. A resting EKG may also show a heart problem that
would make an exercise EKG unsafe.

Why It Is Done

An exercise
electrocardiogram is done to:

  • Help find the cause of unexplained chest
    pain or pressure.
  • Help decide on the best treatment for a person with angina.
  • See how well people who
    have had a
    heart attack or heart surgery are able to tolerate
    exercise.
  • Help find the cause of symptoms that occur during
    exercise or activity, such as dizziness, fainting, or rapid, irregular
    heartbeats (palpitations).
  • Check for a blockage or
    narrowing of an artery after a medical procedure, such as
    angioplasty or
    coronary artery bypass surgery, especially if the
    person has chest pain or other symptoms.
  • See how well medicine or
    other treatment for angina or an irregular heartbeat is
    working.
  • Help you make decisions about starting an exercise program
    if you have been inactive for a number of years and have an increased chance of
    having heart disease.

Exercise electrocardiograms are not recommended if you're healthy and have no symptoms of heart disease.footnote 1

How To Prepare

Tell your doctor if you:

  • Are taking any medicines, including a medicine
    for an erection problem (such as Viagra). You may need to take nitroglycerin
    during this test, which can cause a serious reaction if you have taken a
    medicine for an erection problem within the previous 48 hours. Ask your doctor
    whether you need to stop taking any of your other medicines before the
    test.
  • Are allergic to any medicines, such as those used to numb the
    skin (anesthetics).
  • Take a blood thinner, or if you have had bleeding problems.
  • Have joint problems in your hips or legs that may make
    it hard for you to exercise.
  • Are or might be pregnant.

Talk to your doctor about any concerns you have regarding
the need for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information form ( What is a PDF document? ).

Your doctor may recommend how you
should eat before the test. For example, your doctor may suggest you only eat a
light breakfast before your test.

An exercise EKG may be dangerous and should not be done in some situations. Be sure to tell your doctor if you:

  • Think you are having a heart
    attack.
  • Are having angina that is not relieved with rest (unstable angina).
  • Have high blood pressure
    that is not controlled with medicine.
  • Have untreated,
    life-threatening irregular heart rhythms (arrhythmias).
  • Have severe
    narrowing of one of your heart valves (aortic valve stenosis).
  • Have inflammation in your heart muscle
    (myocarditis).
  • Have a severe decrease in the amount of red blood
    cells (anemia).
  • Have a stretched and bulging
    section in the wall of the large artery that carries blood from the heart
    (aortic aneurysm) or in one of the chambers of the
    heart (ventricular aneurysm).
  • Have severe lung disease.

Remove all jewelry from your neck, arms, and wrists. Wear
flat, comfortable shoes (no bedroom slippers) and loose, lightweight shorts or
sweat pants. Men are usually bare-chested during the test. Women often wear a
bra, T-shirt, or hospital gown. Avoid wearing any restrictive clothing other
than a bra.

You may want to stretch your arm and leg muscles
before beginning an exercise EKG.

How It Is Done

An exercise electrocardiogram (EKG or
ECG) is usually done in a doctor's office, clinic, or hospital lab by a health
professional or doctor. The test results are evaluated by an
internist,
family medicine doctor, or
cardiologist.

Before the test

  • Areas on your arms, legs, and chest where
    small pads or patches (electrodes) will be placed are cleaned and may be shaved to
    provide a clean, smooth surface to attach the electrodes.
  • The electrodes
    are hooked to a machine that traces your heart activity onto a piece of paper.
    Your chest may be loosely wrapped with an elastic band to keep the electrodes
    from falling off during exercise. A blood pressure cuff will be wrapped around
    your upper arm so that your blood pressure can be checked every few minutes
    during the test.

During the test

For exercise, you typically either walk
on a treadmill or pedal on a stationary bicycle while being monitored by an EKG
machine. Your EKG will be monitored on screen, and paper copies will be printed
out for later review before you start the exercise, at the end of each section
of exercise, and while you are recovering.

The test is usually
performed in a series of stages, each lasting 3 minutes. After each 3-minute
stage, the resistance or speed of the treadmill or bicycle is increased.

  • For the treadmill test, the treadmill will move slowly in a level or slightly inclined
    position. As the test progresses, the speed and steepness of the treadmill will
    be increased so that you will be walking faster and at a greater
    incline.
  • For the stationary bicycle, you
    will sit on the bicycle with the seat and handlebars adjusted so that you can
    pedal comfortably. You can use the handlebars to help you balance, but you
    should not use them to support your weight. You will be asked to pedal fast
    enough to maintain a certain speed. The resistance will then be gradually
    increased, making it harder to pedal.
  • In both the treadmill and the bicycle tests, your EKG, heart
    rate, and blood pressure will be recorded during the exercise. Your heart rate
    and EKG will be recorded continuously. Your blood pressure is usually measured
    during the second minute of each stage. It may be measured more frequently if
    the readings are too high or too low. During the test, you might be asked to give a number that answers the question "How hard do you feel the exercise is?" The number will be on a scale from 6 to 20 and is called a rating of perceived exertion.
  • The test continues until you
    need to stop, until you reach your maximum heart rate, until you begin to show
    symptoms of stress on your heart and lungs (such as fatigue, extreme shortness
    of breath, or angina), or until the EKG tracing shows decreased blood flow to
    your heart muscle.
  • The test may also be stopped if you develop
    serious irregular heartbeats or if your blood pressure drops below your resting
    level.

After the test

When the exercise phase is
completed:

  • You will be able to sit or lie down and rest.
  • Your EKG and blood pressure will be checked for about 5 to 10
    minutes during this time.
  • The electrodes are then removed from your
    chest, and you may resume your normal activities.
  • Do not take a hot
    bath or shower for at least an hour, since hot water after vigorous exercise
    can make you feel dizzy and faint.

The entire test usually takes 15 to 30
minutes.

How It Feels

The electrodes may feel cool when they
are put on your chest. If you have a lot of hair on your chest, a small area
under each electrode may need to be shaved. When the electrodes are taken off,
they may pull your skin a little.

The room where the exercise
electrocardiogram is done may be kept cool for comfort, since you will warm up
rapidly when you begin to exercise.

The blood pressure cuff on
your arm will be inflated every few minutes. This will squeeze your arm and
feel tight. Tell your health professional if this is painful.

While exercising, you may have leg cramps or soreness; feel tired, short
of breath, or lightheaded; have a dry mouth; and sweat. You might even have
some mild chest pain or pressure. Tell the health professional or doctor if you have these
symptoms.

Risks

An exercise electrocardiogram is generally
safe. Emergency equipment will be available in the testing area. Risks
include:

  • Irregular heartbeats during the
    test.
  • Severe angina symptoms.
  • Fainting.
  • Falling.
  • Heart
    attack.

The electrodes are used to transfer an image of the
electrical activity of your heart to tracing on paper. No electricity passes
through your body from the machine, and there is no danger of getting an
electrical shock.

Results

An exercise electrocardiogram (EKG or
ECG) is a test that checks for changes in your heart while you exercise. Your
doctor may be able to talk to you about your results right after the test.
But complete test results may take several days.

Your doctor
will look at the pattern of spikes and dips on your electrocardiogram to check
the electrical activity in different parts of your heart. The spikes and dips
are grouped into different sections that show how your heart is working.

Exercise electrocardiogram (EKG or ECG) results
Normal:

You reach your target heart rate (based on your age) and can exercise without chest pain or other symptoms of heart
disease.

Your blood pressure increases steadily
during exercise.

Your EKG tracings do not show any
significant changes. Your heartbeats look normal.

Abnormal:

You have angina symptoms, such as chest pain or pressure, during or right after
the test.

You have other symptoms of heart disease,
such as dizziness, fainting, or extreme shortness of breath.

Your blood pressure drops or does not rise
during exercise.

The EKG tracing does not look normal.

Your heartbeats are too fast, too slow, or
very irregular.

Some people who have a normal exercise
electrocardiogram test may still have heart disease, and some people with an
abnormal test do not have heart disease.

What Affects the Test

You may not be able to have the
test or the results may not be accurate if:

  • The electrodes are not securely attached to the
    skin.
  • You are not able to exercise hard enough during the test.
  • You take certain medicines, such as digoxin, phenothiazines,
    and some antiarrhythmic medicines.
  • You have a low
    potassium level.
  • You smoke or eat a heavy
    meal before the test.

What To Think About

An exercise EKG is not always
accurate. The test results from an exercise EKG are always evaluated along with
other information, such as your symptoms and other risk factors.

  • The test is less accurate
    in young or middle-aged women who do not have typical symptoms of heart
    disease.
  • If your doctor recommends a test, ask what it is for and why you need it. You can help decide if a test is right for you. Talk with your doctor to make that decision. For more information, see Heart Tests: When Do You Need Them?
  • Further tests, such as cardiac perfusion scanning, stress
    echocardiogram, or cardiac catheterization, may be needed to further evaluate
    an abnormal exercise EKG test result.

Other Places To Get Help

Organizations

National Heart, Lung, and Blood Institute (U.S.)
www.nhlbi.nih.gov

American Heart Association
www.heart.org

Related Information

References

Citations

  1. U.S. Preventive Services Task Force (2012). Screening for coronary heart disease with electrocardiography: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm.

Other Works Consulted

  • Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
  • Chou R, et al. (2011). Screening asymptomatic adults with resting or exercise electrocardiography: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 155(6): 375–385.
  • Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
  • Gibbons RJ, et al. (2002). ACC/AHA 2002 guideline update for exercise testing: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation, 106(14): 1883–1892.
  • Lauer M, et al. (2005). Exercise testing in asymptomatic adults. A statement for professionals from the American Heart Association Council on Clinical Cardiology, Subcommitee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation, 112(5): 771–776.
  • Myers J, et al. (2009). Recommendations for clinical exercise laboratories. A scientific statement from the American Heart Association. Circulation, 119(24): 3144–3161.
  • U.S. Preventive Services Task Force (2012). Screening for coronary heart disease with electrocardiography: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm.

Credits

ByHealthwise StaffPrimary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology E. Gregory Thompson, MD - Internal Medicine Martin J. Gabica, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer George Philippides, MD - Cardiology

Current as ofFebruary 20, 2018