An Exercise Stress Test (EST) is an ECG performed under conditions of gradually increasing physical exercise. The “stress” placed on the heart and cardiovascular system by running on a treadmill or pedalling an exercise cycle may reveal changes on the ECG to suggest coronary artery disease (angina).
How the Test is Performed
Undergoing an Exercise Stress Test (EST) involves exercising to the maximum effort possible for that individual. The test is performed in a specialised laboratory where an experienced doctor (often a cardiologist) supervises the procedure. The patient is attached to ECG leads which continuously record the heart’s electrical activity. Usually a treadmill is used to exercise the patient, with gradually increasing difficulty, to achieve the highest possible workload. Frequent blood pressure and pulse measurements are taken during the exercise, and continuous ECG recording will detect any evidence of heart muscle ischaemia (where the oxygen demand of the heart muscle is greater than the oxygen supplied by the blood flow to the heart muscle).
The test is stopped when maximal workload is reached, or if ECG changes suggestive of angina occur, or blood pressure decreases. Equipment and staff for a full resuscitation are usually available in case of any adverse events.
Medical Conditions and Symptoms
An Exercise Stress Test (EST) is often requested by a General Practitioner (GP), Emergency Physician or Cardiologist, in cases of chest pain where the cause is not certain. Symptoms of shortness of breath on exertion, waking up in the night with severe breathing difficulty (paroxysmal nocturnal dyspnoea or PND), or ankle swelling may all be due to heart failure, where the heart’s ability to pump is impaired. Heart failure (left ventricular failure = LVF, congestive cardiac failure = CCF) is sometimes due to ischaemic heart disease, also known as coronary artery disease. IHD (ischaemic heart disease) may cause chest pain (angina) or symptoms of heart failure.
Test Results Explained
The Exercise Stress Test (EST) is usually reported as:
- negative – a normal test – which significantly decreases the likelihood of coronary artery disease
- positive – a test result where a diagnosis of coronary artery disease (ischaemic heart disease, angina) is definite
- inconclusive – usually due to non-diagnostic ECG changes, or when the test is terminated early due to exhaustion, before maximum heart rate or workload is reached
Related Specialists
- General Practitioner (GP)
- Cardiologist
- Emergency Physician
- General Physician
- Occupational Health Physician
- Anaesthetist
Related Procedures
- Pre-operative Anaesthetic assessment
- Percutaneous Coronary Intervention (PCI)(=PTCA: Percutaneous Coronary Angioplasty - with or without coronary stent placement)
- Coronary Artery Bypass Grafting (CABG)
Related Tests
- Glucose Tolerance Test
- Electrocardiogram (ECG)
- Dipyridamole-Thallium Scan (Dip-Thall)
- Echocardiogram (Echo)
- Chest X-Ray (CXR)
- Troponin
- Lipid Profile (Cholesterol Test)
Also Known As
- Stress ECG
- Exercise ECG
- Treadmill test
- Cardiac stress test
- Exercise Tolerance Test
