Primary care

What is an exercise ECG?

In an exercise ECG, the physician uses electrodes to record the electrical actions of the heart while the patient is physically active. This makes it possible to detect certain cardiovascular diseases, such as coronary heart disease, and to make statements about the patient's individual physical fitness.

When is a stress ECG done?

Some heart diseases only become apparent during physical exertion. Especially in coronary heart disease (CHD), the resting ECG is often unremarkable. In the exercise ECG, on the other hand, the disease can be diagnosed by rhythm disturbances or ECG changes. Other reasons for an exercise ECG are:

  • Control after heart attack or bypass surgery
  • Exercise-induced cardiac arrhythmia
  • Follow-up assessment of a treated arrhythmia
  • Hypertension
  • Assessment of individual performance
  • Checking the success of a drug treatment (for example against high blood pressure)

Procedure of an exercise ECG

As with the resting ECG, the doctor sticks electrodes on the patient's skin and connects them to an ECG device via cables. This 12-lead ECG now records the heart action while the patient is physically active, for example on a treadmill or a stationary bicycle (bicycle ergometer). Different load phases can be set on the sports equipment, which correspond to the physical load in everyday life:

  • 25 to 50 watts: normal walking
  • 75 to 100 watts: climbing stairs or slow cycling
  • 125 to 150 watts: jogging or fast cycling
  • over 150 watts: heavy athletic strain

The load is increased by 25 watts every two minutes. The stress ECG duration is about 15 minutes. In case of dangerous ECG changes, excessive increase in blood pressure (> 250 mmHg systolic and >120 mmHg diastolic) and if the patient experiences discomfort, the doctor stops the exercise ECG immediately. Otherwise, the wattage is increased further until the maximum heart rate (=220 minus age) is reached or the person is exhausted. After the exercise, the patient is observed for another six minutes to assess the decrease in heart rate.

Evaluation of the exercise ECG

In addition to the power - measured in watts - the practice also checks the subjective performance perception of the patient. For this purpose, the person gives feedback on his or her perception of the severity of the load during the examination. For monitoring and diagnostics, blood pressure and heart rate are also determined.

The heart rate at rest is 60 to 80 beats per minute and naturally increases under physical stress. In order to determine the individual target value of the performance capacity, the doctor uses the following rule of thumb for the stress ECG: The number of years of the person's life is subtracted from a heart rate of 220 beats per minute. This results in the person's exercise limit.  

If the patient suffers from a heart disease, typical changes are often seen in the ECG. However, especially in patients who do not yet have coronary artery disease and/or who do not have any symptoms, the stress ECG can also provide false normal findings. This means that there are no abnormalities, even though the person has CHD. For this reason, doctors usually supplement the stress ECG with other examinations.

How do I get a stress ECG at Avi Medical?

You cannot book a stress ECG directly in one of our practices. This is usually done in connection with an examination for conorary heart disease or a suspicion thereof.