Exertional Cardiac Monitoring
Exercise ECG (Stress Test)
An Exercise ECG records heart rhythm and electrical activity while physical workload is gradually increased under clinical supervision. It shows how the heart behaves during exertion and recovery.
On this page
Overview
What Is an Exercise ECG?
An Exercise ECG, often called a stress test, is a monitored test in which you exercise while your heart is recorded. It is carried out under clinical supervision.
- Monitored exercise, with workload increased gradually
- A continuous ECG recording
- Observation of how your heart rate responds
- Attention to any symptoms you notice
The test focuses on heart rhythm and electrical activity during exertion. It is one of several tools described on the Diagnostics page.
Why it is useful
Why Exercise Changes Heart Assessment
A resting recording shows the heart at one moment. Physical activity changes the conditions in which the heart works, so some information only appears during or after exertion.
Heart rate
The rate rises with workload and falls again in recovery.
Autonomic tone
Exercise shifts the balance of the nervous system signals that regulate the heart.
Electrical demand
The heart’s electrical system works under a higher load.
Symptoms
Some symptoms are brought on by effort and can be observed while they occur.
Some rhythm problems may appear only during or after exertion, which is why this test can add information that a resting ECG does not.
A general outline
How the Test Works
The exact protocol depends on the clinic and on the reason for the test. Your care team will tell you what to expect and give you individual instructions.
Preparation
You are told how to get ready.
Electrodes
ECG electrodes are placed on your chest.
Baseline
A recording is made at rest.
Exercise
Workload is increased step by step.
Recovery
Monitoring continues as you settle.
What clinicians observe
ECG Monitoring
During the test, the ECG is watched continuously. Clinicians pay attention to several features:
- the heart rhythm
- the heart rate
- the conduction of electrical signals
- extra or ectopic beats
- arrhythmias that appear with exercise
Changes may be noted both during exertion and in the recovery period afterwards.
Rate response
Heart Rate Response
How the heart rate rises with exercise, and how quickly it settles during recovery, can provide clinically useful information about how the heart and its regulation are working.
There are no universal targets. What counts as an expected response depends on the person, and your clinician will interpret it in your own context.
What you notice
Symptoms During Exercise
You will be asked to tell the team about anything you feel. The staff may monitor for:
- palpitations
- dizziness
- shortness of breath
- chest discomfort
- difficulty keeping up with the exercise (exercise intolerance)
These symptoms can have many causes and do not necessarily mean an arrhythmia. The ECG recorded at the time helps put them in context.
Tell the team straight away if you feel unwell during the test.
Looking for rhythm problems
Rhythm Assessment
An Exercise ECG may be considered when the question is about rhythm during exertion, for example:
- palpitations that happen with exercise
- suspected exercise-related arrhythmias
- how the heart rate responds
- ectopic beats that appear during exertion
It adds one piece of information that your care team combines with your history and other tests.
Choosing tests
When It May Be Used
An Exercise ECG may be suggested where it can answer a specific question about your heart rhythm or your symptoms on exertion. Your care team decides whether it is suitable for you.
It is not needed for every person with an arrhythmia, and it is not the right test for everyone. Other tests, such as Holter monitoring, may be more suitable for some questions.
Comparison
Exercise ECG vs Resting ECG
The two tests answer different questions and complement each other. Neither is better than the other in every situation.
Resting ECG
A snapshot of the heart’s electrical activity at rest. See ECG.
Exercise ECG
An assessment of rhythm and electrical activity during increasing workload and recovery.
Comparison
Exercise ECG vs Holter
Both record the heart’s rhythm, but under different conditions.
Exercise ECG
A controlled, supervised assessment of what happens during exercise.
Holter monitoring
A continuous ambulatory recording during normal daily activity. See Holter Monitoring.
If symptoms are brief or occasional, an event recorder may also be considered.
After the test
Results
A clinician reviews the recording, your symptoms and your heart-rate response together. The result is interpreted in the context of your history and any other tests.
Your care team will explain what the findings mean for you and whether further tests or treatment are appropriate. A result is rarely read in isolation, and one test seldom gives the full picture.
Questions
Frequently Asked Questions
Is an Exercise ECG the same as an ECG at rest?
Will I be monitored throughout?
What if I cannot exercise strenuously?
Do I need to prepare?
What if I feel unwell during the test?
Does a normal result rule out an arrhythmia?
How is it different from Holter monitoring?
When will I get the result?
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