ABSTRACT
The symptom-limited exercise electrocardiogram (ECG) can be a valuable tool for the assessment of patients with ischaemic heart disease and exercise-related arrhythmias. However, failure to interpret exercise ECGs correctly limits their usefulness. Exercise ECG testing should always be undertaken with a specific question in mind, and an appreciation of its limitations. Exercise ECG testing can be useful in the assessment of patients with known coronary artery disease, it should not be used to diagnose or exclude stable angina in patients who are not already known to have coronary artery disease. Unless the exercise test is being performed to assess the effectiveness of treatment, patients should be advised to tail-off any existing anti-anginal treatment over the 3 days before the test. The most common indicator of myocardial ischaemia on exercise ECG testing is the development of ST segment depression.
