ABSTRACT
DIAGNOSIS Electrocardiographic evidence of myocardial ischemia can be detected by changes in the ST segment on the standard electrocardiogram (ECG), by use of an exercise test or ambulatory monitoring. Exercise testing is commonly used to examine for potentially inducible ischemia, albeit symptomatic or silent. Similarly to the standard ECG, exercise testing reveals information concerning the magnitude and extent of myocardial ischemia. Ambulatory monitoring gives information on the frequency and duration of ischemia occurring spontaneously or during daily activities, with or without symptoms. Significant ischemia on exercise testing (312) and ambulatory monitoring (313) is defined as the development of horizontal or down-sloping ST segment depression *1 mm measured 80 ms after the J point when compared with the baseline ECG. In ambulatory monitoring, one
312 Electrocardiograms at rest before exercise testing (heart rate 70 bpm) (A) and during exercise testing at maximum work load (heart rate 145 bpm) (B). ST segment depression >4 mm of down-sloping nature.
