Stress ECGs

The stress ECG is an exercise test whilst attached to an ECG (electrocardiograph) machine. A resting ECG is a useful test to check the history of the heart, old damage, enlargement from strain or high blood pressure and any arrythmia problems are often picked up. The stress ECG, however, is looking to see if, under load, any of the heart muscles is developing ischaemia (lacking oxygenated blood) that would indicate a partially blocked artery supplying the heart itself.

Doctors are very keen to detect early, any blocked arteries (coronary artery disease) because the modern treatments for this are excellent and truly life saving. Lowering cholesterol with statins can gradually unblock arteries and stents are excellent for more severe blockages. In most situations a stress ECG is likely to pick this up before symptoms such as angina, heart failure or most dangerously, a heart attack occurs.

Like all tests the stress ECG has limitations. It may miss some cases but more likely may diagnose a problem where none actually exists. This may require further testing and referral to a cardiologist to investigate. Luckily, the advances in CT scanners mean a CT angiogram often can be used in this situation, which is far cheaper and less invasive than the cardiac catheter that used to be required.

It is important to understand that blocked artery disease is not just heart disease but also stroke, peripheral vascular disease and about a third of dementia cases are caused by blocked artery disease, so understanding and lowering your cardiac risk also reduces the risk of these diseases.

If you have several risk factors such as:

  • you are male
  • you are older in age
  • you have high blood pressure
  • you have high cholesterol
  • you smoke
  • you are unfit/overweight
  • you have a family history of heart disease
  • you have diabetes
  • you experience chest pain or breathlessness on exertion

Then a stress ECG may be a good idea.

It involves a discussion about risk and suitability before starting. Adhesive chest leads are attached and a resting ECG is recorded. The stress part of the ECG is approximately 15 minutes on an exercycle under increasing load to a moderately hard (not maximal) effort.

You need to bring suitable clothing as you will get sweaty. Results are explained as you go and the recording is visible on the big screen. A normal result is reassuring. Advice and the implications of a positive test are discussed at the time.

A stress ECG can be incorporated into our Full Medicals or done separately. Please feel free to phone in and discuss with our nurses.