Exercise Stress ECG Essentials

After completing this course, you will be able to

• Determine when an exercise stress ECG is the appropriate first-line test by applying pre-test probability models based on age, sex, symptoms, and risk factors
• Screen patients for absolute and relative contraindications and select the safest and most informative exercise modality
• Evaluate gait, strength, and mobility to choose between treadmill, cycle, or alternative exercise modes
• Measure ST-segment shifts accurately by identifying the J point and assessing depression or elevation 60–80 ms afterward
• Discriminate between horizontal, downsloping, and upsloping ST changes and classify which patterns meet diagnostic criteria for ischemia
• Identify high-risk ECG features—including early, deep, or persistent ST depression or exercise-induced ST elevation—that require test termination or urgent follow-up
• Interpret nondiagnostic or artifact-limited tracings and justify when additional evaluation is required
• Recognize exercise-induced patterns consistent with ischemia or angina in patients with non-obstructive coronary arteries (ANOCA / INOCA)
• Apply sex-specific considerations and technical adjustments, such as optimal lead placement in women, to improve ECG accuracy
• Synthesize ECG findings, symptoms, and physiologic responses to craft concise, clinically actionable stress test reports