EXERCISE ECG (ETT)

Exercise ECG is a technique used to assess the cardiac response during exercise.

Twelve lead ECG is recorded, while the patient walks or runs on a motorized treadmill.

The traditional Bruce protocol is followed. The limb leads are placed on the shoulders and hips,

rather than wrists and ankles. Blood pressure is recorded, symptoms are assessed such as

anginal pain and ST depression or elevation is noted.

The test is positive, if there is anginal pain, blood pressure falls or fails to rise, ST depression > 1 mm (planar or

down sloping depression is more important rather than up sloping ST depression which is non-specific).

Sometimes, ST elevation may occur, which indicates transmural ischemia due to coronary spasm or critical stenosis.

The patient who can exercise < 6 min., generally have poor prognosis. Sustained fall of blood pressure indicates

severe coronary artery disease.

ETT may be false positive (20%), or false negative. It has a specificity of 80% and sensitivity of 70%.

• To confirm the diagnosis of ischemic heart disease.

• To evaluate stable angina.

• Selecting patient for CABG, PTCA, cardiac catheterization.

• To assess prognosis following myocardial infarction.

• To assess outcome after coronary revascularization (coronary angioplasty).

• To diagnose and evaluate the treatment of exercise induced arrhythmias.

• In presence of unstable angina.

• Decompensated heart failure.

• Severe hypertension.

Protocols