Coronary heart disease electrocardiogram

Stress testing is used for risk stratification and diagnosis of coronary artery disease.

Exercise EKG/Stress EKG is preferred initial test unless the patients have uninterpretable EKG not in a condition to exercise. Few uninterpretable EKG conditions are

• WPW syndrome
• > 1 mm of ST depression at rest
• Left bundle branch block
• Ventricular pacing
• Resting abnormalities of ST segment and T waves.

• In ECG recording
  • Maximum ST elevation
  • Number of leads showing changes
  • Duration for onset of ST segment changes
  • Duration for ST segment change recovery
  • ST/HR indices
  • Occurrence exercise induced ventricular arrhythmia

• Hemodynamic markers
  • Maximum heart rate, blood pressure, RPP
  • Exertional hypotension
  • Chronotropic incompetence
  • Heart rate recovery

• Exercise capacity
  • Duration
  • Workload

• Ischemia
  • Angina
  • Time of onset