Stress ECG: test your heart health under stress

The exercise ECG, also known as ergometry, is a key diagnostic procedure in cardiology to check your heart's response to physical exertion. While a resting ECG only provides a snapshot of cardiac activity during relaxation, the Stress ECG to see how your cardiovascular system reacts when it is challenged. In our practice, PD Dr. Raphael Bruno carries out this important test under continuous medical supervision in order to reliably detect circulatory disorders, arrhythmias or abnormal blood pressure.

The stress ECG: the detailed procedure in our practice

We want you to feel safe and well informed throughout the examination. A Stress ECG (ergometry) follows a standardized and monitored procedure.

Preparation for the test

Good preparation helps to achieve meaningful results. The following table gives you an overview.

Preparation step	Recommendation	Why is this important?
Clothing	Bring comfortable sportswear and sports shoes.	They should be able to move and exert themselves freely without being restricted by clothing.
Food & drink	Do not eat a large meal approx. 2 hours before the test.	A full stomach can put additional strain on the cardiovascular system and lead to discomfort.
Medication	Take your medication as usual, unless your doctor has explicitly ordered otherwise.	Medications such as beta blockers in particular influence the heart rate and must be taken into account in the evaluation.
State of health	Only carry out the test if you feel healthy. If you have an acute infection (fever, cold), the appointment must be postponed.	Exercise during an infection can be dangerous and damage the heart (risk of myocarditis).

The procedure

Preparation: First, ECG electrodes are placed on your chest and back and a blood pressure cuff is attached to your upper arm. We record a resting ECG and measure your blood pressure in a sitting position as baseline values.
The load phase: You sit on a bicycle ergometer. The test begins with a very low load level (e.g. 25 or 50 watts). The load is gradually increased every two minutes.
Monitoring: During the entire time, your ECG, heart rate and blood pressure will be continuously monitored. We will regularly ask you how you are feeling and about any symptoms such as chest pain, shortness of breath or dizziness.
Abort: The test is terminated if you have reached your exercise limit, if previously defined termination criteria (e.g. certain ECG changes) occur or if you wish to terminate the test due to symptoms.
The recovery phase: After the end of the exercise, you remain seated on the bike for a few minutes. We will continue to record your ECG and blood pressure to see how quickly your cardiovascular system returns to normal.

Evaluation of the stress ECG: What your cardiologist looks for

The evaluation of a stress ECG is complex and requires the experience of a cardiologist. Dr. Raphael Bruno assesses not just a single value, but the overall picture from various parameters.

The most important criteria are:

ECG changes: The main focus is on the so-called ST segment. A drop in this distance under stress is the classic sign of an oxygen deficiency (ischemia) of the heart muscle.
Heart rhythm: Do extrasystoles or other, more complex arrhythmias occur during exercise?
Heart rate: Does the heart rate increase adequately to the load? Is the age-appropriate maximum heart rate reached?
Blood pressure: Is there a normal, excessive (hypertensive) or insufficient (hypotensive) rise in blood pressure? A drop in blood pressure under stress is a warning sign.
Symptoms: Do typical symptoms such as chest tightness (angina pectoris) occur at a certain exercise level and do these correlate with ECG changes?
Performance: What is the maximum wattage achieved? This is an objective measure of physical fitness.

The result is then explained to you in detail and clearly.

For whom is a stress ECG not suitable? (contraindications)

Safety has top priority. Therefore, there are certain health conditions for which a Stress ECG must not be carried out, as the exposure would represent too high a risk.

These absolute contraindications include, among others:

A recent heart attack (within the first few days)
Unstable angina pectoris (chest pain at rest)
Acute inflammation of the heart muscle or pericardium (myo-/pericarditis)
Severe, symptomatic aortic stenosis (severe narrowing of the aortic valve)
Uncontrolled, severe cardiac arrhythmia
Acute pulmonary embolism or febrile illnesses

Before each examination, your cardiologist will ensure that you do not have any of these contraindications.

Frequently asked questions about exercise ECG (ergometry)

Here we answer common questions that patients ask us before a stress test.

What happens if I get symptoms during the test?

You will be under constant medical supervision. If you develop any relevant symptoms such as chest pain, severe dizziness or pronounced shortness of breath during the stress ECG, please let us know immediately. The test will then be stopped immediately. The patient's safety has top priority at all times.

How strenuous is the stress ECG?

The effort is individual and is adapted to your personal fitness. The aim is to push you to your limits, but not beyond them. The load starts very low and is slowly increased so that you can gradually get used to it. You can end the test yourself at any time if you are unable to continue.

What does a „positive“ stress ECG mean?

A „positive“ or „pathological“ Stress ECG means that typical signs of a circulatory disorder of the heart (signs of ischemia) have occurred during the examination. This is an important finding that usually leads to further examinations, such as stress echocardiography or a cardiac catheterization

Can I also do the test on a treadmill?

In some centers, ergometry is also performed on a treadmill. In Germany and in our practice, the bicycle ergometer is the standard. The advantage of the bicycle is a more stable ECG recording with fewer muscle artifacts as well as easier and more accurate blood pressure measurement during the examination.

Why do I have to exert myself at all? Is a resting ECG not enough?

A resting ECG is often completely unremarkable in the case of stable coronary heart disease, as the blood flow is still sufficient at rest. Only physical exertion provokes the lack of oxygen supply and makes the underlying disease visible in the ECG. Stress ECG visible. The examination therefore provides crucial additional information.

My blood pressure was very high under stress. What does that mean?

An excessive rise in blood pressure under stress is referred to as exercise-induced hypertension. This can be an early indication of high blood pressure that has not yet manifested itself and represents a separate risk factor for future cardiovascular disease. This finding requires close observation and, if necessary, an adjustment of the therapy.

I am taking a beta blocker. Can I still have a stress ECG?

Yes, but the beta blocker will lower your maximum heart rate. It is important that your doctor knows this as it will affect the interpretation of the result. Sometimes the doctor will ask you to pause the beta-blocker before the test in order to achieve a higher workload - but this should only be done on the doctor's explicit instructions.

How long does the entire examination take?

For the Stress ECG including preparation (applying the electrodes, resting measurement), the actual exercise phase (usually 8-12 minutes) and the follow-up phase, you should plan a total of around 20 to 30 minutes.

Safety through targeted diagnostics

The Stress ECG is a proven, safe and extremely informative test to assess the health of your heart under real-life conditions. It helps us to set the right course for your further treatment and gives you confidence in dealing with your physical resilience. If a stress test is recommended for you or you suffer from stress-related complaints, please make an appointment for a comprehensive cardiological assessment.