Exercise testing should be discontinued if there is any evidence that a complication may be occurring.


Testing Notes:

• In a person with significant pre-existing disease, testing should be done by a trained professional who is available to continuously monitor the patient and the testing equipment.

• In patients with significant pre-existing disease who require testing at maximal exertion, it is desirable to test the patient at a submaximal level first and to see how this is tolerated.


Absolute Indications


(1) Acute myocardial infarction or suspicion of a myocardial infarction.


(2) Onset of moderate-to-severe angina.


(3) Drop in systolic blood pressure with increasing workload accompanied by signs or symptoms or drop below standing resting pressure.


(4) Serious arrhythmias

(4a) second or third degree atrioventricular block

(4b) sustained ventricular tachycardia

(4c) increasing premature ventricular contractions

(4d) atrial fibrillation with fast ventricular response


(5) Signs of poor perfusion

(5a) pallor

(5b) cyanosis

(5c) nausea

(5d) cold and clammy skin


(6) Unusual or severe shortness of breath.


(7) Central nervous system symptoms

(7a) ataxia

(7b) vertigo

(7c) visual or gait problems

(7d) confusion.


(8) Technical inability to monitor the electrocardiogram.


(9) Patient's request


Relative Indications


(1) Pronounced electrocardiogram changes from baseline.

(1a) > 2 mm of horizontal or downsloping ST-segment depression

(1b) > 2 mm of ST-segment elevation (except in aVR)


(2) Any chest pain that is increasing.


(3) Physical or verbal manifestations of severe fatigue or shortness of breath.


(4) Wheezing.


(5) Leg cramps or intermittent claudication (grade 3 on 4-point scale)


(6) Hypertensive response (systolic blood pressure > 260 mm Hg; diastolic blood pressure > 115 mm Hg)


(7) Less serious arrhythmias, such as supraventricular tachycardia.


(8) Exercise-induced bundle branch block that cannot be distinguished from ventricular tachycardia.


To read more or access our algorithms and calculators, please log in or register.