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VOLUME 1 , ISSUE 2-4 ( April-December, 2022 ) > List of Articles


The Role of Stress Electrocardiography in Modern Cardiology

Amer Iglica, Edin Begic, Alen Dzubur, Zijo Begic, Nedim Begic, Fikret Veljovic, Mirza Dilic, Maida Imamovic

Keywords : Electrocardiography, Heart, Ischemia, Prevention

Citation Information : Iglica A, Begic E, Dzubur A, Begic Z, Begic N, Veljovic F, Dilic M, Imamovic M. The Role of Stress Electrocardiography in Modern Cardiology. 2022; 1 (2-4):243-248.

DOI: 10.5005/jp-journals-11005-0019

License: CC BY-NC 4.0

Published Online: 20-03-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To point out the importance of stress electrocardiography and to present the indications, contraindications, as well as reasons for test termination with reference to the interpretation of the findings. Background: Despite the development of modern cardiology and the availability of methods for the visualization of coronary artery disease (CAD), stress electrocardiography still has a role in clinical practice. Review results: It is a safe, affordable, and cheap test for the evaluation of CAD, with clear indications, contraindications, and a clearly defined population for which it is intended. Conclusion: It is imperative to correlate findings of stress electrocardiography with clinical symptoms, comorbidities, positive family history, and life habits, as well as pharmacological therapy of the patient. Clinical significance: Stress electrocardiography should be a part of the daily work of cardiologists.

  1. Kharabsheh SM, Al-Sugair A, Al-Buraiki J, et al. Overview of exercise stress testing. Ann Saudi Med 2006;26(1):1–6. DOI: 10.5144/0256-4947.2006.1
  2. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300(24):1350–1358. DOI: 10.1056/NEJM197906143002402
  3. Abbott JA, Tedeschi MA, Cheitlin MD. Graded treadmill stress testing. Patterns of physician use and abuse. West J Med 1977;126(3):173–178.
  4. Will PM, Walter JD. Exercise testing: improving performance with a ramped Bruce protocol. Am Heart J 1999;138(6 Pt 1):1033–1037. DOI: 10.1016/s0002-8703(99)70067-0
  5. van der Cammen-van Zijp MHM, Ijsselstijn H, Takken T, et al. Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values. Eur J Appl Physiol 2010;108(2):393–399. DOI:10.1007/s00421-009-1236-x
  6. Badawy MM, Muaidi QI. Cardio respiratory response: validation of new modifications of Bruce protocol for exercise testing and training in elite Saudi triathlon and soccer players. Saudi J Biol Sci 2019;26(1):105–111. DOI: 10.1016/j.sjbs.2017.05.009
  7. Suzuki K, Hirano Y, Yamada H, et al. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018;16(3):105–129. DOI: 10.1007/s12574-018-0382-8
  8. Appropriate use of non-invasive testing for diagnosis of stable coronary artery disease. URL: (retrieved on: 10 June, 2020).
  9. Miller TD, Askew JW, Anavekar NS. Noninvasive stress testing for coronary artery disease. Heart Fail Clin 2016;12(1):65–82. DOI: 10.1016/j.hfc.2015.08.006
  10. Acampa W, Assante R, Zampella E. The role of treadmill exercise testing in women. J Nucl Cardiol 2016;23(5):991–996. DOI: 10.1007/s12350-016-0596-y
  11. Singh H, Aneja GK, Mehrotra TN, et al. Complications of treadmill testing. J Assoc Physicians India 1996;44(5):313–315.
  12. Rijneke RD, Ascoop CA, Talmon JL. Clinical significance of upsloping ST segments in exercise electrocardiography. Circulation 1980;61(4):671–678. DOI: 10.1161/01.cir.61.4.671
  13. Stuart RJ, Ellestad MH. Upsloping S-T segments in exercise stress testing: six year follow-up study of 438 patients and correlation with 248 angiograms. Am J Cardiol 1976;37(1):19–22. DOI: 10.1016/0002-9149(76)90493-8
  14. Haines DE, Beller GA, Watson DD, et al. Exercise-induced ST segment elevation 2 weeks after uncomplicated myocardial infarction: contributing factors and prognostic significance. J Am Coll Cardiol 1987;9(5):996–1003. DOI: 10.1016/s0735-1097(87)80299-1
  15. Djurdjevic V. Ergometrija. Medicinska knjiga, Beograd-Zagreb, 1978. 77-202.
  16. Task Force Members, Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949–3003. DOI: 10.1093/eurheartj/eht296
  17. O’Toole L. Angina (chronic stable). BMJ Clin Evid 2008;2008:0213.
  18. Wee Y, Burns K, Bett N. Medical management of chronic stable angina. Aust Prescr 2015;38(4):131–136. DOI: 10.18773/austprescr.2015.042
  19. Uchida AH, Moffa PJ, Riera AR, et al. Exercise-induced left septal fascicular block: an expression of severe myocardial ischemia. Indian Pacing Electrophysiol J 2006;6(2):135–138.
  20. Gao Y, Xia L, Gong YL, et al. Electrocardiogram (ECG) patterns of left anterior fascicular block and conduction impairment in ventricular myocardium: a whole-heart model-based simulation study. J Zhejiang Univ Sci B 2018;19(1):49–56. DOI: 10.1631/jzus.B1700029
  21. Massin MM. The role of exercise testing in pediatric cardiology. Arch Cardiovasc Dis 2014;107(5):319–327. DOI: 10.1016/j.acvd.2014.04.004
  22. Giardini A, Khambadkone S, Rizzo N, et al. Determinants of exercise capacity after arterial switch operation for transposition of the great arteries. Am J Cardiol 2009;104(7):1007–1012. DOI: 10.1016/j.amjcard.2009.05.046
  23. Massin M, Hövels-Gürich H, Däbritz S, et al. Results of the Bruce treadmill test in children after arterial switch operation for simple transposition of the great arteries. Am J Cardiol 1998;81(1):56–60. DOI: 10.1016/s0002-9149(97)00863-1
  24. Pasquali SK, Marino BS, McBride MG, et al. Coronary artery pattern and age impact exercise performance late after the arterial switch operation. J Thorac Cardiovasc Surg 2007;134(5):1207–1212. DOI: 10.1016/j.jtcvs.2007.06.022
  25. Begic Z, Begic E, Mesihovic-Dinarevic S, et al. The use of continuous electrocardiographic holter monitoring in pediatric cardiology. Acta Inform Med 2016;24(4):253–256. DOI: 10.5455/aim.2016.24.253-256
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