An ECG can be performed as a resting, exercise or long-term ECG.

Resting ECG

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During a resting ECG the body must be relaxed (at rest), as the neighboring muscles and nerves also produce electrical tension. The electrodes are attached to predetermined locations on the body, located on the chest, arms and legs, which are connected to the ECG machine via a cable. The electrodes can detect electrical tension of less than a millivolt, which is then transcribed onto graph paper to produce an ECG.

Exercise ECG

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An exercise ECG (or stress ECG) is performed under physical stress, as some changes are only detected when the heart is strained. For example, a resting ECG is particularly unremarkable in the setting of Coronary Artery Disease (CAD).

Many heart rhythm disorders or ECG changes can be better detected and diagnosed via an exercise ECG. In addition, an exercise ECG is performed as part of the evaluation of chest pain in certain situations:

• Following a heart attack or cardiac bypass operation
• Stress-induced rhythm disorders
• Evaluation of a rhythm disorder following treatment
• High blood pressure
• Assessment of individual physical capacity

As with a resting ECG, the electrodes are attached to the skin and are connected to the ECG machine via a cable. The patient is placed on either a treadmill or a stationary bicycle. The level of resistance/speed is increased at regular intervals (usually every 2-3 minutes) until the patient can no longer exercise, the maximum heart rate is reached or symptoms and/or ECG changes indicating stress to the heart are present. The ECG reading, heart rate and blood pressure are continuously monitored during the test, and for a few minutes following, in order to observe the return of the heart rate to its baseline.

An exercise ECG should not be performed in the following situations, as it could cause cardiac injury:

• Heart attack within the last 5 days
• Heart muscle inflammation
• Acute lung embolism
• Acute coronary syndrome
• Severely elevated blood pressure
• Certain ventricular arrhythmias
• Severe angina pectoris (chest tightness)
• Narrowing of the aorta

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Long-term ECG

An additional way to measure the activity of the heart is a long-term ECG. This measures the heart’s activity over 24 hours and can therefore detect many changes. The electrodes are attached to the skin and connected to a small mobile recording device via a cable. The gathered data is then interpreted by a physician.

A long-term ECG is often used in the following situations:

• Presence of ECG changes under stress
• Extra ventricular beats
• Heart block
• Atrial arrhythmias
• Excessively high or low pulse
• Pauses of the heart beat with loss of consciousness

Long-term ECG’s are typically used to monitor heart rhythm or rate disturbances.

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