Exercise Electrocardiogram

(Also called as Exercise EKG, Stress EKG, and Stress Test)

Overview

click image to enlarge

The Heart's Electrical Conduction System

The heart is, in the simplest terms, a pump made up of muscle tissue. Like all pumps, the heart requires a source of energy in order to function. The heart's pumping energy comes from an innate electrical conduction system which stimulated the heart to pump.

An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node), which is a small set of specialized tissue located in the right atrium (right upper chamber) of the heart. The sinus node generates an electrical stimulus periodically (60 to 100 times per minute under normal conditions). This electrical stimulus travels down through the conduction pathways (similar to the way electricity flows through power lines from the power plant to your house) and causes the heart's chambers to contract and pump out blood. The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart). The electrical impulse travels from the sinus node to the atrioventricular (AV) node, where it stops for a very short period, then continues down the conduction pathways via the bundle of His into the ventricles. The bundle of His divides into right and left pathways to provide electrical stimulation to both ventricles.

What is EKG?

This electrical activity of the heart is measured by an electrocardiogram. By placing electrodes at specific locations on the body (chest, arms, and legs), a graphic representation, or tracing, of the electrical activity can be obtained. Changes in an EKG from the normal tracing can indicate one or more of several heart-related conditions.

Many medical conditions can cause changes in the EKG pattern including, but not limited to, the following:

• ischemia - decreased blood flow to the heart muscle due to clogged or partially clogged arteries.
  
  
• heart attack (Also called myocardial infarction, or MI.) - damage to the heart muscle due to insufficient blood supply.
  
  
• conduction disorder - a dysfunction in the heart's electrical conduction system, which can make the heart beat too fast, too slow, or at an uneven rate.
  
  
• electrolyte disturbance - an imbalance in the level of electrolytes, or chemicals, in the blood, such as potassium, magnesium, or calcium.
  
  
• pericarditis - an inflammation or infection of the sac which surrounds the heart.
  
  
• valve disease - malfunction of one or more of the heart valves may cause an obstruction of the blood flow within the heart.
  
  
• enlarged heart - a condition caused by various factors, such as valve disorders, high blood pressure, congestive heart failure, conduction disturbances, etc.

An exercise EKG, or EKG done while you are exercising on a treadmill or stationary bicycle, is often performed for one or more of the following reasons:

• During a physical examination, an EKG may be performed to obtain a baseline tracing of the heart's function. This baseline tracing may be used later as a comparison with future EKGs, to determine if any changes have occurred.
  
  
• An EKG may be performed as part of a work-up prior to a procedure such as surgery, to determine if there is a pre-existing heart condition that may cause complications during or after the procedure.
  
  
• An EKG may be performed to assess the function of an implanted pacemaker.
  
  
• An EKG may be performed to determine the effectiveness of certain heart medications.
  
  
• An EKG may be performed to assess the heart's status after an MI, or after a heart-related procedure such as a cardiac catheterization, heart surgery, electrophysiological studies, etc.

click image to enlarge So Just What Do All Those Funny Squiggles Mean? Almost everyone knows what a basic EKG tracing looks like. But what does it mean? The first little upward notch of the EKG tracing is called the "P wave." The P wave indicates that the atria (the two upper chambers of the heart) are contracting to pump out blood. The next part of the tracing is a short downward section connected to a tall upward section. This next part is called the "QRS complex." This part indicates that the ventricles (the two lower chambers of the heart) are contracting to pump out blood. The next short upward segment is called the "ST segment." The ST segment indicates the amount of time from the end of the contraction of the ventricles to the beginning of the rest period before the ventricles begin to contract for the next beat. The next upward curve is called the "T wave." The T wave indicates the resting period of the ventricles. When your physician studies your EKG, he/she looks at the size and length of each part of the EKG. Variations in size and length of the different parts of the tracing may be significant. The tracing for each lead of a 12-lead EKG will look different, but will have the same basic components as described above. Each lead of the 12-lead EKG is "looking" at a specific part of the heart, so variations in a lead may indicate a problem with the part of the heart associated with a particular lead.

Heart and Vascular Health Services at
Rush University Medical Center

At Rush University Medical Center in Chicago, Illinois, cardiologists, cardiovascular surgeons, researchers and nurse specialists work in teams to address the full scope of heart problems, whether common or complex. Working in state-of-the art facilities, using some of the world¿s most sophisticated technology, these experts are on the leading edge of diagnosis, treatment and discovery. From preventive measures to heart transplantation, they are helping to revolutionize heart care.

For more information about cardiovascular services at Rush visit our Heart & Vascular Programs home page.

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