Treading Lightly: ST-Segment Elevation on an Exercise Electrocardiogram

ST-segment elevation during an exercise ECG test is rare. It has been estimated to occur in approximately 0.1% of patients who have not had a previous myocardial infarction and have no pathologic Q waves on the baseline ECG. It is likely that in current practice the incidence of ST elevation during exercise treadmill testing is even less frequent, given the sheer volume of tests currently performed--especially in low-risk individuals. Exercise testing has a class IA indication for patients who have symptoms suggesting ischemia, an intermediate pretest probability of coronary artery disease based on gender, age, and type of symptoms, an ability to exercise, and no repolarization abnormalities on the baseline ECG. Here, Stauber et al examine the results of the exercise ECG test of the 68-year-old man with exertional chest pain.