Exercise Stress ECG

What it does

Exercise Stress ECG reads a treadmill or bicycle exercise test. The test is still a common first investigation for chest pain in many health systems and is often reported by junior doctors, who have to combine several strands into one conclusion: how the ST segment behaves at each stage and in recovery, how far the patient exercised, how heart rate and blood pressure responded, which arrhythmias occurred, and whether angina appeared.

The run reads the stage-averaged complexes or the full-disclosure recording, measures the ST deviation by stage and in recovery, notes arrhythmias and the chronotropic response, and combines exercise time, the maximal ST deviation and the angina index into the Duke Treadmill Score with its risk class.

Intended use

Decision support for physicians who report exercise tests: a consistent measurement of the ST response and a calculated Duke Treadmill Score, so the conclusion and the next step rest on the same numbers every time.

Who it is for

Cardiology residents and junior doctors who report stress tests, cardiologists who supervise them, and primary-care and sports physicians who receive the reports.

Accepted input

• Full-disclosure export of the whole test from the stress system.
• Report pages as PDF or images, with the stage-averaged complexes and the protocol table. Most centres can export only these pages, so the run is built to read them.
• Protocol data: stage times, total exercise time, heart rate and blood pressure per stage, as printed in the report or passed alongside it.

Requirements

Requirement	Why
Stage-averaged complexes or full disclosure for each stage and recovery	ST deviation is measured per stage
Calibration pulse or scale on images	ST deviation in millimetres depends on the gain
Total exercise time and protocol	The Duke score is defined for exercise time on the Bruce protocol
Angina index entered by the supervising physician	Exercise-induced angina cannot be read from the ECG
Patient age and sex	Age-predicted heart rate and the chronotropic response

Optional context

The indication, symptoms during the test, the reason for stopping and rate-limiting drugs such as beta-blockers can be passed in clinical_context; they qualify the chronotropic response and the guidance.

The result

One structured result per test with measurements, the score and its inputs, and the averaged complexes that show the maximal ST deviation.

Section	Content
Duke Treadmill Score	Score and risk class from exercise time, maximal ST deviation and the entered angina index, with ST response per stage and in recovery, arrhythmias, heart-rate and blood-pressure response
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

The ST deviation is measured with the same measurement code used for the resting 12-lead ECG, applied to the stage-averaged beats, so resting and exercise values are comparable.

Standards

• Output: Encapsulated PDF of the stress report alongside the structured result.
• Score: Duke Treadmill Score and its risk classes (Mark, Ann Intern Med 1987).

Score notes

The score is exercise time in minutes on the Bruce protocol − 5 × maximal ST deviation in millimetres − 4 × angina index (0 none, 1 non-limiting, 2 test-limiting). A score of +5 or more is low risk, −10 to +4 moderate risk and −11 or less high risk. Each input is shown next to the result: exercise time, the stage and lead of the maximal ST deviation, and the angina index as entered, so every term can be checked.