A stress ECG is a heart test that records your heart’s electrical activity while you exercise. It helps assess how your heart rhythm behaves as your heart rate rises, and whether symptoms or signs of strain appear under exertion.

A resting ECG records your heart’s electrical activity while you are resting and lying still.

A stress ECG records your heart’s electrical activity during exercise, which can reveal problems that may not show up at rest.

A stress ECG may be recommended if you have symptoms that occur during activity, such as:

• Chest discomfort or tightness.

• Shortness of breath with exertion.

• Palpitations during exercise.

• Dizziness or lightheadedness.

• Reduced exercise tolerance or unusual fatigue.

It is also useful if you have multiple risk factors for heart disease and your doctor wants a clearer assessment.

You may benefit from a stress ECG if you:

• Experience chest pain or pressure during exertion.

• Get breathless more easily than expected.

• Have palpitations during exercise.

• Have multiple cardiovascular risk factors (blood pressure, cholesterol, diabetes, smoking history, family history).

• Want a medically supervised check before returning to exercise after illness or time off training.

A stress ECG can help assess for:

• Exercise-induced ischemia (reduced blood flow to the heart muscle during exertion).

• Exercise-related arrhythmias (abnormal heart rhythms triggered by exertion).

• Abnormal heart rate response to exercise.

• Abnormal blood pressure response to exercise.

• Exercise tolerance and recovery patterns.

A stress ECG can provide clues that suggest reduced blood flow to the heart muscle during exertion, which may be consistent with coronary artery disease.

It is not the same as a CT coronary angiogram or invasive angiography, and your doctor will guide you if further testing is needed.

Sometimes, yes. Many people with exertional symptoms have a normal resting ECG. A stress ECG can reveal changes that only occur when the heart is working harder.

Symptoms that deserve careful assessment include:

• Chest tightness, pressure, heaviness or burning with exertion.

• Shortness of breath that feels out of proportion.

• Dizziness or near-fainting during activity.

• Sudden decline in exercise capacity.

• Palpitations triggered by exertion.

If symptoms are severe, worsening, or occurring at rest, urgent medical care may be needed.

A typical stress ECG includes:

1) Electrode stickers placed on the chest for continuous monitoring.

2) Baseline blood pressure and resting ECG.

3) gradual exercise with increasing workload until your target heart rate is achieved.

4) Blood pressure checks during the test.

5) Recovery ECG and blood pressure monitoring after exercise for 6 minutes.

You are supervised throughout and can stop at any time.

At Peak, stress ECG testing is performed on a medical-grade ECG bicycle ergometer.

Many patients find bike testing more comfortable and approachable than treadmill testing, especially if they have joint discomfort, balance concerns, or anxiety about running.

A bicycle stress ECG can be:

• Lower impact on knees and hips.

• More stable and secure (seated position).

• Less intimidating for many patients.

• Well suited to patients who are used to cycling.

• Supports diagnostically accurate ECG and blood pressure monitoring.

Yes. Stress ECG testing is widely used and generally safe when performed in a supervised medical setting. ECG and blood pressure are monitored throughout, and the test can be stopped immediately if needed.

Most appointments take 30–60 minutes, including preparation, exercise time, and recovery monitoring.

No, it isn’t painful. The exercise component may feel like cycling uphill gradually, depending on your fitness level and the protocol used. Minor discomfort may occur when removing of the adhesive electrode stickers afterwards.

As a general guide:

• Please ensure your skin is clean and dry and do not apply body oils or moisturisers before the test as this makes it difficult for electrodes to stick.

• Wear comfortable clothing and shoes suitable for cycling.

• Feel free to bring a sweat towel with you.

• Avoid a heavy meal and caffeinated beverages before the test.

• Avoid smoking and vaping before the test.

• Stay well hydrated.

• Take your usual medications on the morning of the test, unless you have been instructed otherwise.

• Bring a list of your current medications with you.

• If you use an asthma pump/inhaler, please bring it with.

• Arrive 10 – 15 minutes early.

Often it’s best to avoid caffeine beforehand, as it can affect heart rate and symptoms. If you’re unsure, ask us when booking.

This depends on the reason for the test and the medication involved. Take your medication as prescribed unless your doctor has advised otherwise. If unsure, check with us before your appointment.

Wear:

• Comfortable exercise clothing.

• Shoes suitable for cycling.

• Bring a sweat towel with.

Avoid very tight or restrictive clothing if possible.

For accurate ECG lead placement, electrodes are placed on the chest. You may be asked to remove your shirt or wear clothing that allows access to the chest area. We keep the process professional and respectful.

If the result suggests changes that need further evaluation, your doctor may recommend:

• Additional blood tests.

• Echocardiography (heart ultrasound).

• Referral to a cardiologist.

• Further imaging if appropriate.

We’ll explain the findings clearly and guide next steps.

A normal stress ECG is often reassuring. Depending on your symptoms and risk factors, your doctor may still recommend follow-up or additional testing. It can also help guide safe exercise advice and prevention strategies.

In many cases, stress ECG testing is best arranged after a consultation so we can ensure the test is appropriate and safe for your symptoms. If you already have a referral, we can usually accommodate this.

Please contact Peak Family Practice directly by telephone, whatsapp or email to ensure appropriate scheduling. If you’re unsure whether you need a resting ECG, stress ECG, or another assessment, we’re happy to guide you.

Peak Family Practice is a private GP practice based at
4 Victoria Avenue, Hout Bay, Cape Town.

Yes. There is easy parking right outside the entrance.
There is also street parking available on Victoria Avenue.

You can email us at reception@peakpractice.co.za, call us on
021 300 9252, or use the contact form on this website.