What abnormal findings can be revealed by a stress test?

• A. Chest pain with no ECG changes
• B. No ECG changes, chest pain, and increased heart rate
• C. ECG changes, chest pain, and increased heart rate
• D. Normal results with exercise

Answer: (C)

The test looks for evidence of myocardial ischemia as the heart is stressed. The strongest indicators of an abnormal stress test are when the ECG shows changes suggestive of ischemia (such as ST-segment changes) while the patient experiences chest pain during exertion. Seeing these signs together with a heart-rate increase that occurs with exercise supports that the heart is not getting enough blood flow under stress, pointing to underlying coronary disease.

So, when you observe ECG changes during exercise, plus chest pain, plus an appropriate heart-rate response (increase with exercise), that combination best indicates an abnormal stress test result. The other scenarios—chest pain without ECG changes, or no ECG changes with symptoms, or a completely normal test—are less consistent with definitive ischemia.