Exercise Stress Testing in Clinical Cardiology: A Practical Guide to Performance and Interpretation

Exercise stress testing remains one of the most widely used and cost-effective diagnostic tools in clinical cardiology. Beyond the traditional evaluation of induced ischemia, it provides valuable information on functional capacity, blood pressure response and arrhythmic behavior during exercise. In particular, the test plays a crucial role in assessing and interpreting exercise-induced arrhythmias, including tachyarrhythmias, such as premature ventricular beats (PVBs) and bradyarrhythmias, as well as corroborating the suspicion of some ion channel diseases. The usefulness of exercise testing is also highlighted in patients with devices, where it can help evaluate their function and exercise adaptation, as well as in specific conduction disorders, such as Wolff-Parkinson-White syndrome. This practical guide summarizes the key aspects of performing and interpreting the exercise stress test, focusing on hemodynamic and arrhythmic findings and their clinical implications, and includes several illustrative clinical cases.