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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Indications for terminating exercise testing Absolute indications •  Drop in systolic blood pressure >10 mmHg from baseline, despite an increase in workload when accompanied by any other evidence of ischemia •  Moderate-to-severe angina, defined as level 2 angina, approaching level 3; the angina scale is described below •  Increasing nervous system symptoms (eg, ataxia, dizziness, or near syncope) •  Signs of poor perfusion (cyanosis or pallor) •  Technical difficulties monitoring the ECG or systolic blood pressure •  Patient's request to stop •  Sustained ventricular tachycardia •  ST segment elevation (>1.0 mm) in leads without diagnostic Q waves (other than V1 or aVR) Relative Indications •  Drop in systolic blood pressure ≥10 mmHg from baseline. despite an increase in workload in the absence of other evidence of ischemia •  ST or QRS changes such as excessive ST depression (>2 mm of horizontal or downsloping of ST segment depression) or marked axis shift •  Arrhythmias other than sustained ventricular tachycardia, including multifocal ventricular premature beats, ventricular triplets, supraventricular tachycardia, heart block, or bradyarrhythmias •  Fatigue, shortness of breath, wheezing, leg cramps, or claudication •  Development of bundle branch block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia •  Increasing chest pain •  Hypertensive response (systolic blood pressure >250 mmHg and/or diastolic blood pressure >115 mmHg) Four-level angina scale for exercise tolerance testing Level Onset of angina, mild but recognized as the usual angina-of-effort pain or discomfort with which the patient is familiar 1 Same pain, moderately severe and definitely uncomfortable but still tolerable 2 Severe anginal pain at a level that the subject will wish to stop exercising 3 Unbearable chest pain; the most severe pain the patient has felt 4 Data from Gibbons, RJ, Balady, GJ, Bricker, JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002; 106:1883.