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Pacemakers and ICDs produce pacing spikes on ECG, which may interfere with ischemia interpretation. Stress testing is not always contraindicated but requires physician oversight. Recognizing artifacts and limitations ensures proper test documentation and accurate clinical decision-making.

Blood pressure is checked at each stage to identify abnormal responses, such as hypotension, hypertensive crises, or absent rise in systolic BP. These may indicate ischemia, heart failure, or conduction problems. Monitoring ensures timely intervention to prevent adverse events.

Atrial fibrillation with aberrant conduction produces an irregular wide-complex tachycardia. VT is usually regular, monomorphic, and faster. SVT is narrow-complex, while junctional rhythms are slower and regular. Recognizing AF with aberrancy prevents misdiagnosis of VT and ensures appropriate management.

Atrial fibrillation (AF) is characterized by chaotic atrial activity with no distinct P waves, producing an irregularly irregular ventricular rhythm. QRS complexes are usually narrow unless aberrancy is present. Flutter produces sawtooth atrial waves, sinus arrhythmia retains sinus P waves with variable rate, and junctional tachycardia has absent or inverted P waves but typically regular rhythm. AF recognition is crucial for patient management, especially regarding anticoagulation and rate control.

Atrial fibrillation is identified by the absence of discrete P waves, presence of fibrillatory waves, and an irregularly irregular QRS pattern. Ventricular rate varies depending on AV nodal conduction, often >100 bpm in uncontrolled cases. Flutter shows sawtooth waves and often regular conduction. Sinus arrhythmia is phasic and related to respiration, but P waves remain uniform. MAT has three or more P wave morphologies but is less chaotic than AF. Recognizing AF is vital for risk assessment of stroke and rate/rhythm management strategies.