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Tremors from Parkinson’s disease cause muscle artifact, producing irregular baseline fluctuations. The CCT should explain the importance of relaxation and stillness and may try repeated recordings if artifact persists. Cancellation is unnecessary, and electrode placement remains standard. Pediatric electrodes are not required unless patient size dictates. Awareness of tremor-related artifact helps ensure usable tracings.

Hypokalemia produces flattened or inverted T waves, prominent U waves, and possible ST depression. Hyperkalemia causes peaked T waves. Short PR intervals may indicate WPW, and ST elevation indicates myocardial injury. Electrolyte recognition is a vital ECG skill.

Inferior wall ischemia or infarction manifests as ST elevation or Q waves in leads II, III, and aVF. Leads I and aVL reflect the lateral wall; V1–V2 reflect the septum; V5–V6 reflect the lateral wall. Recognizing which leads correspond to specific heart regions is essential for localizing MI and guiding management.

Arrhythmias, particularly premature ventricular contractions (PVCs) and premature atrial contractions (PACs), are the most common complication during stress testing. Most are benign and transient. Serious events such as MI, VF, or stroke are rare but possible. Recognizing and documenting arrhythmias helps guide test interpretation. Proper screening, continuous ECG monitoring, and emergency preparedness reduce risks. CCTs must be vigilant in identifying arrhythmias and escalating when necessary.

V3 and V4 represent the anterior wall of the left ventricle. V1–V2 are septal, V5–V6 lateral, and II, III, aVF inferior. Recognizing lead groupings helps localize myocardial infarction or ischemia. Anterior infarctions are typically more extensive and have prognostic significance.