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Normally, systolic blood pressure rises progressively with increasing workload due to higher cardiac output. Diastolic pressure typically stays the same or may decrease slightly due to vasodilation. A drop in systolic BP or a sharp rise in diastolic BP indicates abnormal hemodynamic response and may necessitate test termination. Monitoring BP trends is essential in stress testing safety and interpretation.

The Bruce protocol is the most widely used treadmill stress test protocol. It involves 3-minute stages with progressively increasing treadmill speed and incline, providing standardized workloads. The Balke and Naughton protocols involve smaller, gradual increments and are often used in deconditioned or cardiac patients. Ramp protocols allow continuous, small increases. The Bruce protocol’s reproducibility and established norms make it the default choice for diagnostic testing, although other protocols may be preferred in specific populations.

Metallic objects like necklaces, bracelets, or piercings can introduce electromagnetic interference that produces artifact on ECG tracings. They do not directly change electrode polarity but can distort signals. Removing jewelry also ensures better electrode adhesion and patient safety during procedures. CCTs should always check for and remove interfering items before applying electrodes.

Loose-fitting clothing helps prevent pulling on electrodes or wires, reducing artifact and electrode detachment. Tight clothing may pull wires and cause discomfort. Exposing electrodes unnecessarily increases risk of dislodgment or skin irritation. Proper clothing advice improves comfort and test reliability.

Acute pulmonary embolism is an absolute contraindication due to high risk of decompensation. Controlled arrhythmias and mild COPD may allow stress testing with precautions. Stable angina is not absolute but requires careful monitoring. Screening for contraindications protects patient safety and aligns with AHA guidelines.