ECG 12c. The ECG above belongs to the same patient. It was recorded 1 minute after termination of the test (recovery phase).
Leads II, III and aVF show upsloping ST depression. Leads V1 and V2 show ST segment elevation.

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ECG 12d. The ECG above belongs to the same patient. It was recorded 2 minute after termination of the test (recovery phase).
Leads II, III and aVF show upsloping ST depression. Leads V1 and V2 show ST segment elevation.

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ECG 12e. The ECG above belongs to the same patient. It was recorded 1 minute after termination of the test (recovery phase).
Now leads II, III and aVF show horizontal ST segment depression. Leads V5 and V6 also show horizontal ST depression.
Leads V1 and V2 still show ST segment elevation.
ST segment deviations arising during recovery phase of an exercise test is very important in diagnosing coronary artery disease.
Coronary angiography was performed after this treadmill exercise test.
He then underwent coronary artery bypass grafting surgery for significant stenoses in his LAD and Diagonal arteries.

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ECG 13a. The ECG above belongs to a 58 years-old diabetic, hypertensive man.
He has coronary artery disease, old myocardial infarction and left ventricular systolic dysfunction (EF 38%).
He had undergone coronary artery bypass grafting surgery 15 years ago.
In the last 2 years, stents were implanted in his Cx and LAD coronary arteries.
He still has significant several coronary artery stenoses which were not suitable for stenting.
The above ECG was recorded at the onset of his treadmill exercise test.
ST depression in leads II, III, aVF, V5 and V6 is seen. Lead aVR shows less than 1 mm ST elevation.

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ECG 13b. The ECG above belongs to the same man. It was recorded at the third minute of his treadmill exercise test.
New-onset ST segment depression appeared in lead V4. ST segment depression is also increased in leads V5 and V6.

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ECG 13c. The ECG above belongs to the same man. It was recorded at the sixth minute of his treadmill exercise test.
Leads II, III, aVF, V4, V5 and V6 show prominent ST segment depression.
Lead aVR shows ST segment elevation.

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ECG 13d. The ECG above belongs to the same man. It was recorded 14 seconds after stopping the treadmill.
Leads II, III, aVF, V4, V5 and V6 show prominent ST segment depression.
Lead aVR shows ST segment elevation.
These ECG changes are due to stenosed coronary arteries resulting in myocardial ischemia during exercise.

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ECG 14a. The ECG above belongs to a 56 years-old man complaining of chest pain.
It was recorded before the onset of treadmil exercise test (stress test).
No ST segment depression is seen in the above pre-test ECG.
In the past, 3 coronary stents were implanted.

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ECG 14b. The ECG above belongs to the same man.
It was recorded at the 6th minute of his treadmill exercise test.
ST segment depression is seen in several leads.

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ECG 14c. The ECG above belongs to the same man.
It was recorded at the 8th minute of his treadmill exercise test.
ST segment depression is seen in several leads.

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ECG 14d. The ECG above belongs to the same man.
It was recorded one minute after stopping the treadmill (recovery period).
Persistence of ST segment depression during the recovery period strongly suggests myocardial ischemia.
This patient underwent coronary angiography two days after the above excercise test.
3-vessel (multivessel) coronary artery disease was diagnosed and he underwent coronary bypass surgery.

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ECG 15a. The ECG above belongs to a 63 years-old man complaining of chest pain.
It was recorded just before the onset of treadmil exercise test (stress test).
No ST segment depression is seen in the above pre-test ECG.

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ECG 15b. The ECG above belongs to the same man.
It was recorded at the 3rd minute of his treadmill exercise test.
ST segment depression starts to appear in inferior and lateral leads.

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ECG 15c. The ECG above belongs to the same man.
It was recorded at the 6th minute of his treadmill exercise test.
ST segment depression is deeper in inferior and lateral leads.

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ECG 15d. The ECG above belongs to the same man.
It was recorded at the peak (9 minutes 33 seconds) level of the treadmill exercise test.
İnferior and lateral leads show ST segment depression. The test was stopped after this recording.

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ECG 15e. The ECG above belongs to the same man.
It was recorded three minutes after stopping the treadmill (3rd minute of the recovery period).
Persistence of ST segment depression during the recovery period strongly suggests myocardial ischemia.
This patient underwent coronary angiography and a stent was implanted at the proximal segment of his
Circumflex (Cx) coronary artery. His other coronary arteries were normal.

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