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Absolute Indications

1. Suspicion of a myocardial infarction or acute myocardial infarction (heart attack)
2. Onset of moderate-to-severe angina (chest pain)
3. Drop in systolic blood pressure (SBP) below standing resting pressure or drop in SBP with increasing workload accompanied by signs or symptoms
4. Signs of poor perfusion (circulation or blood flow), including pallor (pale appearance to the skin), cyanosis (bluish discoloration), or cold and clammy skin
5. Severe or unusual shortness of breath
6. CNS (central nervous system) symptoms
   1. e.g., ataxia (failure of muscular coordination), vertigo (An illusion of dizzying movement), visual or gait (pattern of walking or running) problems, confusion)
7. Serious arrhythmias (abnormal heart rhythms)
   1. e.g.: second / third degree AV block, atrial fibrillation with fast ventricular response, increasing premature ventricular contractions or sustained ventricular tachycardia)
8. Technical inability to monitor the ECG
9. Patient's request (to stop)

Relative Indications

1. Any chest pain that is increasing
2. Physical or verbal manifestations of shortness of breath of severe fatigue
3. Wheezing
4. Leg cramps or intermittent claudication (grade 3 on a 4-point scale)
5. Hypertensive response (SBP >260 mm Hg; DBP>115 mm Hg)
6. Pronounced ECG changes from baseline
   1. >2 mm of horizontal or down sloping ST- segment depression, or >2 mm of ST-segment elevation (except in aVR)
7. Exercise-induced bundle branch block that cannot be distinguished from ventricular tachycardia
8. Less serious arrhythmias (abnormal heart rhythms) such as supraventricular tachycardia