Objective: To explore the application value of treadmill exercise test and dynamic electrocardiogram in diagnosing coronary heart disease. Methods: A total of 185 patients with suspected coronary heart disease admitted to the Department of Electrocardiography in Wujia District of Central People’s Hospital from February 2023 to February 2024 were selected according to the inclusion and exclusion criteria, including 93 males and 92 females, aged from 38 to 75 years, with an average age of (55.86 ± 3.25) years. Treadmill exercise test and dynamic electrocardiogram were performed on all patients, and the results of coronary angiography were used as the gold standard. Results: The results of coronary angiography in 185 patients showed that 148 patients were diagnosed as positive, accounting for 80%. The coronary heart disease detection rate in the treadmill exercise test group was 97.30%, which was significantly higher than that in the Holter group, and the difference was statistically significant (P < 0.05). The accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of the treadmill exercise test group were 95.68%, 89.19%, 97.30%, 97.30%, and 89.19%, respectively, which were significantly higher than those of the Holter group (P < 0.05). The misdiagnosis rate and missed diagnosis rate of the treadmill exercise test group were 10.81% and 2.70%, which were significantly lower than those of the dynamic electrocardiogram group, and the difference was statistically significant (P < 0.05). Conclusion: Both treadmill exercise testing and Holter have unique advantages and limitations. In clinical practice, treadmill exercise testing has a high application value in the diagnosis of coronary heart disease and can effectively reduce the misdiagnosis rate.