TWO-STEP EXERCISE ELECTROCARDIOGRAM FOLLOW-UP INVESTIGATION IN PATIENTS WTTH CHEST PAIN AND NORMAL RESTING ELECTROCARDIOGRAM

Journal/Book: Reprinted from The Journal of the American Medical Association February 7 1953 Vol. 151 pp. 458-462. 1953;

Abstract: Arthur M. Master M.D. Leon Pordy M.D. and Kenneth Chesky M.D. New York From the Cardiographic Laboratory Mount Sinai Hospital. Read before the Section an General Practice at the 101st Annual Session of the American Medical Association Chicago June 11 1952. SUMMARY Follow-up studies have been reported of 300 patients seen consecutively in private practice beginning in 1946. The majority of the patients complained of pain in the chest. The resting 12-lead electrocardiogram of all 300 was normal. The patients were divided into two equal groups. The first group consisted of 150 patients with both negative single and negative double Master two-step exercise tests. The second group consisted of 150 patients in whom either the Single or double two-step exercise electrocardiogram was positive. Both groups were frequently examined or questioned. The average follow-up period extended for from three to four years. Among the group of 150 patients with negative single and double Master two-step exercise tests only 1 woman sustained a coronary occlusion three years later. No other instances of spontaneous coronary disease episodes occurred. Therefore negative tests indicated that the chest pain was noncardiac in origin. In one-third of these cases further study revealed the true cause for the patient's complaint to be arthritis gallbladder disease or gastrointestinal disease (including hiatus hernia). Negative single and double Master two-step exercise tests practically exclude the presence of coronary insufficiency in patients with chest pain and normal resting electrocardiograms. Of course this is not absolute. Among the group of 150 patients with positive single or double Master two-step exercise tests 86 patients (nearly 60% ) had spontaneous attacks of coronary occlusion or insufficiency either before or after the exercise test was found to be positive. Twelve deaths occurred among these patients-10 as a result of coronary occlusion. Of the remaining 64 Gases 49 had definite clinical coronary artery disease. Coronary insufficiency may occur either an a functional or an organic basis. Thus in the remaining 15 persons in this group the clinical Impression that the heart disturbance was functional was confirmed by a normalization of the positive exercise tests following the administration of dihydroergocornine. In thousands of patients in whom the two-step tests have been performed since 1929 we have never had a single accident. The test is performed only when the resting electrocardiogram is normal. The single two-step test is performed first and only when this is negative should the double two-step test be done. The Master two-step test is also useful in examinations of firemen policemen taxi drivers train engineers truckmen pilots and officers in the armed forces and in any person exposed to undue mental and physical strain. In fact it might well be extended to various phases of industry. It is particularly valuable in compensation work and life insurance disability. The two-step test is valuable not only as a diagnostic aid but also as a gage of the improvement or regression of existent heart disease; however diagnosis or prognosis must never depend solely an the two-step exercise electrocardiogram. ___MH

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