Submaximal treadmill exercise testing of patients with coronary artery disease.

The submaximal treadmill exercise test is a valuable noninvasive tool for the diagnosis of overt or latent coronary artery disease (CAD). When submaximal heart rates of 80% to 90% of the predicted maximal rates are attained and when ST-segment depression of at least 1 mm is taken as a criterion of ischemia, testing by any of the various exercise protocols with continuous ECG monitoring affords reasonable specificity and sensitivity. The objectives of testing are to (1) diagnose and determine the severity of CAD, (2) assess functional capacity, (3) observe the natural history of disease, (4) evaluate the effects of medical and surgical treatment, and (5) evaluate responses to physical conditioning or to programs directed toward prevention of CAD.

Familial occurrence of sinus bradycardia, short PR interval, intraventricular conduction defects, recurrent supraventricular tachycardia, and cardiomegaly.

Four members of a family presenting with sinus bradycardia, a short P-R interval, intraventricular conduction defects, recurrent supraventricular tachycardia (SVT), syncope, and cardiomegaly had His bundle studies and were found to have markedly shortened A-H intervals (30 to 55 msec.) with normal H-V times (35 to 50 msec.).

Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients.

Short-term results of aggressive surgical management were compared with results of medical management in forty-three patients with preinfarction angina admitted to the coronary-care unit (CCU) over an 18 month period. These patients were selected from 1,609 consecutive admissions to the CCU because they met strict criteria for preinfarction angina: severe chest pain at rest, ST-segment elevation or depression during pain which subsided rapidly after cessation of pain, and normal serum enzymes (CPK, SGOT, and LDH). Twenty-three patients had coronary angiography, done with operating room and pump standby.