Study on Multistage Maximal Stress Exercise Test

ABSTRACT

The maximal stress exercise test was studied in 49 normal korean and 231 cases of various diseases. Bicycle ergometer was used in 122 cases and treadmill was used in 109 cases by modified Bruce protocol which was designed by author. The maximal heart rate, maximal work capacity, End point of maximal exercise and ST changes especially in coronary artery disease were investigated. Total 231 cases in cluded 8 cases of myocardial infarction, 46 cases of anginal pectoris, 91 cases of atypical anginal pain, 68 cases of hypertension and 18 and of diabetes mellitus. The results are as follows; 1. The maximal heart rate was markedly reduced in myocardial infarction(115/min. comparing 162/min. in normal) and slightly less reduction in angina pectoris. Also mild reductions were observed in atypical anginal pain, hypertension and diabetes mellitus. 2. The maximal work capacity was markedly reduced in myocardial infarction(93 wt comparing 180 wt in normal). It was only slightly reduced in anginal pectoris, atypical anginal pain, hypertension and diabetes mellitus which were not significantly reduced from that of normal, especially in anginal pectoris, the reduction on maximal work capacity was unremarkale comparing that of maximal heart rate. 3. The End point of maximal exercise test were exhaution in 34%, leg pain in 30%, maximal heart rate in 22%, ST depression more than 1 mm in 21%, dyspnea in 19%, anginal pain in 15% by bicycle ergometer, while by treadmill test, the End point were exhaution in 47%, dyspnea in 35%, Maximal heart rate in 22%, ST depression more than 1 mm in 19%, leg pain in 15% and anginal pain in 10%. 4. In coronary artery disease, the positive maximal exercise test(sensitivity) was 76% in treadmill test and 68% in bicycle ergometer test. 5. The ST changes among 231 patients druing the maximal exercise test occured in 47 cases(20%). In 43 cases the ST segment depressed more than 1 mm and the degree of depression ranged 1-3.5mm. The upward sloping type and horizontal depression type were equally common. There were 4 cases(1.7%) of ST elevation during exercise which returned to normal after exercise. There were 3 cases among 54 cases of coronary artery disease(5.5%) and 2 cases among 46 cases of anginal pectoris(4.3%). In one case of anginal pectoris with elevated ST segment, myocardial infarction occured in few days later. Therefore it appears that the variant angina in this study is very few.