An appraisal of the exercise electrocardiogram test

Development of our knowledge of coronary heart disease during the past generation has occurred concurrently with, and indeed has been largely due to, the broadened application and understanding of electrocardiography. Beyond the clinical syndromes of myocardial infarction and angina pectoris, it is recognized that there is a vast substratum of asymptomatic coronary disease which is not readily detected by conventional diagnostic techniques. Even in patients with angina pectoris, the standard resting electrocardigram is normal in one-third to one-half the instances [1, 2]. Accordingly, various stress test have been developed to detect latent impairment of coronary flow reserve, i.e., coronary insufficiency. Of these, the best known, safest, most readily applicable and standardized is the Master double two-step exercise test [3].