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Mental stress and the left ventricular ejection fraction
dio#am record6d in parasternal lot& axis view Ming a prominent Ien velltlicular tdeculation (#row).
tion of the left ventricular cavity in avoiding misdiagnosis of normal Variants. Bret A. witi-, MD Dominic ~ristofaro, MD Long Beach, California 13 August 1992
REFERENCES
1. Mamn BJ, Klnes HG, McIntosh C. Jntraventricu-
lar musclebandmimickingasymmetricvenaicnlarsep tsl hypertrophyandhypertmphiccardiomyopathy.Am J Cardiol 1992;70:13&131. 2. Boyd MB, Seward JB, Tajik AJ, Edwards WD. Frequencyand location of prominentleft ventticulat aabecnlationsat autopsyin 474 normalhumanheruts: implicationsfor evaluationof mural thrombi by twodimensional echocardiography.J Am CON Cardiol 1987;9:323-326.
3. RobertsWC. Anontalonsleft ventricnlar band.An nnemphasizedcauseof a precordisl musicalmurmnr. Am J Cm-did 1%9;23:735-737. 4. Vered2, Meltrer RS,BenjaminP,MOUOM, Neufeld H. Ptevslenceand signiticanceof false tendonsin the left ventricle as determinedby echocardiography.Am J Cardioi 1984;53:33&332. S. Perry LW, RuckmsnRN, ShapiroSR, Kuehl KS, Gslioto FM, Scott LP. Left ventricular false tendons in children: prevalenceas detectedby 2dimensional echocsrdiographyandclinical significance.Am J Cardial 1983;52:126&1266. 6. Keren A, Billiighsm ME, Popp RL. Echccardiographic recognition and implications of ventricular hypertrophic trabeculations and aberrant bands. Circulation 1984.70~836842. 7. NishimuraT, Kondo M, UmadomeH, ShimonoY. Echocardiogrsphicfeaturesof false tendonsin the left ventricle.Am J Cardiol 1981:48:177-183.
Avoid the Phrase Electrocardi~ grqMmic “Changes”
Knowing Spodick to be fastidious in his use of terminology, I was surprised to read the first sentenceof the article “Electrocardiographic Features of Restrictive Pulmonary Disease, and Comparison with Those of Obstructive Pulmonary Disease,” in The American Journal of Cardiology, August 1, 1992, of which he is part author. He used the term “electrocardiographic changes. ” I think Spodick might agree that what he in fact intended to say was “electrocardiographic ab500
normalities” or “electrocardiographic pattern” or “ECG features” as in the title. More than just a semanticquibble, I am frequently called by emergency room physicians who claim to see “changes” in an ECG when indeed what they are describing is an abnormality with no prior ECG documentation to justify the term “change.” It is of courseunderstood that what has been meant by the term “change” has generally been “change from normal” (not good English in any case), but this could equally apply to “changes within normal,’ ’ which of course has yet another meaning. I hope Spodick would join me in a plea that the term “electrocardiographic changes” be confined to those in which a true “change” is documented, by deli&ion requiring at least 2 sequentialtracings. If what is meant is “abnormality,” then that term (or perhaps a shorter term of the same meaning) could be employed. If the word “change” refers to “change within normal,” as often appearsto be the casein this article, the term “pattern” or “features” would seema clearer description. Philip J. Millman, MD Watertown, New York 17 August 1992
REPLY: hIillman is, of course, absolutely correct and I wholeheartedly join him in his proposal that the word “change” be used in its precise (therefore appropriate) sense. “Abnormality” is basic, and if there is an abnormality, whether it is a “change” should remain in the realm of comparisonwith a previous status.As Millman notes, that status could be normal or abnormal. I am grateful to him for pointing this out. David H. SpOdlCk, MD, MC Worcester, Massachusetts 3 September 1992
MentalstrassandthaLeft Mcular Ejection Fraction
Ironson et al’ report that patients with coronary artery disease demonstrated greater reduction in ejection fraction during angerrecall than during other mental stress, such as giving a speech defending themselves against a hypothetical charge of shoplifting. In contrast, Rozanski
THE AMERICANJOURNALOF CARDIOLOGY VOLUME71
FEBRUARY15, 1993
et al reported that a personally relevant, emotionally arousing speaking task clearly induced more ischemic abnormalities than other mental stress.*These tindings and the correlation of a compromised selfimage to coronary risk (coronary artery disease) suggest determining the emotional significance of speech by monitoring the frequency and duration of hesitation pausesof 1 second or more (4.79 f 2.48/rnim 1.50 f 0.33 second [mean & SD]), which correlate with coronary arterv diseaseand mood, respec&ely.3Ernest H. Fl’idmall, MD Cleveland, Ohio 8 September 1992
REFERENCES 1. honson G, Taylor CB, Boltwocd M, Bsrtzokis T, Dennis C, ChesneyM, SpitzerS, SegallGM. Effects of anger on left ventricular ejection fraction in core nary army disease.Am J Cardiol 1992;70:281-285. 2. Rozanski A. Bsirev CN. Krsntz DS. FriedmanJ. ResserKJ, M&e11M: Hilton-Chalfen S, He&n L; BietendorfJ, BennanDS. Mentsl stressandthe induction of silentmyocsrdialischemiain patientswith cotsnary artery disease. N Engl .l Med 1988;318: 100~1012. 3. Friedmsn EH. Letter to the editor. J Psychmom Res 1991;35:741.
Readership
Response
Our recent editorial that appeared in your journal, “Questions Unresolved by the Third International Study of Infarct Survival,” by Sobel and Collen has evoked a prodigious number of requests for reprints. In addition, I have received somecomplimentary comments about the importance of the airing of the views expressed.My purpose in writing to you is simply that as an editor you are undoubtedly subjected to distressing correspondence all too often. It seemsto be that you should be advised when the extensive readership of your journal and the journal’s remarkably positive and profound influence result in such an obvious and unusual response to a single article. I knew that The American Journal of Cardiology had profound impact, but I was surprised and delighted to seethat it is such a powerful vehicle for dissemination of clinically relevant information and views. Thanks for the opportunity you provided to us. Best regards. Burt011 E. &bel, MD St.Louis, Missouri 24 August 1992
tion of the left ventricular cavity in avoiding misdiagnosis of normal Variants. Bret A. witi-, MD Dominic ~ristofaro, MD Long Beach, California 13 August 1992
REFERENCES
1. Mamn BJ, Klnes HG, McIntosh C. Jntraventricu-
lar musclebandmimickingasymmetricvenaicnlarsep tsl hypertrophyandhypertmphiccardiomyopathy.Am J Cardiol 1992;70:13&131. 2. Boyd MB, Seward JB, Tajik AJ, Edwards WD. Frequencyand location of prominentleft ventticulat aabecnlationsat autopsyin 474 normalhumanheruts: implicationsfor evaluationof mural thrombi by twodimensional echocardiography.J Am CON Cardiol 1987;9:323-326.
3. RobertsWC. Anontalonsleft ventricnlar band.An nnemphasizedcauseof a precordisl musicalmurmnr. Am J Cm-did 1%9;23:735-737. 4. Vered2, Meltrer RS,BenjaminP,MOUOM, Neufeld H. Ptevslenceand signiticanceof false tendonsin the left ventricle as determinedby echocardiography.Am J Cardioi 1984;53:33&332. S. Perry LW, RuckmsnRN, ShapiroSR, Kuehl KS, Gslioto FM, Scott LP. Left ventricular false tendons in children: prevalenceas detectedby 2dimensional echocsrdiographyandclinical significance.Am J Cardial 1983;52:126&1266. 6. Keren A, Billiighsm ME, Popp RL. Echccardiographic recognition and implications of ventricular hypertrophic trabeculations and aberrant bands. Circulation 1984.70~836842. 7. NishimuraT, Kondo M, UmadomeH, ShimonoY. Echocardiogrsphicfeaturesof false tendonsin the left ventricle.Am J Cardiol 1981:48:177-183.
Avoid the Phrase Electrocardi~ grqMmic “Changes”
Knowing Spodick to be fastidious in his use of terminology, I was surprised to read the first sentenceof the article “Electrocardiographic Features of Restrictive Pulmonary Disease, and Comparison with Those of Obstructive Pulmonary Disease,” in The American Journal of Cardiology, August 1, 1992, of which he is part author. He used the term “electrocardiographic changes. ” I think Spodick might agree that what he in fact intended to say was “electrocardiographic ab500
normalities” or “electrocardiographic pattern” or “ECG features” as in the title. More than just a semanticquibble, I am frequently called by emergency room physicians who claim to see “changes” in an ECG when indeed what they are describing is an abnormality with no prior ECG documentation to justify the term “change.” It is of courseunderstood that what has been meant by the term “change” has generally been “change from normal” (not good English in any case), but this could equally apply to “changes within normal,’ ’ which of course has yet another meaning. I hope Spodick would join me in a plea that the term “electrocardiographic changes” be confined to those in which a true “change” is documented, by deli&ion requiring at least 2 sequentialtracings. If what is meant is “abnormality,” then that term (or perhaps a shorter term of the same meaning) could be employed. If the word “change” refers to “change within normal,” as often appearsto be the casein this article, the term “pattern” or “features” would seema clearer description. Philip J. Millman, MD Watertown, New York 17 August 1992
REPLY: hIillman is, of course, absolutely correct and I wholeheartedly join him in his proposal that the word “change” be used in its precise (therefore appropriate) sense. “Abnormality” is basic, and if there is an abnormality, whether it is a “change” should remain in the realm of comparisonwith a previous status.As Millman notes, that status could be normal or abnormal. I am grateful to him for pointing this out. David H. SpOdlCk, MD, MC Worcester, Massachusetts 3 September 1992
MentalstrassandthaLeft Mcular Ejection Fraction
Ironson et al’ report that patients with coronary artery disease demonstrated greater reduction in ejection fraction during angerrecall than during other mental stress, such as giving a speech defending themselves against a hypothetical charge of shoplifting. In contrast, Rozanski
THE AMERICANJOURNALOF CARDIOLOGY VOLUME71
FEBRUARY15, 1993
et al reported that a personally relevant, emotionally arousing speaking task clearly induced more ischemic abnormalities than other mental stress.*These tindings and the correlation of a compromised selfimage to coronary risk (coronary artery disease) suggest determining the emotional significance of speech by monitoring the frequency and duration of hesitation pausesof 1 second or more (4.79 f 2.48/rnim 1.50 f 0.33 second [mean & SD]), which correlate with coronary arterv diseaseand mood, respec&ely.3Ernest H. Fl’idmall, MD Cleveland, Ohio 8 September 1992
REFERENCES 1. honson G, Taylor CB, Boltwocd M, Bsrtzokis T, Dennis C, ChesneyM, SpitzerS, SegallGM. Effects of anger on left ventricular ejection fraction in core nary army disease.Am J Cardiol 1992;70:281-285. 2. Rozanski A. Bsirev CN. Krsntz DS. FriedmanJ. ResserKJ, M&e11M: Hilton-Chalfen S, He&n L; BietendorfJ, BennanDS. Mentsl stressandthe induction of silentmyocsrdialischemiain patientswith cotsnary artery disease. N Engl .l Med 1988;318: 100~1012. 3. Friedmsn EH. Letter to the editor. J Psychmom Res 1991;35:741.
Readership
Response
Our recent editorial that appeared in your journal, “Questions Unresolved by the Third International Study of Infarct Survival,” by Sobel and Collen has evoked a prodigious number of requests for reprints. In addition, I have received somecomplimentary comments about the importance of the airing of the views expressed.My purpose in writing to you is simply that as an editor you are undoubtedly subjected to distressing correspondence all too often. It seemsto be that you should be advised when the extensive readership of your journal and the journal’s remarkably positive and profound influence result in such an obvious and unusual response to a single article. I knew that The American Journal of Cardiology had profound impact, but I was surprised and delighted to seethat it is such a powerful vehicle for dissemination of clinically relevant information and views. Thanks for the opportunity you provided to us. Best regards. Burt011 E. &bel, MD St.Louis, Missouri 24 August 1992