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The fastest rate attained in the Master Two-Step Test
Annotations
F ip . 1. The illustration reveals the Master Two-Step Test recorded on a patient u>. B.), a man aged 39 years with angina pectoris. The upper row shows the last trip being recorded in a V, lead. The heart rate is 160 beats per minute. It givee the fastest rate attained in the two-step test. The lower row shows the first “immediate” post-exercise traeing in the same V4 lead, with a rate of 120 beats per minute. Ordinarily, this 6gure would be recorded as the faetest rate attained, whereas it is actually 160 beats per minute.
The fastest
rate attained
in the Master
Many investigators have expressed the opinion that the fastest heart rate attained in the Master Two-Step Test is not high enough to demonstrate significant ischemic S-T segment depression and therefore the heart has not been subjected to sutEcient stress to study cardiac function. We have papers in preparation to refute this theory. Meanwhile, we would like to describe a method that can be utilized by the doctor with only an ordinary electrocardiograph machine (non-monitored) to obtain the fastest heart rate in the exercise (Fig. 11. The rate is always fastest during the last trip of the two-step test. To record this rate, the electrocardiograph machine should be flipped on just as the patient begins the last trip so that there is an immediate
Two-Step
Test
recording of the electrocardiogram. This is essential, because between the time the patient completes the test and lies down and is quickly readied for the “immediate” postexercise tracing, 10 to 30 seconds may be lost during which time the highest rate as registered would have fallen 10 to 40 beats per minute. Although this tracing will be unreadable from the point of view of the S-T segment depressions, the QRS will bs delineated every time so that the correct rate can be measured. Arthur M. Master, M.D. Emeritus Clinical Professor of Medicine The Mount Sinai Medical Center New York, N. Y.
Of viral nephritis
It is interesting that for many years the streptococcus has been considered to be almost the sole cause of acute glomerulonephritis. This etiologic concept has prevailed despite the fact that most patients with the chronic forms of glomerulonephritis present no past history of acute glomerulonephritis or of a streptococcus related infection. However, one will not find things that are not sought. Unless the proper questions are asked, the proper answers will not
American Heart Journal
be obtained With these and other views in mind, we searched for a possible viral etiology of glomerulonephritia Mice and cynomolgus monkeys were infected with Coxsackie B, virus, and acute and chronic glomerulonephritis were noted to develop (Fig. 1).‘*2 Histologic and electron microscopic studies showed the renal lesions to have the same pathologic characteristics as lesions found in man suffering with acute and chronic glomerular lesions of
139
F ip . 1. The illustration reveals the Master Two-Step Test recorded on a patient u>. B.), a man aged 39 years with angina pectoris. The upper row shows the last trip being recorded in a V, lead. The heart rate is 160 beats per minute. It givee the fastest rate attained in the two-step test. The lower row shows the first “immediate” post-exercise traeing in the same V4 lead, with a rate of 120 beats per minute. Ordinarily, this 6gure would be recorded as the faetest rate attained, whereas it is actually 160 beats per minute.
The fastest
rate attained
in the Master
Many investigators have expressed the opinion that the fastest heart rate attained in the Master Two-Step Test is not high enough to demonstrate significant ischemic S-T segment depression and therefore the heart has not been subjected to sutEcient stress to study cardiac function. We have papers in preparation to refute this theory. Meanwhile, we would like to describe a method that can be utilized by the doctor with only an ordinary electrocardiograph machine (non-monitored) to obtain the fastest heart rate in the exercise (Fig. 11. The rate is always fastest during the last trip of the two-step test. To record this rate, the electrocardiograph machine should be flipped on just as the patient begins the last trip so that there is an immediate
Two-Step
Test
recording of the electrocardiogram. This is essential, because between the time the patient completes the test and lies down and is quickly readied for the “immediate” postexercise tracing, 10 to 30 seconds may be lost during which time the highest rate as registered would have fallen 10 to 40 beats per minute. Although this tracing will be unreadable from the point of view of the S-T segment depressions, the QRS will bs delineated every time so that the correct rate can be measured. Arthur M. Master, M.D. Emeritus Clinical Professor of Medicine The Mount Sinai Medical Center New York, N. Y.
Of viral nephritis
It is interesting that for many years the streptococcus has been considered to be almost the sole cause of acute glomerulonephritis. This etiologic concept has prevailed despite the fact that most patients with the chronic forms of glomerulonephritis present no past history of acute glomerulonephritis or of a streptococcus related infection. However, one will not find things that are not sought. Unless the proper questions are asked, the proper answers will not
American Heart Journal
be obtained With these and other views in mind, we searched for a possible viral etiology of glomerulonephritia Mice and cynomolgus monkeys were infected with Coxsackie B, virus, and acute and chronic glomerulonephritis were noted to develop (Fig. 1).‘*2 Histologic and electron microscopic studies showed the renal lesions to have the same pathologic characteristics as lesions found in man suffering with acute and chronic glomerular lesions of
139