THE TWO-STEP EXERCISE ELECTROCARDIOGRAM: A TEST FOR CORONARY INSUFFICIENCY

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Abstract
Diagnosis of heart disease is often complicated by the fact that in 40% of patients, objective evidence of organic involvement cannot be obtained. Physiologically, ecg. indications of coronary insufficiency are more likely to become evident in tracings made following standard exercise than at rest. Coronary insufficiency is practically excluded if 2 tests are negative, i.e., a single "2-step" test and then a double "2-step." Coronary insufficiency exists if the ecg. following the "2-step" exercise is positive. Depression of the RS-T segment of over 0.5 mm. in any lead is a positive result, also a change from an upright T wave to an isoelectric or inverted T wave (except in lead III). The "2-step" test is a simple, safe, standardized procedure.