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Exercise Tolerance Test: The Decision to Refer-Reply
Arthur Hartz, MD, PhD;
John E. Midtling, MD, MS
Medical College of Wisconsin Milwaukee
Arch Fam Med. 1993;2(12):1222.
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In reply
There were four major issues raised by Grauer:
First, Grauer states that the scenario was incomplete because the results of the exercise tolerance test (ETT) were inadequately described. Grauer acknowledges, however, that 2 mm of downsloping ST-segment depression with moderate exercise (8 metabolic equivalents of exercise) is a "markedly abnormal result." More details about the stress test might have confirmed the result, but during extensive pilot testing of this scenario, no clinicians required additional information. The clinicians also seemed satisfied that no ST-segment depression after the patient achieved 90% of maximum predicted heart rate was a normal test. Thus, we do not believe the results of our study would have been substantially affected if we had added additional information that confirmed the impression given in the scenario.
Second, Grauer is correct in stating that there were no middle ground results. The intent of our study was to describe the variation in
. . . [Full Text PDF of this Article]
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