Master Two-step Test Research Articles

Angina pectoris with normal coronary arteriograms: Hemodynamic and metabolic response to atrial pacing

Seventeen subjects ranging from 36 to 58 years of age presented with chest pain suggestive of myocardial ischemia. Each patient had a positive double Master's two-step test with ST segment depression of 0.5 mm. or more in the postexercise ECG. In each case coronary angiography and left ventriculography were normal. Hemodynamic and metabolic investigations were carried out during sinus rhythm and atrial pacing. Thirteen patients experienced pain during pacing but only one showed an abnormal hemodynamic response. Two patients showed abnormal myocardial lactate metabolism during the control period and four during pacing-induced tachycardia. The increase in ejection fractions in this group suggests hyperdynamic ventricular contraction which could result in increased oxygen requirements and thus induce ischemic pain in the absence of arteriographically demonstrable coronary artery disease.

Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease

A group of 1,390 asymptomatic men screened for latent coronary artery disease by maximal treadmill testing and double Master two-step test were followed up for a mean of 6.3 years. Angina, sudden death or acute myocardial infarction was used as the end point for coronary heart disease. There were differences in testing sensitivity and specificity among age and subject groups, but maximal treadmill testing out-performed the double Master test as a screening technique. Maximal treadmill testing demonstrated a 60.9 percent sensitivity, 92 percent specificity and a 20 percent probability that coronary artery disease would develop in a subject with an abnormal response. A risk ratio of 14.3 was obtained and demonstrated that maximal treadmill testing was a valuable screening technique for latent coronary artery disease. However, limitations of the sensitivity and specificity of the functional S-T segment response were apparent. The abnormal S-T segment response to exercise testing did not absolutely predict the future presentation of coronary artery disease, and a normal response to maximal treadmill testing did not rule out this possibility. Because premature ventricular contractions demonstrated a very low sensitivity, predictive value and risk ratio they were not a practical indicator of increased risk for latent coronary artery disease except when associated with an abnormal S-T segment response.

Postexercise Phonocardiogram Thirty-Month Follow-up in Normal Subjects

One hundred clinically normal subjects who had resting and postexercise phonocardiograms recorded at rest and after a double Master two-step exercise test in the supine and left lateral decubitus positions were followed up for 30 months. In four patients coronary artery disease developed within 30 months. The resting or postexercise third or fourth heart sound recorded in the supine or left lateral decubitus position did not correlate significantly with subsequent development of coronary artery disease. ( JAMA 228:1569-1570, 1974)

The fastest rate attained in the Master Two-Step Test

The fastest rate attained in the Master Two-Step Test

P wave changes on exercise in patients with isolated mitral stenosis

Patients with mitral stenosis usually showed a marked increase in the P negativity following exercise. The P terminal force in Lead V 1 in 20 cases with isolated mitral stenosis was −0.090 mm. sec. before exercise, which changed to −0.177 mm. sec. following the single Master two-step test. Normal adults never showed such changes on exercise. The phenomenon was considered to be due to the posterior rotation of the P wave vector in the horizontal plane, which was induced by the enlargement of the left atrial wall on exercise.

Variant angina pectoris.

Letters, Comments, and Corrections1 May 1972Variant Angina PectorisBÉLA PÁLOSSY, M.D., SÁNDOR SZÉPLAKI, M.D.BÉLA PÁLOSSY, M.D.Search for more papers by this author, SÁNDOR SZÉPLAKI, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-5-832 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The very interesting paper by Silverman and Flamm (Ann Intern Med 75:339-343, 1971) about the variant form of angina pectoris prompted us to report that we have seen two similar cases.In one patient in studying the cause of his chest pain, a Master's two-step test was done. After 20 steps a transitory unconsciousness was caused by ventricular arrhythmia. At the onset of this dangerous state an unusual ischemic ST elevation, the "Prinzmetal dome phenomenon," was seen. During selective coronary arteriography of the left coronary artery, done 2 months later, an intensive chest pain and multiple ventricular... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: BÉLA PÁLOSSY, M.D.; SÁNDOR SZÉPLAKI, M.D.Affiliations: IVth Department of Internal Medicine Postgraduate Medical School Budapest XIII Hungary PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTheoretical Investigation of Metal Hydrides : Electronic Properties and Superconductivity 1 May 1972Volume 76, Issue 5Page: 832-832KeywordsAnginaAngiographyArrhythmiaCoronary arteriesIschemiaLeft coronary arteryStable coronary artery disease ePublished: 1 December 2008 Issue Published: 1 May 1972 PDF downloadLoading ...

Effect of Position on the Resting and Postexercise Phonocardiogram

Phonocardiograms were recorded at the maximum apical impulse in the left lateral decubitus position at rest and after a double Master two-step test in 100 normal subjects, mean age 51, in whom this procedure was previously performed in the supine position. In the left lateral decubitus position, 36 of the 100 normal subjects (36 percent) had a resting fourth heart sound, and 61 of these 100 subjects (61 percent) had a postexercise fourth heart sound. In the left lateral decubitus position, 19 of the 100 normal subjects (19 percent) had a resting third heart sound, and 46 of the 100 subjects (46 percent) had a postexercise third heart sound. Resting and postexercise fourth and third heart sounds are more frequently recorded in normal subjects in the left lateral decubitus position than in the supine position. Phonocardiograms were recorded at the maximum apical impulse in the left lateral decubitus position at rest and after a double Master two-step test in 100 normal subjects, mean age 51, in whom this procedure was previously performed in the supine position. In the left lateral decubitus position, 36 of the 100 normal subjects (36 percent) had a resting fourth heart sound, and 61 of these 100 subjects (61 percent) had a postexercise fourth heart sound. In the left lateral decubitus position, 19 of the 100 normal subjects (19 percent) had a resting third heart sound, and 46 of the 100 subjects (46 percent) had a postexercise third heart sound. Resting and postexercise fourth and third heart sounds are more frequently recorded in normal subjects in the left lateral decubitus position than in the supine position.

Transient hemiblock: An abnormal type of response to the Master two-step test

Transient hemiblock: An abnormal type of response to the Master two-step test

Master's two-step test.

Excerpt To the editor: In their recent ANNALSpaper (74:509-517, 1971) on correlations with the two-step test, Fitz-Gibbon and associates stated, The double Master's two-step test yields an unaccep...

Postexercise electrocardiogram in patients with abnormal resting electrocardiograms.

One hundred and ten patients with chest pain syndromes and resting electrocardiograms demonstrating ST-T abnormalities and/or prior transmural myocardial infarctions were studied by means of the Master's two-step exercise test and selective coronary cine arteriography. Criteria for negativity were modified so that subjects with postexercise heart rates less than 110 beats/min, who did not develop significant ST-segment changes, were excluded from evaluation. Eighty-six per cent of the coronary artery disease group and 27% of the normal coronary artery group had positive postexercise electrocardiograms. Conversely, of the patients with positive results, 88% had anatomic coronary artery disease. With this degree of stress, positive responses ≧2 mm were invariably associated with multi-vessel disease. The type of pre-existing ECG abnormality did not influence either the frequency or severity of positive responses. False-negative subjects had no distinctive features relating to type of abnormal electrocardiogram, or location of vessel involvement, although most of these patients had significant disease of only one major coronary artery.

Energy Cost of Sexual Activity

To the Editor. —The article by Hellerstein and Friedman Sexual Activity and the Postcoronary Patient (Arch Intern Med 125: 987-999, 1970) deserves comment regarding the inferences about the energy cost of sexual activity. To assess the oxygen cost of sexual activity, the authors have used the heart rate during sexual intercourse and compared it with the heart rate obtained during bicycle ergometer test conducted with the patient upright. Based on that, the authors were able to calculate that the oxygen cost of sexual activity corresponds to 60.3% of the maximal oxygen uptake as determined by ergometric tests. Moreover, the authors claim that the equivalent oxygen cost during sexual activity is less than that of a standard single Master two-step test. My objections to the use of these inferences to estimate oxygen consumption stems from the fact that one of the most important factors in determining the cardiovascular response to effort

Electrocardiographic and hematological changes by exercise test in coronary patients and pyridinolcarbamate pretreatment. A double-blind crossover trial

Forty hospitalized patients with angina pectoris, 25 men and 15 women, 37 to 75 years of age, were subjected to Master's two-step test. Three hours before the test, 1.0 Gm. of pyridinolcarbamate or placebo was given orally using a double-blind technique. Before, immediately after, and 3, 5, 7, 10, and 30 minutes after exercise, electrocardiographic changes and clinical symptoms were observed. In 20 of the above subjects prothrombin activity, calcium clotting time, and the platelet and adhesive platelet count was measured. Thirty-three of the 40 patients pretreated with placebo developed ischemic ECG findings immediately to 10 minutes after the exercise test. Seventeen of the same 40 subjects pretreated with pyridinolcarbamate developed ischemic ECG findings. The difference between placebo and pyridinolcarbamate was statistically significant at p < 0.001. For the second exercise test the 17 patients who had received pyridinolcarbamate for the first test were pretreated with placebo, and 13 showed positive ischemic ECG changes. The 23 patients who had received placebo for the first exercise test were pretreated for the second test with pyridinolcarbamate, and 10 developed positive ECG changes. There was no significant difference noted between the two exercise tests in regard to the appearance of ischemic ECG changes. The appearance of anginal pain after exercise was prevented by pretreatment with pyridinolcarbamate (p < 0.05). In comparison to other 39 healthy volunteers, the patients with angina pectoris showed enhanced blood coagulability and lower platelet count. In healthy persons, enhanced blood coagulability was observed one minute after the exercise test (p p < 0.01). In coronary patients, the enhancement of blood coagulability, which showed a stronger response than that of the healthy group, and the decrease of platelet and adhesive platelet count was observed one to ten minutes after the exercise test (p < 0.01). These changes lessened or disappeared after pretreatment with pyridinolcarbamate (p < 0.05).

The effect of exercise on the Achilles tendon reflex time.

In 10 healthy male medical students, exercise was found to shorten the Achilles tendon reflex time significantly. The mean Achilles tendon reflex (tap to half-relaxation) time at rest was 250 msec; after a five minute walk It was shortened by 24 msec. (9·6%); and after maximum exertion with Master's two-step exercise test it was shortened by 52 msec. (20·8%). As the Achilles tendon reflex time Is usually measured as an out-patient procedure, the effect of exercise has to be considered in Its interpretation as a test of thyroid function.

The Master two-step test

The Master two-step test

Recording master's two-step test electrocardiograms

<h3>To the Editor:—</h3> The interpretation of Master's two-step electrocardiogram tracings may be expedited by recording all four tracings on one strip of paper. The stylus of the electrocardiograph machine, is set to record as close as possible to the bottom edge of the paper and record the resting tracing. Opening the machine, the paper is manually wound back onto the feed roll. The stylus is then positioned above the first tracing, the patient performs the prescribed exercise, and the one-minute tracing is recorded. The same number of cycles or the same length of paper as the resting tracing are used for each lead. The paper is again wound backwards onto the feed roll and the three-minute tracing is recorded above the previous one, the rerolling is repeated, and the eightminute tracing is recorded above the previous (Figure). The first tracing can be positioned at the top of the paper, and

Recording Master's Two-Step Test Electrocardiograms

To the Editor:— The interpretation of Master's two-step electrocardiogram tracings may be expedited by recording all four tracings on one strip of paper. The stylus of the electrocardiograph machine, is set to record as close as possible to the bottom edge of the paper and record the resting tracing. Opening the machine, the paper is manually wound back onto the feed roll. The stylus is then positioned above the first tracing, the patient performs the prescribed exercise, and the one-minute tracing is recorded. The same number of cycles or the same length of paper as the resting tracing are used for each lead. The paper is again wound backwards onto the feed roll and the three-minute tracing is recorded above the previous one, the rerolling is repeated, and the eightminute tracing is recorded above the previous (Figure). The first tracing can be positioned at the top of the paper, and

Electrocardiographic response to maximal exercise: Treadmill and double master exercise tests in middle-aged Chinese men

A prospective study of cardiovascular disease was started in Taiwan in 1965 with the initial emphasis on ischemic heart disease. In the first year of screening examination, 942 middle-aged Chinese men were examined. The multi-stage treadmill test and double Master two-step test were used in addition to the complete clinical history, physical examination and various laboratory tests. Seventy-five (8%) of the 942 patients given the treadmill exercise test showed S-T segment depression of 1 mm. or more after exercise; 89 showed either an S-T segment depression of 0.5 to 0.9 mm. or a respiratory variation of junctional and segmental S-T depressions. The remainder showed S-T segment changes of lesser magnitude. The procedure for the exercise test was modified in the early recovery period to diminish the occurrence of postexercise hypotension in Chinese men. As a result of this modification, the maximal frequency of appearance of postexercise abnormal S-T depression was delayed to four to six minutes after maximal exercise. The prevalence of resting and postexercise T abnormalities was significantly different when persons with abnormal S-T depressions were compared with age-matched controls. Also, the prevalence of a high amplitude R in the left precordial lead differed significantly between the groups with and without abnormal S-T segment depressions ( p < 0.01). QRS axis deviation, exercise arrhythmias and heart rate response did not differ significantly. Exercise S-T segment depression of 1 mm. or more was found in 22 patients subjected to a double Master two-step test. The prevalence of this abnormality was roughly one-third that occurring with treadmill exercise. Exercise arrhythmias and T abnormalities occurred less frequently in the double Master test. The significance of these changes is discussed.

Measurement and characteristics of over-all noise content in exercise electrocardiograms

Signal processing techniques were developed to analyze hum and noise, the two main factors influencing the quality of exercise electrocardiograms. Hum was accurately evaluated by Fourier analysis methods, and the noise characteristics by appropriate sampling procedures and autocorrelation analysis. In a sample study of 41 typical exercise ECG records, the average hum over a 3-minute record was 34 μv peak to peak with a minimum of 4 μv peak to peak and a maximum of 340 μv peak to peak. Noise was found to closely approximate Markoffian “random” noise plus periodic components closely correlated to both the periodicity of the exercise test and of respiration. The total noise varied from a root-mean-square value of 60 μv to a maximum of 915 μv. The periodic noise power averaged 8 per cent of the total noise power, with a minimum of 1 per cent to a maximum of 30 per cent of the total power. Pilot studies were made to determine differences in the noise content due to slight variations in the anatomic position of the electrodes, and due to different stress tests. Significant and consistent variations were seen in noise content of electrodes whose position varied slightly. Similarly, it was determined that the average standard deviation of the noise in the Master two-step test was about 50 per cent higher than that from a bicycle ergometer test. An improvement in the average signalto-noise ratio was found by means of spatial averaging, i.e., linear weighting of the signals from electrodes located very close together anatomically. This “realtime” averaging also reduced the statistical chance that a single bad electrode would ruin an entire record. Also, of considerable interest are the encouraging results when multiple redundancy of leads was employed. Here, instead of continuously averaging all 3 signals from the closely spaced electrodes, all signals were continuously monitored and the best combination of 2 leads was selected. This selected combination gave noise figures that were better than the best single lead in all but 3 out of 19 test runs.

Pyridinolcarbamate, a bradykinin antagonist in veins: A preliminary report on pharmacologic and clinical observations

Pyridinolcarbamate, a bradykinin antagonist in veins: A preliminary report on pharmacologic and clinical observations

The physiologic fallacy of adjusting for body weight in performance of the Master two-step test

The physiologic load imposed by the double Master two-step test and by a similar step test in which work was carried out at a rate of 40 steps per 3 minutes was evaluated in 14 male subjects having a wide range of body weights. Gross oxygen consumption varied less among individuals during the Master procedure (the S.D. was 25.6 per cent of the mean) than during the 40-step test, in which all subjects worked at the same rate (the S.D. was 41.7 per cent of the mean). However, expression of energy requirements per unit of body weight decreased the coefficient of variation for the energy cost of the 40-step test (9.4 per cent) well below that of the Master test (26.7 per cent). Oxygen requirements per kilogram of body weight were very high for lighter subjects, reaching 38.6 ml. per minute, and very much less for heavy subjects (minimum, 19.1 ml. per minute). The lightest subjects were, therefore, approaching their maximal oxygen intakes while the heavier men were farthest from maximal. These data illustrate the error in decreasing the rate of work for heavier subjects performing the step test, and demonstrate that the Master procedure fails to provide a physiologically equivalent work load for individuals differing in body weight.