The "Two-Step" Exercise Electrocardiogram in Functional Heart Disturbances and in Organic Heart Disease: The Use of Ergotamine Tartrate

Abstract

Patients with functional cardiac disturbances, including chest pain, may present electrocardiographic abnormalities (pronounced RS-T depressions and T-wave inversions) after the "2-step" exercise test which are indistinguishable from those found in organic heart disease. Ergotamine tartrate was employed intravenously in conjunction with "2-step" tests in 10 cases for the objective differentiation of functional from organic heart involvement. However, ergotamine was found to be contraindicated as a routine for this purpose because of its anginal-provoking properties. We have substituted dihydroergecornine (DHO-180), a newer, safer ergot alkaloid, in our further investigation of this problem.

Differential Diagnosis of Angina Pectoris

“…The test was followed by one of his typical attacks of weakness and faintness from which he recovered within a half hour. Since that time the following precautions have been taken: the test is not done in a patient whose history suggests myocardial infarction, either impending or within the preceding 6 months; the test is never p3rformed in a patient who complains of marked weakness or faintness on exertion; the first test in each patient is used to allay apprehension and to accustom the subject to the procedure, i.e., the patient is rarely permitted to perform more than 20 trips. The comparative safety of the test during the past 20 years is undoubtedly due in great measure to these precautions and, considering the nature of the condition, undoubtedly due, in some measure, to good fortune.…”

“…The comparative safety of the test during the past 20 years is undoubtedly due in great measure to these precautions and, considering the nature of the condition, undoubtedly due, in some measure, to good fortune. Two of the 3 untoward effects in the last 20 years were in patients who had been treated with hypotensive drugs (octyl nitrite and reserpine). These patients developed severe hypotension, faintness, and perspiration a few minutes after the completion of the test; recovery was complete in both subjects within a half hour.…”

Cardiac Diagnostic Methods in Coronary Artery Disease: Electrocardiogram, “2-Step” Exercise Test and Ballistocardiogram

“…there is a respiratory variation in the amplitude of the complexes, being of greater amplitude in inspiration than in expiration. Criteria for abnormality include : (1) diminished or absent I-waves ; (2) exaggeration of the normal respiratory variation so that the amplitude of the waves during expiration is 50 per cent or less than during inspiration; 3slurring or notching of I, J, or K-waves ; (4) early "M" pattern-prominent H-waves; (5) late "M" pattern-late, deeply notched J-waves; (6) prominent diastolic waves (L, M, N, 0, and so on) ; (7) deep, wide or absent K-waves; or (8) low amplitude or totally bizarre complexes. Any one record may display one alteration alone or various combinations.…”