Sensitivity of exercise electrocardiography for acute cardiac events during moderate and strenuous physical activity: the Lipid Research Clinics Coronary Primary Prevention Trial
Many exercise programs require that men entering the programs have an exercise electrocardiogram (''exercise stress test'') first. Fifteen percent of sudden cardiac deaths occur during moderate or intense physical activity, and electrocardiography can uncover exercise-induced myocardial ischemia (transient reduction in heart circulation) and arrhythmias (abnormal heart rhythms) in people with no symptoms. However, it has never been shown that these abnormal results can predict cardiac events such as heart attack during physical activity. To determine the usefulness of exercise electrocardiogram as a screening technique to reduce the hazards of physical activity, data on 3,617 men from the Lipid Research Clinics Coronary Primary Prevention Trial (CPPT) were analyzed. Exercise-induced abnormalities on an electrocardiogram are associated with an increased risk of activity-related nonfatal heart attack and coronary heart disease (CHD) death. However, this test is not a good predictor of which men with high cholesterol will have heart trouble during physical activity. The overall sensitivity of the submaximal exercise electrocardiogram suggests that the absence of abnormal findings does not rule out heart trouble during physical activity, and if these findings were used to identify those at risk, approximately 80 percent of cases of activity-related heart attacks and other acute events among seemingly healthy men would be missed. The utility of this screening test is therefore limited. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Strength of indication for cesarean delivery: comparison of private physician versus resident service labor management
Doctors in private or group practice may have different reasons for performing a cesarean delivery than doctors who work in a hospital. In a study of 119 cesarean deliveries performed at one hospital, the strength of the indication for a cesarean delivery was stronger among women delivered by a hospital-based doctor.
Publication Name: American Journal of Obstetrics and Gynecology
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