The electrocardiographic response to exercise was compared with the results of coronary angiography in 89 patients with Type II hyperlipoproteinemia who had previous myocardial infarction or typical angina or both (43 patients) (Group A), 'atypical angina' (16 patients) (Group B) or positive electrocardiographic response to exercise without other evidence of cardiac disease (30 patients) (Group C). Thirty nine of 43 in Group A had ≥50 per cent stenosis, and 26 (67 per cent) of these 39 had negative exercise tests. In Group B, 5 of 16 had ≥50 per cent stenosis, and three had positive exercise tests (one patient had a false positive test). In Group C, eleven of 30 (37 per cent) had ≥50 per cent stenosis; however, nine (30 per cent) had minor stenoses (≤50 per cent), and 10 (33 per cent) normal coronary arteries. The diagnostic usefulness of exercise electrocardiography is limited. False negative responses are frequent in patients with clinically suspected coronary disease, and false positive responses frequent in asymptomatic patients.
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