Saleem Sharieff, Khan Shah e Zaman.
Exercise Tolerance Test in patients presenting with chest pain and normal Electrocardiogram.
J Coll Physicians Surg Pak Jan ;12(6):348-52.

Objective: To report the prevalence of abnormal exercise tolerance test (ETT) responses and to assess the risk factors for ischemic heart disease (IHD) in a population referred for the evaluation of chest pain with a normal baseline electrocardiogram (ECG). Design: A prospective study. Place and Duration of Study: The study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan between 1st January 2000 and 31st December 2000. Subjects and Methods: One thousand one hundred and twenty-seven consecutive adult patients presenting in the outpatient department (OPD) with history of chest pain and having a normal baseline ECG were the subjects of the study after excluding patients with indeterminate or inconclusive test response. All these subjects underwent ETT and were screened for risk factors for IHD. Results: Of the patients studied 56.6% had abnormal ETT response. Male to female ratio of all patients was 4.85:1. Overall mean age was 50.3 ± 8.8 years. 65.9% of diabetic patients had ETT suggestive of silent myocardial ischemia (p=0.012). Age > 50 years (p= <0.0001), male sex (p= 0.015), diabetes mellitus (p=0.0033) and positive family history of IHD (p=0.0014) were the risk factors found in patients with abnormal ETT response. Conclusion: Age of more than 50 years, male gender, diabetes mellitus and positive family history of IHD are the significant risk factors for the development of ischemic heart disease in our population. Silent myocardial ischemia is common in diabetics.

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