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To the Editor.—
As an occupational physician for a major corporation, I have recently had occasion to review the techniques and predictive value of cardiovascular stress testing. Although I am convinced of the value of traditional techniques, it has occurred to me that other techniques are also indicated. Specifically, I am referring to psychophysiologic methods to yield a higher percentage of meaningful, positive results.It is known that stress-induced catecholamine discharge is a normal response producing tachycardia and a normal frequency of premature contractions. This stress reaction, however, taken to inappropriate excess under given conditions becomes pathogenic. I am referring to the sedentary, high-powered, pressured executive who is continually stressed during the working day. His resultant cardiovascular stress reaction, coupled with shallow hyperventilation and muscular tension, contribute to an increased myocardial oxygen demand. His unhealthy, maladaptive response is to bear down harder to the task at hand with resultant Valsalva
Lippin RA. Stress Testing. JAMA. 1976;235(22):2388-2389. doi:10.1001/jama.1976.03260480010004