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Dr Bruce points out that the protocol cited (Doan et al) is incorrect because target heart rates rather than "maximum exercise to symptomatic limits" were used as an endpoint to the test. This point is of course correct. The protocol cited for graded, multistage, submaximal exercise testing was used except for the endpoint. The test was terminated when the patient reached 88% of his predicted maximal heart rate in an asymptomatic state. Blood pressure was monitored throughout the test and postexercise period. The maximal systolic blood pressure rise was only 15 to 20 mm Hg. Diastolic pressure did not vary notably from the control value. The patient's blood pressure did not vary after the test until he collapsed. Dr Bruce advocates an endpoint of "maximal exercise to symptomatic limits," but at the same time observes that failure to interrupt exercise testing when there is a limited rise in
Lintgen AB. Myocardial Infarction After Exercise Testing-Reply. JAMA. 1976;236(6):561. doi:10.1001/jama.1976.03270060014009