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To the Editor:—
The comment of Dr. Salomon contains a valid criticism, namely, that the patient was not subjected to a stress test in order to confirm the presence of coronary insufficiency. In my own practice and in the clinic I use the Master two-step exercise test routinely in this type of case to determine if ischemic changes are produced in the electrocardiogram during exercise. In this type of patient it would be of diagnostic value, not only from the standpoint of making a positive diagnosis of coronary insufficiency but also from the standpoint of differentiating between coronary artery disease and hiatus hernia. Our previous studies have indicated that patients with hiatus hernia will have a negative exercise test unless they have associated coronary artery disease.
Dack S. Coronary Sclerosis and Hiatus Hernia-Reply. JAMA. 1962;179(10):825. doi:10.1001/jama.1962.03050100078023
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