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February 4, 1974

Vagal Reaction to Physical Fitness Test

Author Affiliations

Irvine, Calif

JAMA. 1974;227(5):559. doi:10.1001/jama.1974.03230180057029

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To the Editor.—  The letter by Z. Schlesinger (226:1119,1973) draws the following comment.Postexertional hypotension itself (without sinus arrest) is relatively common in patients asked to stand or sit in the postexercise period, especially in "deconditioned" patients. Because of its frequency and other technical reasons, I have recorded postexercise records in the recumbent position. Since doing this, I have seen no cases of syncope in "healthy" individuals in approximately 1,000 submaximal tests (90% of age-predicted heart rate).The described postexercise period of hypotension and bradycardia, although probably vagal in origin, does not necessarily speak for a normal cardiovascular system in spite of the patient's apparent "health." Postexertional symptoms similar to these are not uncommon in individuals with increased impedance to left ventricular ejection (as in muscular subaortic or valvular aortic stenosis). Muscular subaortic stenosis is often missed. Also, it is quite possible that a similar reaction could be due to