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Victor C. Jacobsen, M.D.
JAMA. 1946;130(8):530. doi:10.1001/jama.1946.02870080064022.
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To the Editor: —  The discussion by Blumgart, Boas and others and by Master regarding the effect of effort on the incidence of coronary occlusion, coronary thrombosis and myocardial infarction shows the need of more precise use of these terms.Blumgart (The Journal, July 14, 1945, p. 775) contributes a report on the relation of effort to "attacks" of acute myocardial infarction as he saw it in army training camps. Acute myocardial infarction does not occur as an "attack" per se but is a result of sudden deprivation of an area of heart muscle of its blood supply by occlusion of the main supplying artery or a sufficient number of its branches. Arteriosclerosis is generally the underlying cause of the narrowing of the artery, but this is never a sudden process. The occlusion caused by atheromatous intimal thickening may reach a point where a slight increase in myocardial effort will


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