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Laurence A. Grossman, M.D.; Milton Grossman, M.D.
JAMA. 1955;158(3):179-180. doi:10.1001/jama.1955.02960030029009a.
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Difficult diagnostic problems often occur when patients have pain in the chest and upper extremities. This pain may be of minor significance or may have serious meaning. In the presence of established coronary artery disease anginal pain is frequently atypical. Cardiac and extracardiac pain may have the same location and similar areas of referral. In approximately 40% of the patients who have coronary artery disease with myocardial insufficiency, physical examination, x-ray and fluoroscopic examinations, and the resting electrocardiogram are normal. Therefore, the aid of other diagnostic tests has been sought. Various procedures have been devised for testing the adequacy of coronary flow. Deviations from the normal electrocardiogram have been shown to occur during anginal attacks. The exercise test has been accepted as a clinical method of establishing the presence of coronary insufficiency. The "two-step" exercise test was first standardized by Master and Oppenheimer. Initially, a measured amount of exercise was

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