Triggering of Acute Myocardial Infarction by Exercise

To the Editor: The articles by Mittleman et al. and Willich et al. (Dec. 2 issue) 1 , 2 suggest that exercise can provoke myocardial infarction, particularly in patients who do not exercise regularly. The accompanying editorial discusses this possibility and weighs the pros and cons of exercise from the viewpoint of its effects on the heart 3 . However, neither the studies nor the editorial addresses the possibility that patients who had a myocardial infarction during or just after exercise were in a critical state and that the myocardial infarction might well have occurred without the exercise, which simply advanced the infarction . . .